Consequences of Delayed Chest Closure During Lung Transplantation

Rafiroiu, Stefana; Hassouna, Habiba; Ahmad, Usman; Koval, Christine; McCurry, Kenneth R.; Pettersson, Gösta; Ibrahim, Mudathir; Johnston, Douglas R.; Budev, Marie; Murthy, Sudish C.; Toth, Andrew J.; Blackstone, Eugene H.; Tong, Michael Z.

doi:10.1016/j.athoracsur.2019.08.016

Cited by 13 publications

(24 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a matched cohort of primary closure, Shigemura et al (57) have shown the delayed chest closure resulted in decrease incidence of severe primary graft dysfunction. There was no increase incidence of wound infection in our group's recent report (59) and the Force et al series (56); however, there was an increased hospital stay and morbidity. In contrast, Aguilar et al have reported increased incidence of wound infection (58).…”

Section: Delayed Chest Closuresupporting

confidence: 38%

“…The strategy of delayed chest closure has been adopted by several LTx groups to address intra-operative complications such as coagulopathy, significant pulmonary edema, or hemodynamic instability when chest closure is attempted (56)(57)(58)(59). Our technique for delayed chest closure includes negative pressure wound therapy using a foam sponge then sealed by adhesive dressing or occasionally sponge packing and covering of the incision with a latex membrane that is stapled to the skin (59). The sternal edges or ribs are retracted with a plastic or metal bridge.…”

Section: Delayed Chest Closurementioning

confidence: 99%

See 1 more Smart Citation

Bilateral sequential lung transplantation: technical aspects

Elgharably¹,

Javorski²,

McCurry³

2021

J Thorac Dis

Self Cite

View full text Add to dashboard Cite

The surgical technique for lung transplantation has evolved dramatically over the last three decades. Significant improvements in short term outcomes in the early years of lung transplantation were due, in large part, to techniques developed to reduce airway anastomotic complications in single lung transplantation. Following development of the technique of en bloc double lung transplantation, evolution to the bilateral sequential technique further reduced airway complications for double lung transplantation.More recently, some programs have utilized the en bloc double lung transplant technique with bronchial artery revascularization to aid airway healing and potentially improve short-and long-term outcomes. The experience with bronchial artery revascularization remains limited to a few series, with the technique having not been widely adopted by most lung transplant programs. With the implementation of priority allocations schemes in many countries, patients with higher risk profiles are being prioritized for transplantation which results in more complex procedures in fragile recipients with multiple comorbidities. This includes the increased need for concomitant cardiac procedures as well as performing lung transplantation after prior cardiothoracic surgery. Different surgical approaches have been described for bilateral sequential lung transplantation with or without intra-operative mechanical circulatory support (MCS), such as sternotomy, clamshell (bilateral anterior thoracotomies with transverse sternotomy), and bilateral thoracotomy incisions.Herein, we aim, not only to describe the various surgical approaches for double lung transplantation, but to provide a comprehensive review of other aspects related to the recipient pathology and different anatomical variants as well as handling technical challenges that might be encountered during the procedure.

show abstract

Section: Delayed Chest Closuresupporting

confidence: 38%

Section: Delayed Chest Closurementioning

confidence: 99%

Bilateral sequential lung transplantation: technical aspects

Elgharably¹,

Javorski²,

McCurry³

2021

J Thorac Dis

Self Cite

View full text Add to dashboard Cite

show abstract

“…They reported that PGD requiring ECMO support, one-year acute rejection episode, and 30- and 90-day mortality were higher in the DCC group. In a study by Rafiriou et al [ 8 ] , between 2009 and 2016, 51 (7%) of 770 patients who underwent lung transplantation were performed DCC and were compared with PCC. The average DCC duration was 4.6±2.3 days.…”

Section: Discussionmentioning

confidence: 99%

“…DCC is a well-defined method used in complicated cases of cardiac surgery since the 1970s [ 7 ] . However, it does not have a long history and extensive knowledge in lung transplantation [ 6 , 8 ] . Only a few serious case series have been published in the last decade [ 4 , 8 , 9 ] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Delayed Chest Closure for Oversized Lung Allograft in Lung Transplantation: a Retrospective Analysis from Turkey

Yeginsu¹,

Taşçı²,

Vayvada³

et al. 2021

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

Introduction The aim of this study was to evaluate the delayed chest closure (DCC) results in patients who underwent lung transplantation. Methods Sixty patients were evaluated retrospectively. Only bilateral lung transplantations and DCC for oversized lung allograft (OLA) were included in the study. Six patients who underwent single lung transplantation, four patients who underwent lobar transplantation, two patients who underwent retransplantation, and four patients who underwent DCC due to bleeding risk were excluded from the study. Forty-four patients were divided into groups as primary chest closure (PCC) (n=28) and DCC (n=16). Demographics, donor characteristics, and operative features and outcomes of the patients were compared. Results The mean age was 44.5 years. There was no significant difference between the demographics of the groups ( P >0.05). The donor/recipient predicted total lung capacity ratio was significantly higher in the DCC group than in the PCC group (1.06 vs . 0.96, P =0.008). Extubation time (4.3 vs . 3.1 days, P =0.002) and intensive care unit length of stay (7.6 vs. 5.2 days, P =0.016) were significantly higher in the DCC group than in the PCC group. In the DCC group, postoperative wound infection was significantly higher than in the PCC group (18.6% vs. 0%, P =0.19). Median survival was 14 months in all patients and there was no significant difference in survival between the groups (16 vs. 13 months, P =0.300). Conclusion DCC is a safe and effective method for the management of OLA in lung transplantation.

show abstract

Long-term survival and clinical outcomes of delayed chest closure following lung transplantation

Hirama,

Akiba,

et al. 2024

Surg Today

View full text Add to dashboard Cite

Purposes Delayed chest closure (DCC) is a widely accepted procedure in the context of lung transplantation (LTx); yet there are few reports detailing its long-term survival and clinical outcomes. Methods We reviewed the medical records of recipients who underwent deceased-donor lung transplantation (LTx) at Tohoku University Hospital. Long-term survival, including overall survival, freedom from chronic lung allograft dysfunction (CLAD), and CLAD-free survival and the clinical outcomes of graft function and physical performance and constitution were reviewed in recipients with DCC. Results Between 2009 and 2022, 116 patients underwent LTx, 33 of whom (28.4%) required DCC. The intra—and post-operative courses of the recipients who required DCC were more complicated than those of the recipients who underwent primary chest closure (PCC), with frequent volume reduction surgery and longer periods of invasive mechanical ventilation. Pulmonary vascular disease was considered a risk factor for these complications and DCC. Nonetheless, long-term survival and graft functions were comparable between the DCC and PCC groups. The physical performance and constitution of recipients who required DCC continued to improve, and by 2 years after transplantation, exhibited almost no difference from those who underwent PCC. Conclusions In view of the profoundly complicated intra- and post-operative courses, DCC should be performed cautiously and only when clinically indicated, despite which it can result in equivalent long-term survival and acceptable outcomes to PCC.

show abstract

Consequences of Delayed Chest Closure During Lung Transplantation

Cited by 13 publications

References 21 publications

Bilateral sequential lung transplantation: technical aspects

Bilateral sequential lung transplantation: technical aspects

Delayed Chest Closure for Oversized Lung Allograft in Lung Transplantation: a Retrospective Analysis from Turkey

Long-term survival and clinical outcomes of delayed chest closure following lung transplantation

Contact Info

Product

Resources

About