Techniques and results of lobar lung transplantations.

Abstract

OBJECTIVES:

We report our experience of lobar lung transplantations (LLTs) in patients with small thoracic volume.

METHODS:

Since 1988, 50 LLTs were done for cystic fibrosis (n=35), fibrosis (n=7), bronchiectasis (n=3), emphysema (n=3) and lymphangiomyomatosis (n=2). There were 44 females and 6 males (mean age 31±13 years, mean size 155±5.5 cm and mean predicted total lung capacity (TLC) 4463±598 ml). Mean ratio between donor and recipient-predicted TLC was 1.65±0.26. Six patients were listed in high emergency, 2 of them on ECMO as a bridge to transplantation. Forty middle/lower right lobe with left lower LLT, four bilateral lower LLT and six split left lung LLT were performed through a clamshell incision (n=12) or a bilateral antero-lateral thoracotomy (n=38), with epidural analgesia in 17 cases. Thirty-two patients were transplanted under circulatory support (CPB n=16, veno-arterial ECMO n=16). In 11 cases, the right venous anastomosis was enlarged by a pericardial cuff. Ischaemic time was 4.4±1.2 h for the first lobe and 6.1±1.3 h for the second.

RESULTS:

Median mechanical ventilation weaning time was 10.5 (1-136) days. Four patients were extubated in the operating room. Ten patients needed ECMO for primary graft dysfunction. In-hospital mortality was 28% related to sepsis (n=6), PGD (n=3), haemorrhage (n=2), broncho-vascular fistula (n=1), and multiorgan failure (n=2). Eight patients required endoscopic treatments for airway complications. Mean best FEV1 was 72±16% of the theoretical value. The actuarial 3-year and 5-year survival rates were 60 and 46%, respectively.

CONCLUSIONS:

LLTs are a reliable solution and can be performed with satisfactory functional results and survival rates.

• Authors: Delphine Mitilian, Edouard Sage, Philippe Puyo, Pierre Bonnette, François Parquin, Marc Stern, Marc Fischler, Alain Chapelier, Foch Lung Transplant Group
• Journal: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (Eur J Cardiothorac Surg) Vol. 45 Issue 2 Pg. 365-9; discussion 369-70 (Feb 2014) ISSN: 1873-734X [Electronic] Germany
• PMID: 23900745 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Female
• Humans
• Kaplan-Meier Estimate
• Lung (surgery)
• Lung Transplantation (adverse effects, methods)
• Male
• Postoperative Complications
• Treatment Outcome
• Young Adult