[Clinical results after en block double lung transplantation with direct bronchial revascularization. The first three and a half years' experience in Denmark].
En-bloc double lung transplantation with tracheal anastomosis and direct revascularization of the bronchial arteries to the left internal mammary artery has been carried out in Denmark since June 1992. Forty-seven patients (32 with alfa-1 antitrypsin deficiency, 11 with chronic obstructive pulmonary disease, two with cystic fibrosis and two with primary pulmonary hypertension), 25 men and 22 women, average age 39 years (17-64 years), have received their first double-lung transplant with bronchial artery revascularization. Arteriography of the internal mammary artery and bronchial arteries was performed in 42 (89%) of the patients from 1-150 days after the operation. Successful bronchial artery revascularization was demonstrated arteriographically in 40 patients, in two patients the arteriography failed to show bronchial artery revascularization. Arteriography was not performed in five patients due to early complications and death. Bronchoscopy showed rapid, uncomplicated airway healing in 42 patients. Mucosal necrosis under the tracheal anastomosis was found in three patients, and severe obstructive endobronchial growth of the fungus Aspergillus fumigatus was diagnosed in the last two patients. The one- and two-year survival is 83% (Kaplan-Meier). Eleven patients are dead, five due to pulmonary causes and six due to extra-pulmonary causes. Pulmonary function became normal in nearly all surviving patients between three to six months after the transplantation. In conclusion, en-bloc double-lung transplantation with bronchial artery vascularization has shown good short-term results, and the one- and two-year survival gives hope that a successful bronchial artery revascularization will improve the long-term survival following lung transplantation.
Svendsen
U G
UG
Rigshospitalet, medicinsk afdeling B.
Nørgaard
M A
MA
Andersen
C B
CB
Arendrup
H C
HC
Efsen
F
F
Mortensen
S A
SA
Olsen
P S
PS
Thiis
J J
JJ
Pettersson
G
G
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001980:Bronchi / Q000601:surgery; D001981:Bronchial Arteries / Q000000981:diagnostic imaging; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D011379:Prognosis; D011859:Radiography; D014132:Trachea / Q000601:surgery