LUNG TRANSPLANTATION AFTER PREVIOUS THORACIC SURGICAL-PROCEDURES

Background. This study examined results of lung transplantation after previous thoracic surgical procedures. Methods. Twenty percent of the 69 isolated lung transplantations performed at the University of North Carolina between January 1990 and June 1993 were in patients who had undergone a previous thoracic surgical procedure, and an additional 10 % had undergone a previous chest tube placement. Results. No statistic ally significant increase in morbidity or mortality was observed betwe en those having undergone a previous procedure or chest tube placement and all other patients. Specifically, the length of intubation, lengt h of hospital stay, hospital mortality, or the number of patients who experienced major early complications was not significantly different between these groups. A statistically significant increase in the numb er of blood products used was observed in the patients with previous t horacic surgical procedures but not with patients having had previous chest tube placements. However, when the data were reanalyzed with res pect to the use of cardiopulmonary bypass, those patients requiring by pass had a markedly poorer outcome that reached statistical significan ce in all of the parameters studied: hospital death, incidence of majo r complications, length of intubation, hospital stay, incidence of ble eding, and number of blood products used. Conclusions. We conclude tha t although increased bleeding may be encountered, lung transplantation can be performed successfully in patients who have had previous thora cic surgical procedures without increased major morbidity or mortality ; however, the use of cardiopulmonary bypass has been associated with significantly increased morbidity and mortality in our patient populat ion.