CARDIOVASCULAR ENGINEERING Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
	Volume 2, 1997, No 3

``Pneumoreduction'' in Lung Transplantation: A Safe and Efficient Way to Achieve Size Compatibility

O. Artemiou, M. Grabenwger, S. Taghavi, T. Birsan, T. Rinne, E. Wolner, W. Klepetko

Abstract:
Background: Between November 1989 and December 1996, 167 isolated lung transplantations (84 single and 83 sequential bilateral LTX), were performed in 144 patients in Vienna. In 27 (16.2 %) procedures ( 8 single and 19 bilateral) donor lungs were too large to fit into the recipients' chest cavity. Pneumoreduction was perfomed to achieve size compatibility. Methods: Extreme size discordance (n=6) was corrected by lobar TX. Four patients received the middle and lower lobe on the right and the lower lobe on the left, one patient the right upper lobe and a whole left lung and one patient the right middle and lower lobe. Moderate size discordance (n= 21 ) was managed by peripheral non anatomic resections, so called ``tailoring'' of the lung with the use of conventional stapling devices. Sites of resection were the middle lobe on the right side and the lingula on the left. Results: Post- operative complications were observed in 4 patients: One patient had a prolonged air leak and three patients a pulmonary infection. The 30 - day mortality was 18.5 % (5 patients). Two patients after tailoringand one after lobar TX died from septic complication after primary organ failure and one patient after tailoring from toxic liver failure. Another patient was detected to be brain dead after an uneventful lobar transplantation procedure. These events were unrelated to the pneumoreduction procedures. Conclusion: Lobar transplantation and tailoring of the lung are safe and efficient methods to manage size discordance in lung transplantation.

Keywords:
LTX, Pneumoreduction, lobectomy, lobar TX, stapler, tailoring

Address for Correspondence:

Reference:
(CVE. 1997; 2 (3): 177-179)

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