Bronchial Omentopexy in Canine Lung Allotransplantation

Dubois, Paul; Choiniere, Louise; Cooper, Joel D.

doi:10.1016/s0003-4975(10)62239-4

Cited by 57 publications

(11 citation statements)

References 16 publications

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“…Based on their early experience, the Toronto Lung Transplant Group reported that eliminating high-dose steroids in the initial immunosuppressive treatment [11] and wrapping of the bronchial anastomosis with omentum improved bronchial healing [6]. Subsequently, other technical modifications of the bronchial anastomosis aimed at improving vascularization of the donor bronchus have been evaluated.…”

Section: Discussionmentioning

confidence: 99%

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Bronchial anastomotic complications following lung transplantation: still a major cause of morbidity?

Schmid

Boehler²,

Speich³

et al. 1997

Eur Respir J

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B Br ro on nc ch hi ia al l aan na as st to om mo ot ti ic c c co om mp pl li ic ca at ti io on ns s f fo ol ll lo ow wi in ng g l lu un ng g t tr ra an ns sp pl la an nt ta at ti io on n: : s st ti il ll l a a m ma aj jo or r c ca au us se e o of f m mo or rb bi id di it ty y? ? We have, therefore, reviewed the results of 67 consecutive bronchial anastomoses at risk in 43 patients surviving more than 7 days following lung transplantation. The bronchial anastomoses were performed using a standardized technique, without direct or indirect revascularization. Regular triple immunosuppressive therapy was given, including prednisone (0.5 mg·kg -1 daily) starting on the day of surgery. Bronchial healing was graded using the Couraud classification. The median follow-up time was 14 months (range 1-45 months).No major airway complications occurred. On 236 serial bronchoscopic examinations, no anastomotic stenoses were observed. One anastomosis showed limited focal necrosis (2 mm) (Couraud 3a), and two anastomoses had partial primary mucosal healing without necrosis (Couraud 2a). In all other anastomoses, primary mucosal healing (Couraud 1) was observed.Carefully performed bronchial anastomosis according to the technique described enables reliable bronchial healing and yields a low complication rate. Additional measures, such as direct revascularization, forced telescoping, omentum wrap and interruption of steroid therapy, are not necessary.

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Section: Discussionmentioning

confidence: 99%

“…Bronchial complications with a mortality of 2-4% are still reported in 4-12% of lung transplant recipients [3,4]. Various technical measures, such as reconstruction of the bronchial circulation [5], omental wrap [6] and other methods, have been proposed to improve healing of the donor bronchus.…”

mentioning

confidence: 99%

Bronchial anastomotic complications following lung transplantation: still a major cause of morbidity?

Schmid

Boehler²,

Speich³

et al. 1997

Eur Respir J

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“…This problem has been addressed by minimizing dissection near the recipient airway so as to preserve the native bronchial circulation. In addition, healing and revascularization of the airway have been enhanced by wrapping the anastomosis with omental [34][35][36][37] or intercostal muscle flaps [38]. Pedicled internal mammary artery wraps are also of potential value [391.…”

Section: Airway Managementmentioning

confidence: 99%

Critical Care Management of Lung Transplant Recipients

Bierman

Stein

Stuart

et al. 1991

J Intensive Care Med

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In the last 10 years, lung transplantation has become an increasingly common procedure for patients with end-stage respiratory disease. Although long-term survival can be achieved, there is still significant morbidity within the first year. Early postoperative problems that may be anticipated include respiratory insufficiency, airway anastomotic problems, hemorrhage, infection, and episodes of acute rejection. These problems and others make the immediate perioperative period particularly challenging. With aggressive management, however, the probability of a successful outcome can be enhanced.

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“…Bronchial complications in general have an attributable mortality of 2% to 4% (1,11,(13)(14)(15)(16)(17). Various technical measures, such as reconstruction of the bronchial circulation (18), and omental wrap (19) were proposed to improve healing of the donor bronchus. Technical improvements including better organ preservation and postoperative management have reduced the incidence of ischemic airway complications (15,16,20,21).…”

mentioning

confidence: 99%