Sternotomy versus thoracotomy lung transplantation: key tips and contemporary results

Abstract

The purpose of this report is to provide an updated description of the technique of bilateral sequential lung transplant via median sternotomy. A sternotomy provides the advantage of less morbidity than the clamshell incision, as well as exposure to perform mechanical circulatory support and concurrent cardiac procedures. Our experience shows that lung transplantation via a midline sternotomy can be done with equivalent to better short-term outcomes than a clamshell incision, including earlier extubation and fewer transfusions. Familiarity with this technique is important for all surgeons managing end-stage lung disease.

Effect of mode of intraoperative support on primary graft dysfunction after lung transplant

“…Moreover, there are clearly several scenarios in which CPB may be necessary, and there are many proponents of CPB who have been able to achieve good results with it after LTx. 1,2,8,[19][20][21] But the current data suggest a heightened risk of postoperative graft dysfunction with CPB that should be weighed against the potential gains in each individual scenario.…”

Off-pump lung re-transplantation avoiding clamshell thoracotomy is feasible and safe: a single-center experience

“…Due to the limited number of patients and reported experience, the criteria for patient selection and surgical approach in re-LTx are debatable and center-dependent. Due to expected severe adhesions and difficulty in exposure following previous thoracotomy, the clamshell approach and the use of extracorporeal life support (ECLS) could be preferred for re-LTx procedures ( 6 - 8 ). However, this more invasive approach comes with related complications (bleeding, thrombosis, sternal malunion and wound problems, etc.).…”

A comparison of cardiopulmonary bypass versus extracorporeal membrane oxygenation: Does intraoperative circulatory support strategy affect outcomes in pediatric lung transplantation?

“…Studies comparing these approaches in adults found that median sternotomy leads to improved postoperative chest wall movement, less postoperative pain, improved pulmonary function, and fewer wound complications than clamshell incisions 29‐31 . Additional studies have found shorter operative and bypass time, as well as fewer transfusion requirements, in adults operated via a median sternotomy incision 32,33 . Despite the lack of similar studies in pediatric patients, some of the differences observed between our groups could potentially reflect differences in incisional approach.…”