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Ann Thorac Surg 1990;49:785-791
© 1990 The Society of Thoracic Surgeons

Articles

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

Michael K. Pasque, MD*, Joel D. Cooper, MD, Larry R. Kaiser, MD, David A. Haydock, MD, Anastasios Triantafillou, MD, Elbert P. Trulock, MD

Division of Cardiothoracic Surgery and Departments of Surgery, Medicine, and Anesthesia, Washington University School of Medicine, St. Louis, Missouri, USA

Accepted for publication February 28, 1990.

* Address reprint requests to Dr Pasque, 1 Barnes Hospital Plaza, Suite 3105 Queeny Tower, St. Louis, MO 63110.

We previously described a technique for en bloc double-lung transplantation that was initially applied to select patients with cystic fibrosis and emphysema. This procedure is quite complex and associated with several limitations, including a substantial incidence of airway ischemia, postoperative myocardial depression, and cardiac denervation. To address these problems we have developed a simpler procedure for replacing both lungs. The operation is done through a transverse thoracosternotomy and involves sequential replacement of the two lungs. Positive features include separate bronchial anastomoses to reduce ischemic airway complications, elimination of the need for total cardiopulmonary bypass and a period of ischemic cardiac arrest, improved exposure to reduce intraoperative and postoperative hemorrhage, and maintenance of cardiac innervation. Additionally, the technique can be more easily mastered and widely applied. Details of the procedure and its initial clinical application in 3 patients having emphysema, cystic fibrosis, and bronchiolitis obliterans following previous double-lung transplantation, respectively, are described. All 3 patients recovered without complication. Postoperative function was excellent in spite of lung ischemic times ranging up to [equation] hours.




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T. L. Spray, G. B. Mallory, C. B. Canter, and C. B. Huddleston
Pediatric lung transplantationIndications, techniques, and early results
J. Thorac. Cardiovasc. Surg., April 1, 1994; 107(4): 990 - 1000.
[Abstract] [Full Text]

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 Ann. Thorac. Surg.Home page
R. Aeba, B. P. Griffith, R. L. Kormos, J. M. Armitage, T. A. Gasior, C. R. Fuhrman, S. A. Yousem, and R. L. Hardesty
Effect of cardiopulmonary bypass on early graft dysfunction in clinical lung transplantation
Ann. Thorac. Surg., March 1, 1994; 57(3): 715 - 722.
[Abstract] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
B. P. Griffith, M. J. Magee, I. F. Gonzalez, R. Houel, J. M. Armitage, R. L. Hardesty, B. G. Hattler, P. F. Ferson, R. J. Landreneau, and R. J. Keenan
Anastomotic pitfalls in lung transplantation
J. Thorac. Cardiovasc. Surg., March 1, 1994; 107(3): 743 - 754.
[Abstract] [Full Text]

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 J. Thorac. Cardiovasc. Surg.Home page
D. H. Adams, A. D. Cochrane, A. Khaghani, J. D. Smith, and M. H. Yacoub
Retransplantation in heart-lung recipients with obliterative bronchiolitis
J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 450 - 459.
[Abstract] [Full Text]

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 J. Thorac. Cardiovasc. Surg.Home page
J. D. Cooper, G. A. Patterson, E. P. Trulock, and t. W. U. L. T. Group
Results of single and bilateral lung transplantation in 131 consecutive recipients
J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 460 - 471.
[Abstract] [Full Text]

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 Ann. Thorac. Surg.Home page
D. A. Blumenstock and C. Lewis
The first transplantation of the lung in a human revisited
Ann. Thorac. Surg., December 1, 1993; 56(6): 000349759390706N - 349759390706N.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
S. Sundaresan, O. Lima, H. Date, A. Matsumura, H. Tsuji, H. Obo, M. Aoe, T. Mizuta, and J. D. Cooper
Lung preservation with low-potassium dextran flush in a primate bilateral transplant model
Ann. Thorac. Surg., November 1, 1993; 56(5): 1129 - 1135.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
G. A. Patterson
Airway revascularization: Is it necessary?
Ann. Thorac. Surg., October 1, 1993; 56(4): 807 - 808.
[PDF]

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 Ann. Thorac. Surg.Home page
R. C. Daly, S. Tadjkarimi, A. Khaghani, N. R. Banner, and M. H. Yacoub
Successful double-lung transplantation with direct bronchial artery revascularization
Ann. Thorac. Surg., October 1, 1993; 56(4): 885 - 892.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
C. Dromer, J.-F. Velly, J. Jougon, C. Martigne, E. M. Baudet, L. Couraud, and The Bordeaux Lung and Heart-Lung Transplant Group
Long-term functional results after bilateral lung transplantation
Ann. Thorac. Surg., July 1, 1993; 56(1): 68 - 73.
[Abstract] [PDF]

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 PerfusionHome page
J. D Cooper
Use of aprotinin in lung transplantation
Perfusion, May 1, 1993; 8(1_suppl): 43 - 46.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
D. Metras, H. Shennib, B. Kreitmann, J. Camboulives, L. Viard, M. Carcassonne, R. Giudicelli, M. Noirclerc, and The Joint Marseille-Montreal Lung Transplant Progr
Double-lung transplantation in children: A report of 20 cases
Ann. Thorac. Surg., February 1, 1993; 55(2): 352 - 357.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
J. Au, T. Hawkins, C. Venables, G. Morritt, C. D. Scott, A. D. Gascoigne, P. A. Corris, C. J. Hilton, and J. H. Dark
Upper gastrointestinal dysmotility in heart-lung transplant recipients
Ann. Thorac. Surg., January 1, 1993; 55(1): 94 - 97.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
T. L. Spray, G. B. Mallory, C. E. Canter, C. B. Huddleston, and L. R. Kaiser
Pediatric lung transplantation for pulmonary hypertension and congenital heart disease
Ann. Thorac. Surg., August 1, 1992; 54(2): 216 - 225.
[Abstract] [PDF]

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 Arch Intern MedHome page
H. Shennib, R. Adoumie, and M. Noirclerc
Current Status of Lung Transplantation for Cystic Fibrosis
Arch Intern Med, August 1, 1992; 152(8): 1585 - 1588.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
H. Shennib, M. Noirclerc, P. Ernst, D. Metras, D. S. Mulder, R. Giudicelli, F. Lebel, J.-F. Dumon, and The Cystic Fibrosis Transplant Study Group
Double-lung transplantation for cystic fibrosis
Ann. Thorac. Surg., July 1, 1992; 54(1): 27 - 32.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
T. M. Egan, J. H. Westerman, C. J. Lambert, F. C. Detterbeck, J. T. Thompson, M. R. Mill, B. A. Keagy, L. J. Paradowski, and B. R. Wilcox
Isolated lung transplantation for end-stage lung disease: A viable therapy
Ann. Thorac. Surg., April 1, 1992; 53(4): 590 - 596.
[Abstract] [PDF]

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 ANN INTERN MEDHome page
K. Clarkson, B. Rosenfeld, J. Fair, A. Klein, and W. Bell
Factor XI Deficiency Acquired by Liver Transplantation
Ann Intern Med, December 1, 1991; 115(11): 877 - 879.
[Abstract] [PDF]

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 JAMAHome page
E. P. Trulock, J. D. Cooper, L. R. Kaiser, M. K. Pasque, N. A. Ettinger, and C. M. Dresler
The Washington University-- Barnes Hospital Experience With Lung Transplantation
JAMA, October 9, 1991; 266(14): 1943 - 1946.
[Abstract] [PDF]

Home page
 Ann. Thorac. Surg.Home page
L. R. Kaiser, M. K. Pasque, E. P. Trulock, D. E. Low, C. M. Dresler, and J. D. Cooper
Bilateral sequential lung transplantation: The procedure of choice for double-lung replacement
Ann. Thorac. Surg., September 1, 1991; 52(3): 438 - 446.
[Abstract] [PDF]


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