Improved technique for bilateral lung transplantation: Rationale and initial clinical experience

Pasque, Michael K.; Cooper, Joel D.; Kaiser, Larry R.; Haydock, David; Triantafillou, Anastasios N.; Trulock, Elbert P.

doi:10.1016/0003-4975(90)90023-y

Cited by 337 publications

(92 citation statements)

References 12 publications

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“…10 -13 The surgical technique of bilateral sequential lung transplantation (LT) involves 2 separate anastomoses of donor LA tissue cuffs surrounding both the right superior and inferior PVs and both the left superior and inferior PVs to the posterior wall of the recipient LA at single venous cuffs created at the right and left PV antra, as shown in Figure 1. 14 This may electrically isolate the donor PV, but residual recipient PV tissue may persist as part of the LA anastomosis. This LA anastomosis also forms lines of conduction block and slow conduction that may result in electroanatomic substrate for reentry.…”

Section: Clinical Perspective On P 510mentioning

confidence: 99%

Atrial Arrhythmias After Lung Transplantation

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Roberts‐Thomson

Stevenson

et al. 2009

Circ: Arrhythmia and Electrophysiology

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Background-Atrial arrhythmias (AAs) including atrial fibrillation (AF) and atrial tachycardia (AT) are often observed after cardiothoracic surgery. Our aim was to evaluate the prevalence and mechanism of AAs after lung transplantation. Methods and Results-All patients (nϭ127) after bilateral sequential lung transplantation followed at our institution over 20 years were included. All patients received postoperative rhythm monitoring and clinic visits with ECG at 1, 3, 6, and 12 months, or as needed. AAs occurred in 40 of 127 (31.5%) patients over 4.2Ϯ4.1 years. AA prevalence at postoperation and 1, 3, 6, 12, and Ͼ12 months was 24%, 11%, 3%, 2%, 4%, and 11%, respectively. Early AAs were predominantly AF, whereas all AAs Ͼ12 months were AT. Time to first AF versus AT was 11Ϯ9 versus 1485Ϯ2462 days (Pϭ0.09). Male sex, age, and preoperative AA predicted any early (Ͻ3 months) AA but did not predict late AA. Early AA did not predict late AT. In 4 patients with drug-resistant AT, electrophysiology studies found AT involving the pulmonary vein/left atrium anastomoses in 3 patients, including donor-to-recipient conduction in 1, border zone macroreentry in 2, and cavotricuspid isthmus dependent flutter in 1; all patients were successfully treated with ablation. Conclusions-AAs after lung transplantation are common. Although AF is common early, AF is rare after healing of left atrial incisions, which probably result in surgical pulmonary vein isolation with rare exception. This raises the question of whether additional surgical or ablation lines at the time of lung transplantation would prevent late AA. (Circ Arrhythmia Electrophysiol. 2009;2:504-510.)

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Section: Clinical Perspective On P 510mentioning

confidence: 99%

Atrial Arrhythmias After Lung Transplantation

See

Roberts‐Thomson

Stevenson

et al. 2009

Circ: Arrhythmia and Electrophysiology

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show abstract

“…As noted previously, BLTx was initially performed as an en bloc procedure with a tracheal anastomosis but, unfortunately, the death rate due to anastomotic breakdown was unacceptably high [12]. The procedure was subsequently modified to the bilateral sequential lung transplant procedure with fashioning of the two telescoped bronchial anastomoses [13]. Airway complications have been commonly seen in up to 20% of anastomoses, although technical innovations seem to be reducing this incidence [14][15][16].…”

Section: Anastomotic Techniquesmentioning

confidence: 99%

Update on lung transplantation: programmes, patients and prospects

Kotsimbos¹,

Williams²,

Anderson³

2012

European Respiratory Review

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“…It wasn't until after the seminal transplantation of single lungs demonstrating significant improvement in symptoms, that lung transplantation became a mainstay for the end-stage emphysema [69][70][71]. Currently, the most common indication for lung transplantation is idiopathic diffuse emphysema and AAT1 deficiency, two criteria that account for the majority of lung transplants [70].…”

Section: Lung Transplantationmentioning

confidence: 99%