title: Technique Resource for Difficult Auricular Anastomosis in Lung Transplantation.
abstract: OBJECTIVE
  Atrial anastomosis in lung transplantation (LT) can present significant technical difficulties, especially when there is a very posterior left inferior pulmonary vein, in donor-recipient disproportion or excessive separation of the receptor's pulmonary veins owing to atrial dilatation; hence, its implementation requires excessive heart handling and longer ischemia time, which result in increased perioperative complications. This technique, which uses the recipient's superior pulmonary vein, avoids these problems, although it is not applicable in all cases because no pressure gradient at the suture level is required. Therefore, the suture diameter must be equal or greater than the sum of both graft pulmonary veins diameters.
  
  
  METHODS
  This retrospective study recorded the age/gender (donor and recipient), preoperative morbidity, type of surgery, perioperative, vascular complications, mortality, and postoperative stay. Descriptive and inferential statistical study was made by SPSS.
  
  
  RESULTS
  We performed 82 LTs between January 2009 and June 2012, 18 with the new technique (14 men/4 women; 52 ± 15 years). There were 14 single lung and 4 double lung transplants. The new technique does not increase the ischemic times when compared with the classic technique. No vascular dehiscence, fistulas, or thrombosis were found. There were observed fewer vascular complications (P = .042). Early mortality was presented in 4 cases (22.2%).
  
  
  CONCLUSIONS
  This new technique achieves the objectives described (no increases in ischemic time, fewer vascular complications). However, an absolute confirmation requires a study comparing similar technical LT given that the new resource was only used in highly complex procedures.
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain. Electronic address: eli_piano@hotmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Arango Tomás
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Cerezo Madueño
authors.affiliation: Thoracic Surgery and Lung Transplantation Unit, Reina Sofia University Hospital, Cordoba, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Salvatierra Velázquez
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods / Q000401:mortality; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D016040:Lung Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D013510:Pulmonary Surgical Procedures / Q000379:methods / Q000401:mortality; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D014019:Tissue Donors