Ann Thorac Surg 2005;79:2161-2162
© 2005 The Society of Thoracic Surgeons
How to do it
Aortic Homograft for Pulmonary Artery Augmentation in Single Lung Transplantation
Pablo Rueda, MD,
Jose Morales, MD,
Enrique Guzman, MD*,
Jose L. Tellez, MD,
Benito A. Niebla, MD,
Alejandro Avalos, MD,
Hilda Patiño, MD
Department of Cardiothoracic Surgery, National Institute of Respiratory Diseases, Mexico City, Mexico
Accepted for publication January 22, 2004.
* Address reprint requests to Dr Guzman, Department of Cardiothoracic Surgery, National Institute of Respiratory Diseases, Calzada Tlalpan 4502, Mexico City 14080, Mexico (E-mail: enriqueg{at}prodigy.net.mx).
 |
Abstract
|
|---|
We present a case of unilateral lung transplantation in which a segment of the donor’s descending aorta was used as a homograft for pulmonary artery augmentation in the donor lung. This technique can be used when the donor’s lung artery has been cut at the base of the hilum during the harvesting procedure.
|
Introduction
|
|---|
Successful lung transplantation is highly dependent on the adequacy of the donor’s lung harvest. When the harvest is inadequate, prolonged implantation time with graft ischemia and prolonged pulmonary artery (PA) clamping ensue. Furthermore, the hilum is deformed with excessive tension and angulation of the arteries that may result in obstruction of the anastomosis.
Some techniques have been suggested to avoid inadequate graft harvesting and to ensure the preservation of a useful length of the hilum vessels [1]. Casula and colleagues [2] proposed the use of donor pericardium to obtain a suitable vascular cuff in pulmonary vein reconstruction. However, we report the use of a homograft of the donor’s aorta to reconstruct a PA that was inadequately short for anastomosis.
|
Technique
|
|---|
A 45-year old woman with pulmonary fibrosis was prepared for transplant of a single left lung. The PA in the donor’s graft had been cut at the base of the hilum. This left an artery with an insufficient cuff for anastomosis to a segment of the recipient’s PA of about 1 cm in length up to the division of the lobar arteries. At the time the graft was harvested, a 5-cm segment of the donor’s descending aorta was removed and transported along with the lung, following standard techniques [3].
At the transplant facility the donor’s lung was placed in the recipient’s thoracic cavity, and the pulmonary veins were anastomosed with 4–0 Prolene (Ethicon, Sommerville, NJ) sutures in a continuous fashion. Then the length of the aortic homograft that was required to allow a tension-free anastomosis of the PA was measured and anastomosed to the donor’s PA with continuous 5–0 Prolene sutures. The PA anastomosis was completed with the same type of sutures. Once the aorta-to-PA anastomosis was completed, the vascular clamp in the recipient’s PA was released uneventfully. Finally, the bronchus was sutured with a 4–0 Prolene continuous stitch (Fig 1A and B).
View larger version (93K):
[in this window]
[in a new window]
|
Fig 1. Aortic graft in place sutured to pulmonary artery. (A) Photograph of aortic homograft. (B) Schematic drawing of the aortic homograft. (AoH = aortic homograft; Br = bronchus; LLL = left lower lobe; LUL = left upper lobe; PA = pulmonary artery.)
|
|
|
Comment
|
|---|
The implantation and reconstruction of donor organs for transplantation can be technically problematic when the organs have been harvested inadequately. If the problem during graft harvesting is a short PA in the donor’s lung, we suggest that a segment of descending thoracic aorta of sufficient length be provided at the same time to the transplant surgical team. This is safe for the anastomosis because the aorta’s diameter is similar to that of the PA and because the anastomosis will be between two vascular structures. Furthermore, harvesting the descending aorta from the donor is a simple and relatively brief procedure, provided the totality of the aorta is not taken for other vascular grafts. A successful outcome in the presence of surgical difficulties in lung transplantation is best achieved when simple techniques are used, as suggested by Schmidt and colleagues [4], who proposed the use of iliac veins to reconstruct anomalous pulmonary veins.
We believe this simple procedure of using a donor aorta homograft to reconstruct the PA during lung transplantation may facilitate the resolution of a challenging problem in lung transplantation surgery.
|
References
|
|---|
- Todd TR, Goldberg M, Koshal A, et al. Separate extraction of cardiac and pulmonary grafts from a single organ donor Ann Thorac Surg 1988;46:356-359.[Abstract/Free Full Text]
- Casula RP, Stoica SC, Wallwork J, Dunning J. Pulmonary vein augmentation for single lung transplantation Ann Thorac Surg 2001;71:1373-1374.[Abstract/Free Full Text]
- Lau CL, Patterson GA. Technical considerations in lung transplantation Chest Surg Clin N Am 2003;13:463-483.[Medline]
- Schmidt F, McGiffin DC, Zorn G, Young KR, Weill D, Kirklin JK. Management of congenital abnormalities of the donor lung Ann Thorac Surg 2001;72:935-937.[Abstract/Free Full Text]
Top
Abstract
Introduction
