Techniques of reconstruction for inadequate donor left atrial cuff in lung transplantation.
BACKGROUND
An inadequate donor left atrial (LA) cuff due to an anatomical abnormality of the pulmonary vasculature or technical errors at the time of procurement can exclude the lungs from transplant. This study aims to describe the incidence, efficacy, and various techniques of LA cuff reconstruction in lung transplantation.


METHODS
A total of 637 pulmonary venous anastomosis in 405 consecutive lung transplants from January 1995 to July 2005 were reviewed. Comparison between the patients who required LA cuff reconstruction (reconstruction group) or who did not (no-reconstruction group) was made in posttransplant outcomes.


RESULTS
An overall incidence of requirement of LA cuff reconstruction was 2.7% (4% on the right, 1% on the left, p = 0.03). Seventy-one percent of LA inadequacy was corrected using a pericardial patch on the anterior LA cuff wall; the remainder required complicated reconstruction for separated/short pulmonary veins to create a new LA cuff. There was no significant difference between the reconstruction and no-reconstruction groups, respectively, in oxygenation (329 +/- 28, 337 +/- 10, p = 0.81), duration of intubation and intensive care unit stay (p = 0.54, p = 0.89, respectively), 30-day mortality (12%, 6%, p = 0.30), and 5-year survival (57%, 52%, p = 0.80).


CONCLUSIONS
Inadequate donor LA cuff is an infrequent but potentially serious complication in lung transplantation. Donor LA cuff reconstruction using donor pericardium or pulmonary artery remnant is a useful technique to salvage surgically marginal lungs without affecting early and late posttransplant outcomes. These lungs should not be excluded from transplantation.
Department of Cardiothoracic Surgery, The Alfred Hospital, Monash University, Melbourne, Australia. takahirooto@aol.com
Takahiro
T
Oto
Marc
M
Rabinov
Justin
J
Negri
Silvana
S
Marasco
Michael
M
Rowland
Adrian
A
Pick
Gregory
G
Snell
Franklin
F
Rosenfeldt
Donald
D
Esmore
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery*; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000601:surgery*; D014019:Tissue Donors; D014656:Vascular Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data