Successful double-lung transplantation with direct bronchial artery revascularization

Richard C. Daly, Samad Tadjkarimi, Asghar Khaghani, Nicholas R. Banner, Magdi H. Yacoub

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Double-lung transplantation with tracheal anastomosis has previously resulted in unacceptable ischemic complications of airway healing. Three patients underwent double-lung transplantation at our institution in 1986 and 1987, and 2 of these required later retransplantation because of airway complications. Recently, we began to perform direct revascularization of the bronchial arteries at their origin on the donor descending thoracic aorta, using recipient internal thoracic artery. Eight patients (2 male and 6 female patients; ages, 10-51 years) underwent nine double-lung transplantations with revascularization. The preoperative diagnoses in these patients were cystic fibrosis (2 patients), atrial septal defect and Eisenmenger's syndrome (1 patient), lymphangioleiomyomatosis (1 patient), bronchiectasis (1 patient), α1-antitrypsin deficiency (1 patient), and primary pulmonary hypertension (2 patients); 1 underwent retransplantation because of pulmonary emboli. There have been no significant airway complications in any patient. Two patients died early postoperatively, 1 of early pulmonary dysfunction (at 1 day postoperatively) and 1 of subarachnoid hemorrhage (at 16 days postoperatively; tracheal healing was excellent in this patient). Follow-up in the remaining 6 patients ranged from 5 to 9 months. Internal thoracic artery angiography was performed on seven grafts, which documented patency of the internal thoracic artery in all seven and bronchial artery perfusion in six. Bronchoscopic examinations have demonstrated excellent airway healing in all six of these grafts, with no dehiscence, granulation, or narrowing of the trachea or distal bronchi. Ulceration of the tracheal anastomosis developed anteriorly in the remaining patient, which has resolved. We conclude that double-lung transplantation is an acceptable therapeutic approach when combined with bronchial artery revascularization, and early airway healing has been excellent. This approach allows simultaneous bilateral lung transplantation with immediate revascularization of the airways to both lungs.

Original languageEnglish (US)
Pages (from-to)885-892
Number of pages8
JournalThe Annals of Thoracic Surgery
Volume56
Issue number4
DOIs
StatePublished - 1993
Externally publishedYes

Fingerprint

Bronchial Arteries
Lung Transplantation
Mammary Arteries
Thoracic Aorta
Lung
Eisenmenger Complex
Lymphangioleiomyomatosis
Transplants
Bronchiectasis
Subarachnoid Hemorrhage
Bronchi

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Successful double-lung transplantation with direct bronchial artery revascularization. / Daly, Richard C.; Tadjkarimi, Samad; Khaghani, Asghar; Banner, Nicholas R.; Yacoub, Magdi H.

In: The Annals of Thoracic Surgery, Vol. 56, No. 4, 1993, p. 885-892.

Research output: Contribution to journalArticle

Daly, Richard C. ; Tadjkarimi, Samad ; Khaghani, Asghar ; Banner, Nicholas R. ; Yacoub, Magdi H. / Successful double-lung transplantation with direct bronchial artery revascularization. In: The Annals of Thoracic Surgery. 1993 ; Vol. 56, No. 4. pp. 885-892.
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