DIRECT BRONCHIAL ARTERY REVASCULARIZATION AND EN-BLOC DOUBLE-LUNG TRANSPLANTATION-SURGICAL TECHNIQUES AND EARLY OUTCOME

Background: Lung transplantation including direct bronchial artery rev ascularization (BAR) has produced promising early results in small cli nical series. Methods: In Copenhagen primary en bloc double lung trans plantation with BAR, with the left mammary artery used as conduit, has been performed in 47 patients from 1992 to the end of 1995. After int roduction of the bloc into the recipient, the mammary-to-bronchial art ery anastomosis is performed as the first anastomosis, allowing perfec t exposure and early reperfusion. Internal mammary-bronchial artery ar teriography has been performed routinely after operation. Results: Bro nchoscopic examination performed in all patients documented normal air way healing in 42, disturbed in two, and complicated in three. Arterio graphy performed in 42 patients demonstrated complete BAR in 25, incom plete in 15, and failed BAR in 2. Failed BAR was associated with compl icated airway healing. The 1- and 2-year survival rate (Kaplan-Meyer) is 83%. Eleven patients have died, only one within 30 days. The total incidence of bronchiolitis obliterans syndrome at 3 years(with Kaplan- Meier technique) is 33%. Successful BAR has also been performed with a n adjusted technique in a limited number of heart-lung and single lung transplantations. Our total experience of BAR in any type of lung tra nsplantation includes 65 patients with an arteriographic BAR success r ate of 94% (50 of 53 examined patients). Conclusions: Experience has i mproved the surgical technique and has made BAR reliable and safe, be it double lung, single lung, or heart-lung transplantation. Early resu lts are good, but only follow-up will show if long-term results after lung transplantation will be improved by BAR. Already today, en bloc d ouble lung transplantation with BAR is a viable alternative to sequent ial bilateral lung transplantation.