Ann Thorac Surg 1995;59:820-821
© 1995 The Society of Thoracic Surgeons
Discussion
DISCUSSION
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See also page 813.
DR KIRK R. KANTER (Atlanta, GA): In view of your conclusions that patients with prior thoracic operations perhaps are not good candidates, it is striking that you do not mention that the 3 patients with obliterative bronchiolitis had been relisted for retransplantation. Would you exclude these patients from consideration for lung retransplantation, or were any of these 3 relisted at any time?
DR SPRAY: In fact, 2 of the 3 were relisted for lung transplantation but died before donor organs were available. I think the retransplantation issue is a very difficult one. Obviously one does not want to squander organs on patients who might not be expected to survive, and certainly the survival in retransplantation is lower than the initial survival. I do not think that the adhesions from a previous thoracic operation necessarily preclude retransplantation.
The most difficult patients, the ones who are most at risk for hemorrhage, are those patients who have pulmonary atresia with nonconfluent pulmonary arteries who have had attempts at unifocalization of aortopulmonary collateral vessels, usually with bilateral thoracotomies, and possibly a previous median sternotomy. These patients are cyanotic and have severe chest wall collaterals into the pulmonary parenchyma. The hemorrhage is not something that can be controlled with aprotinin or other agents. These patients . . . [Full Text of this Article]
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- Nancy D. Bridges, George B. Mallory, Jr, Charles B. Huddleston, Charles E. Canter, Stuart C. Sweet, and Thomas L. Spray
Ann. Thorac. Surg. 1995 59: 813-820.
[Abstract]
[Full Text]
Copyright © 1995 by The Society of Thoracic Surgeons.
