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Ann Thorac Surg 1992;53:88-94
© 1992 The Society of Thoracic Surgeons
Department of Thoracic Surgery, Xavier Arnozan Hospital, and Department of Cardiovascular and Pediatric Cardiac Surgery, Haut Lévêque Hospital, Pessac, France
Accepted for publication July 18, 1991.
* Address reprint requests to Dr Couraud, Department of Thoracic Surgery, Xavier Arnozan Hospital, 33604 Pessac, France.
Donor airway ischemia is the main cause for defective tracheal or bronchial healing after double-lung transplantation. Anatomical studiesa and bronchial arteriograms have shown that the right intercostal bronchial artery is constant (95% of instances) and provides an important blood supply to the distal trachea, the carina, and the right bronchial tree as well as to the left side through a subcarinal and periadventitial anastomostic network. To maintain this important bilateral branchial circulation, it is of capital importance not to mobilize the arteries individually and to avoid large dissections around the carina. Both bronchi can thus be revascularized by indirect aortic reimplantation using a bypass graft to a single aortic patch that includes the origin of the right intercostal bronchial artery. Furthermore, the origin of other vessels (a common trunk and left arteries) can be found within a short distance of the right intercostal bronchial artery and possibly be contained within the same aortic patch. From a series of 56 lung transplantations, 8 patients underwent restoration of the bronchial vascularization using a recipient saphenous vein graft between the donor bronchial arteries and the anterior aspect of the recipient's ascending aorta. A lower tracheal anastomosis was performed. Bronchial arterial blood supply was evaluated both by endoscopy and by arteriography at about the 15th postoperative day. The bronchial circulation was visualized at this time in five of seven arteriographies, and this was associated with excellent tracheal healing in all 8 patients.
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