title: No-clamp technique for pulmonary artery and venous anastomoses in lung transplantation.
abstract: BACKGROUND
  Lung transplantation (LTx) is a complex surgical procedure conventionally performed with clamps on the recipient pulmonary artery (PA) and left atrial (LA) cuff, with or without cardiopulmonary bypass (CPB). The clamps may be awkward to apply and maintain on these structures, potentially causing injury and possibly compromising the quality of anastomosis. We describe a no-clamp technique for performing these types of anastomoses.
  
  
  METHODS
  A total of 184 LTx procedures performed under CPB were grouped depending on clamping of recipient PA and LA during anastomosis using either the "no-clamp" technique (Group 1, n = 41) or the conventional technique (Group 2, n = 143). Pre-operative donor and recipient demographics and baseline characteristics as well as post-operative outcomes were compared.
  
  
  RESULTS
  The demographics and pre-operative baseline characteristics of donors and recipients in both the groups were similar. Patients in Group 1 had a significantly shorter total ischemic time (p < 0.001), CPB time (p < 0.001), decreased incidence of post-LTx atrial fibrillation (p = 0.048), less need for blood and blood products transfusion, and fewer post-LTx pulmonary infections (p = 0.038). No patient in any group had post-LTx stroke. Although the incidence of post-operative bronchiolitis obliterans syndrome (BOS) did not differ between the two groups (p = 0.638), patients in Group 1 had significantly better mid- and long-term survival (p = 0.013): 89.7% vs 80%, 89.7% vs 66.5% and 89.7% vs 62.2% at 1, 3 and 6 years after LTx, respectively.
  
  
  CONCLUSIONS
  The no-clamp technique for anastomosis of PA and LA in LTx is feasible and safe. It may reduce warm ischemia time as well as CPB time, with improvement in post-LTx outcomes. It may also reduce the incidence of post-LTx atrial arrhythmias.
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK. Electronic address: drprashantis@rediffmail.com.
authors.forename: Prashant N
authors.initials: PN
authors.lastname: Mohite
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Garcia-Saez
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Nikhil P
authors.initials: NP
authors.lastname: Patil
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Weymann
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Shirin
authors.initials: S
authors.lastname: Shibani
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Bartlomiej
authors.initials: B
authors.lastname: Zych
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Reed
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Carby
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Fabio
authors.initials: F
authors.lastname: DeRobertis
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Andre R
authors.initials: AR
authors.lastname: Simon
authors.affiliation: Department of Cardiothoracic Transplantation & Mechanical Support, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UK.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011651:Pulmonary Artery / Q000601:surgery*; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D014656:Vascular Surgical Procedures / Q000379:methods
keywords: lung transplantation; pulmonary artery; pulmonary veins