Early experience of double-lung transplantation with bronchial artery revascularization using mammary artery

Abstract

En-bloc double-lung transplantation with tracheal and bronchial revascularization using the left internal mammary artery has been performed in 14 Danish patients. Primary healing of the tracheal anastomosis was observed in 12 patients, in 10 of whom a successful revascularization has been verified by angiography. Two patients have been operated recently and not yet examined by angiography. Mucosal necrosis and subsequent development of bronchial stenosis had to be treated by left-sided pneumonectomy in two patients with failed revascularization. All patients were early survivors (1-14 months). We conclude that bronchial revascularization with the internal mammary artery is possible with an acceptable success rate and is associated with primary healing of the tracheal anastomosis. The impact on long-term results remains to be seen.

Long-term outcome of lung transplantation for cystic fibrosis ? Danish results

“…This could serve as a reinforced alveolar barrier after transplantation potentially leading to a decreased rate of infection and rejection. For this reason, our institution initially applied DLTx with concomitant BAR to the transplant programme [3]. The technique for BLTx with a transverse bilateral thoracosternotomy (clamshell) developed in parallel and the procedure could be done safely without CPB [9].…”

“…The procedure was changed in 1998 and the last 18 patients (62%) received BLTx. The surgical technique in DLTx with concomitant BAR using the recipients' left internal mammarian artery grafted to donor intercostobronchial arteries has been described previously [3]. The tracheal anastomosis was made one tracheal ring above the carina with Prolene w 4-0 as a running suture in the membranous part and interrupted sutures in the cartilaginous part, without telescoping or omental wrapping.…”

Microvascular destruction identifies murine allografts that cannot be rescued from airway fibrosis

“…Recent autopsy studies from Luckraz and colleagues demonstrate a marked loss of microvasculature in nonoccluded small airways from BOS lungs, suggesting airway ischemia as a preceding condition to airway fibrosis (4,5). Accordingly, some have hypothesized that chronic airway ischemia and hypoxia could contribute to airway fibro-obliteration following lung transplantation (6)(7)(8).…”

Treatment of massive haemoptysis with microcoil embolization after en bloc double-lung transplantation with bronchial artery revascularization

“…Revascularization of the bronchial arteries at the time of lung transplantation has been performed with a high success rate, and may have resulted in improved airway healing as well as contributing to a better short-and medium-term survival [6][7][8]. One of our patients experienced an episode of severe haemoptysis 2 yrs after an en bloc double-lung transplantation, with successful direct bronchial artery revascularization of the left lung only.…”