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The Annals of Thoracic Surgery, Vol 57, 506-511, Copyright © 1994 by The Society of Thoracic Surgeons
H Shennib and G Massard
This article reviews the literature on airway healing after lung
transplantation. From a historical point of view, this has been the
Achilles' heel of lung transplantation through two decades, from the first
attempt at single-lung transplantation in 1963 to the clinical successes in
the early 1980s. The overall incidence of lethal airway complications is
estimated to be 2% to 3%, whereas that of late stricture is 7% to 14%.
Comparison of experiences has been difficult without a universal
classification; a new classification for airway and anastomotic
complications and healing is proposed. Ischemia appears to be the most
important factor influencing airway healing. Low-pressure collateral
bronchial blood flow from the pulmonary artery may be affected by low
cardiac output, reperfusion edema, or rejection; mucosal injury may be
further increased by prolonged positive-pressure ventilation. Good
bronchial healing appears to be possible without a protective wrap and with
early use of steroids. The management of bronchial complications is
challenging and requires endoscopic skills including knowledge of
endobronchial laser photocoagulation and stent insertion techniques.
ARTICLES
Airway complications in lung transplantation
Joint Marseille-Montreal Lung Transplant Program, Marseille, France.
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