How to do itOff-Pump Bilateral Lung Transplantation via Median Sternotomy: A Novel Approach With Potential Benefits
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)
- et al.
Bilateral sequential lung transplantation without sternal division eliminates posttransplantation sternal complications
J Thorac Cardiovasc Surg
(1999) Median sternotomy for lung transplantation
Operative Techniques Thorac Cardiovasc Surg
(2015)- et al.
Use of an apical heart suction device for exposure in lung transplantation
Ann Thorac Surg
(2006)