title: Sternal-sparing approach for reoperative bilateral lung transplantation.
abstract: OBJECTIVE
  A sternal-sparing approach for bilateral lung transplantation was recently applied to reoperative lung transplant cases and is compared with the traditional clamshell approach.
  
  
  METHODS
  A retrospective analysis of 15 consecutive reoperative bilateral lung transplants performed from January 2008 to April 2011 was conducted. Outcomes were compared between the first 11 patients who underwent the traditional clamshell and the most recent 4 patients who underwent the sternal-sparing approach.
  
  
  RESULTS
  The indication for retransplantation was obliterative bronchiolitis in all patients. Both groups were similar with regard to age, allograft ischaemic time and operative time. Cardiopulmonary bypass was more frequent in the sternal-sparing group although required for a shorter period of time. The need for postoperative extracorporeal membrane oxygenation for primary graft dysfunction was similar in both groups. The length of ICU care and total hospitalization length of stay were similar for the sternal-sparing group compared with the traditional clamshell approach. Operative mortality and overall survival also did not differ.
  
  
  CONCLUSIONS
  Reoperative bilateral lung transplantation with a sternal-sparing approach is feasible and may yield outcomes similar to those in the traditional clamshell approach. Further analysis with larger numbers of patients is warranted to delineate the benefits of this approach for patients requiring reoperative lung transplantation.
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
authors.forename: Aditya
authors.initials: A
authors.lastname: Bansal
authors.forename: Norihisa
authors.initials: N
authors.lastname: Shigemura
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D015199:Extracorporeal Membrane Oxygenation; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016040:Lung Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D055031:Primary Graft Dysfunction / Q000209:etiology / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Bilateral; Lung transplantation; Redo; Reoperative; Sternal-sparing