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Ann Thorac Surg 1997;63:790-795
© 1997 The Society of Thoracic Surgeons

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Original Article: General Thoracic

Human En Bloc Double-Lung Transplantation: Bronchial Artery Revascularization Improves Airway Perfusion

Department of Thoracic and Cardiovascular Surgery, Harefield Hospital, Harefield, Middlesex, and National Heart and Lung Institute, London, United Kingdom, and Department of Medicine, Aker Hospital, and Department of Cardiothoracic Surgery, Ullevaal Hospital, Oslo, Norway

Accepted for publication October 22, 1996.

Background. Ischemic airway complications are common after en bloc double-lung transplantation with tracheal anastomosis. The aim of this study was to evaluate the effects of a direct revascularization of the donor bronchial artery with the recipient internal thoracic artery on airway perfusion.

Methods. Seven patients undergoing double-lung transplantation with tracheal anastomosis were investigated intraoperatively and postoperatively (12 to 36 hours) with endoscopic laser Doppler flowmetry. Sixteen patients undergoing coronary artery bypass grafting served as a control group.

Results. Two patients who had double-lung transplantation with tracheal anastomosis died of sepsis and multiorgan failure 1 week after transplantation. In the remaining 5 patients healing of the anastomosis was excellent during the observation period of 3 to 52 months. In 5 patients clamping of the attached internal thoracic artery induced a reduction of the laser Doppler flowmetry signal from 10% to 60%. In the 2 patients with the highest graft perfusion level, no clamping effect could be detected. Compared with the control group, perfusion was significantly higher in the transplanted airways intraoperatively, at 71 versus 55 arbitrary perfusion units (p < 0.01). Postoperative transplant airway perfusion values were not significantly different from the intraoperative value. The coefficient of variation of repeated measurements was higher in the transplanted airways, with a coefficient of variation of 0.22 versus 0.17 in the control group (p < 0.01), indicating heterogeneous transplant airway perfusion.

Conclusions. This study has documented that revascularization with the internal thoracic artery supplies the transplanted airway with additional oxygenated blood.

This article has been cited by other articles:

				I. Al-Githmi, N. Batawil, N. Shigemura, M. Hsin, T. W. lee, G.-W. He, and A. Yim Bronchiolitis obliterans following lung transplantation Eur. J. Cardiothorac. Surg., December 1, 2006; 30(6): 846 - 851. [Abstract] [Full Text] [PDF]

				K. NOWAK, M. KAMLER, M. BOCK, J. MOTSCH, S. HAGL, H. JAKOB, and M.-M. GEBHARD Bronchial Artery Revascularization Affects Graft Recovery after Lung Transplantation Am. J. Respir. Crit. Care Med., January 15, 2002; 165(2): 216 - 220. [Abstract] [Full Text] [PDF]