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The Annals of Thoracic Surgery, Vol 52, 438-445, Copyright © 1991 by The Society of Thoracic Surgeons
LR Kaiser, MK Pasque, EP Trulock, DE Low, CM Dresler and JD Cooper
We recently described a technique for bilateral sequential lung
transplantation that replaces the en bloc double-lung operation, a
procedure that was accompanied by frequent problems with airway healing.
Twenty-seven patients have undergone 28 bilateral sequential lung
transplantations over the past 14 months. Eighteen patients had
transplantation because of end-stage emphysema; 6, cystic fibrosis; and 1
each, obliterative bronchiolitis, usual interstitial pneumonitis with
pulmonary fibrosis, and bronchiectasis. Cardiopulmonary bypass was used
electively in the first 5 patients until it was recognized that the
procedure could be done safely without it, and in only 3 additional
recipients has it been employed. Mean ischemic time for the first lung was
276 +/- 43 minutes and for the second lung, 410 +/- 64 minutes. There have
been five deaths, three in the postoperative period (11% operative
mortality) and two late. The other patients are alive and well and do not
require oxygen 2 to 15 months after transplantation. Mean forced expiratory
volume in 1 second rose from 16% +/- 8% of predicted to 84% +/- 17% at 12
weeks. Six-minute walk values increased from a mean of 251 +/- 91 m to 666
+/- 42 m at 24 weeks. The excellent exposure afforded to both hemithoraces
by the thoracosternotomy incision and the rare need of cardiopulmonary
bypass have allowed us to offer the option of transplantation to patients
who formerly would have been turned down because of previous pulmonary
resection or pleurectomy. On four occasions, ventilator-dependent patients
underwent successful transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Bilateral sequential lung transplantation: the procedure of choice for double-lung replacement
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
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