STAPLE PNEUMOREDUCTION WITH FIBRIN SEALANT APPLICATION - A RELIABLE METHOD OF TRANSPLANTING OVERSIZED LUNGS

Transplantation of a large lung allograft into a small chest could lea d to atelectasis and hemodynamic instability. We developed a technique by which larger-sized lungs could be reduced to fit into smaller reci pients. This entails multiple applications of a stapler device to prog ressively remove excessive lung tissue until the lung fits adequately into the recipient's chest cavity. An experimental animal model was us ed to test the applicability and safety of this technique. Because air leak from the resected margins was anticipated, we further examined t he feasibility of reducing the latter by application of fibrin glue. E ight small mongrel dogs (20 to 25 kg) received left lung allotransplan ts from eight larger-sized dogs (35 to 40 kg) with the staple pneumore duction technique. This group was further stratified to receive (group 1A; n = 4) or not receive application of fibrin sealant (group 1B; n = 4) to the stapled resection margins. Group 2 received lungs from sim ilar-sized animals (20 to 25 kg; n = 4 each). Group 3 consisted of siz e-mismatched animals without pneumoreduction (n = 2). Recipient dogs w ere compared for facility of chest closure, gas exchange, and hemodyna mic stability. The ability of the newly implanted lung to support resp iratory function was also assessed by ligation of the opposite pulmona ry artery at 4 hours. No difference was noted between groups 1 and 2 i n terms of these variables. In sharp contrast, group 3 animals showed a rapid and profound drop in blood pressure after chest closure. Furth ermore, a significant decrease (p < 0.05) in air leak was seen with th e application of fibrin (group 1A versus group 1B) at 1 hour (234 +/- 231 cc versus 5821 +/- 2656 cc) and 4 hours (407 +/- 228 cc versus 166 25 +/- 5498 cc). We conclude that the technique of staple pneumoreduct ion can be safely used across size-mismatched donor/recipients, which may allow better allocation of donor lung. The application of fibrin g lue may help decrease postoperative air leak when staple pneumoreducti on is performed.