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Original Articles: General Thoracic

Impact of Anastomotic Techniques on Airway Complications After Lung Transplant

^a Division of Cardiothoracic Surgery, University of Louisville School of Medicine, Louisville, Kentucky
^b Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri

Accepted for publication March 9, 2011.

^_* Address correspondence to Dr Meyers, 3108 Queeny Tower, One Barnes-Jewish Hospital Plaza, St. Louis, MO 63110 (Email: meyersb{at}wudosis.wustl.edu).

Presented at the Fifty-seventh Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 3–6, 2010.

Background: Airway complications are a source of morbidity and expense after lung transplant. Posttransplant stenosis can occur when the donor bronchus is rendered ischemic and is dependent upon collateral flow from the pulmonary capillary system. By shortening the donor bronchus, the tissue at risk for ischemia is reduced. In an effort to reduce airway complications, one surgeon at our institution began dividing the donor bronchus at the lobar carina.

Methods: This is a retrospective analysis of all transplanted patients over the 2-year period before and after the institution of the technique change. To adjust for covariates, we performed a propensity score analysis. Outcome endpoints were postoperative airway complications, specifically, the need for therapeutic bronchoscopy, dilation, stenting, or retransplant.

Results: After instituting the practice of dividing the bronchus at the lobar carina, the incidence of airway complication for the principle surgeon decreased from 13.2% (7 of 53) to 2.1% (1 of 48), resulting in an improved freedom from airway complication for that surgeon. Compared with all transplants performed during this period, the modified anastomosis resulted in fewer airway complications: 2.1% (1 of 48) versus 8.2% (19 of 231). The propensity analysis matched the 48 patients who received the modified anastomosis with 48 patients who received the standard two ring length anastomosis by surgical colleagues. The modified anastomosis group had fewer required interventions for airway complications and had significantly better freedom from airway complication when followed over time.

Conclusions: Decreasing the amount of potentially ischemic tissue implanted from the donor bronchus can reduce posttransplant airway complications.

This article has been cited by other articles:

				T. Kotsimbos, T. J. Williams, and G. P. Anderson Update on lung transplantation: programmes, patients and prospects Eur. Respir. Rev., December 1, 2012; 21(126): 271 - 305. [Full Text] [PDF]