Extracorporeal membrane oxygenator as a bridge to successful surgical repair of bronchopleural fistula following bilateral sequential lung transplantation: a case report and review of literature.
BACKGROUND
Lung transplantation (LTx) is widely accepted as a therapeutic option for end-stage respiratory failure in cystic fibrosis. However, airway complications remain a major cause of morbidity and mortality in these patients, serious airway complications like bronchopleural fistula (BPF) are rare, and their management is very difficult.


METHODS
A 47-year-old man with end-stage respiratory failure due to cystic fibrosis underwent bilateral sequential lung transplantation. Severe post-operative bleeding occurred due to dense intrapleural adhesions of the native lungs. He was re-explored and packed leading to satisfactory haemostasis. He developed a bronchopleural fistula on the 14th post-operative day. The fistula was successfully repaired using pericardial and intercostal vascular flaps with veno-venous extracorporeal membrane oxygenator (VV-ECMO) support. Subsequently his recovery was uneventful.


CONCLUSIONS
The combination of pedicled intercostal and pericardial flaps provide adequate vascular tissue for sealing a large BPF following LTx. Veno-venous ECMO allows a feasible bridge to recovery.
Khan
Nouman U
NU
Department of Cardiothoracic Transplant, Wythenshawe Hospital, Manchester, M23 9LT, UK. n_u_khan@hotmail.com
Al-Aloul
Mohamed
M
Khasati
Noman
N
Machaal
Ali
A
Leonard
Colm T
CT
Yonan
Nizar
N
D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery*; D003550:Cystic Fibrosis / Q000150:complications / Q000601:surgery*; D015199:Extracorporeal Membrane Oxygenation; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010995:Pleural Diseases / Q000209:etiology / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery; D012131:Respiratory Insufficiency / Q000209:etiology / Q000601:surgery