Successful stenting of anastomotic stenosis of the left pulmonary artery after single lung transplantation

Evaluating the Impact of Pulmonary Artery Obstruction After Lung Transplant Surgery: A Systematic Review and Meta-analysis

“…Additional hand searching of conference proceedings, reference lists of included articles, and gray literature revealed an additional 4 citations [46][47][48][49] that satisfied the inclusion criteria. Ultimately, a total of 34 [6][7][8][9][10][11]15, full-text citations were included in the systematic review, of which 24 were case reports, 7,8,15,[23][24][25][27][28][29][30][31][32][35][36][37][38][40][41][42][43]45,[47][48][49] 8 were retrospective studies, 6,[9][10][11]33,34,39,46 and 2 were prospective studies. 26,44 For full-text eligibility, the unweighted κ was calculated to be 0.80 between the 2 independent reviewers.…”

“…Across all included studies, a total of 1696 lung transplant patients were investigated, of which 552 underwent bilateral lung transplantation 6,7,[9][10][11]15,23,24,28,31,33,35,[39][40][41]44,[46][47][48][49] and 414 underwent single-lung transplantation [6][7][8][9][10][11]26,27,29,30,[32][33][34][36][37][38][39]42,43,45,46 ; the type of lung transplant (ie, single or bilateral) was unspecified in the remaining 747 patients. 33,34 Of the 414 patients who underwent single-lung transplantation, 38 underwent right-sided lung transplantation [6][7][8][9][10][11]…”

“…6,9,11,33,44,46 Prevalence of Pulmonary Artery Obstruction Across all lung transplants (n = 1696), a total of 62 cases of pulmonary artery obstruction were reported, for a point prevalence of 3.66% (95% CI: 2.80%-4.50%) (Table 3). [6][7][8][9][10][11]15,[23][24][25][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][45][46][47][48][49] The cause of pulmonary artery obstruction was reported for 61 of these cases: 63.93% (39 of 61) were caused by a narrowing of the pulmonary artery lumen, 6,7,9-11,25,27,31-34,36-38,41,42,46,47,49 24.59% (15 of 61) by distortion or kinking of the pulmonary artery due to donor-recipient size mismatch, 6,10,11,15,24,29,30,35,…”

“…Of the 62 reported cases of pulmonary artery obstruction, 7 were diagnosed in the intraoperative period 7,9,11,24,35 ; 17 were diagnosed in the early postoperative period, [6][7][8]10,11,15,23,29,30,35,39,[46][47][48] including 1 patient who had been previously diagnosed intraoperatively 35 ; and 39 were diagnosed in the late postoperative period. 6,7,10,11,25,27,28,[31][32][33][34][36][37][38][40][41][42][43]45,49 Specifically, pulmonary artery obstruction due to vessel distortion was more likely to be diagnosed in the early postoperative period (8 of 15 patients), 6,10,11,15,23,29,30,35,46,47 whereas pulmonary artery obstruction due to vessel narrowing was more likely to be diagnosed in the late postoperative period (34 of 41 patients). 6,10,11,25,27,28,…”

Commentary: Five “Ws” of pulmonary arterioplasty for lung transplantation: Who, what, why, and where

“…Leaving the vessels long facilitates anastomosis, but risks postoperative kinking after the lung is inflated in a closed chest. 1 , 2 Diameter discrepancy requires the careful circumferential narrowing of the larger vessel to match the smaller vessel, but inadvertent unequal suturing ratios may result in twisting, structuring, or narrowing of the anastomosis. This may result in turbulent flow, intraluminal thrombosis, or reduced flow to that lung, something of significance in single-lung transplantation.…”