How to do it
Off-Pump Bilateral Lung Transplantation via Median Sternotomy: A Novel Approach With Potential Benefits

https://doi.org/10.1016/j.athoracsur.2019.03.055Get rights and content

The clamshell incision is the standard approach for bilateral lung transplantation. There is limited experience with bilateral lung transplantation via median sternotomy, and the use of cardiopulmonary bypass seems to be mandatory in all cases while accepting the potential disadvantages of the extracorporeal circulation. We describe a novel approach for bilateral lung transplantation as an off-pump technique via median sternotomy. This approach has the potential to combine the advantages of median sternotomy with less postoperative pain, better chest wall function, and reduced risk of primary graft dysfunction and bleeding complications.

Section snippets

Technique

A median sternotomy was performed in a 36-year-old female patient with cystic fibrosis, and the pericardium was opened in the midline with retraction stitches at the pericardial edges. After opening the pleura, the right hilum was exposed by traction of pericardial sutures to the opposite site. After pneumonectomy of the native lung, the pericardium was opened circumferentially around the hilum with attention to the phrenic nerve, and the bronchial, arterial, and atrial stumps were mobilized

Comment

The clamshell incision is the most commonly used approach for bilateral lung transplantation. It provides an excellent exposure, but there are a number of disadvantages, such as severe postoperative pain, impaired chest stability, and respiratory mechanics owing to division of transverse sternum and respiratory muscles, thus resulting in slow postoperative recovery and poor early functional performance. Wound complications related to sternal closure are also a problem in these patients.

The less

References (7)

There are more references available in the full text version of this article.

Cited by (0)

View full text