HUMAN EN-BLOC DOUBLE-LUNG TRANSPLANTATION - BRONCHIAL ARTERY REVASCULARIZATION IMPROVES AIRWAY PERFUSION

Background. Ischemic airway complications are common after en bloc dou ble-lung transplantation with tracheal anastomosis. The aim of this st udy was to evaluate the effects of a direct revascularization of the d onor bronchial artery with the recipient internal thoracic artery on a irway perfusion. Methods. Seven patients undergoing double-lung transp lantation with tracheal anastomosis were investigated intraoperatively and postoperatively (12 to 36 hours) with endoscopic laser Doppler fl owmetry. Sixteen patients undergoing coronary artery bypass grafting s erved as a control group. Results. Two patients who had double-lung tr ansplantation with tracheal anastomosis died of sepsis and multiorgan failure 1 week after transplantation. In the remaining 5 patients heal ing of the anastomosis was excellent during the observation period of 3 to 52 months. In 5 patients clamping of the attached internal thorac ic artery induced a reduction of the laser Doppler flowmetry signal fr om 10% to 60%. In the 2 patients with the highest graft perfusion leve l, no clamping effect could be detected. Compared with the control gro up, perfusion was significantly higher in the transplanted airways int raoperatively, at 71 versus 55 arbitrary perfusion units (p < 0.01). P ostoperative transplant airway perfusion values were not significantly different from the intraoperative value. The coefficient of variation of repeated measurements was higher in the transplanted airways, with a coefficient of variation of 0.22 versus 0.17 in the control group ( p < 0.01), indicating heterogeneous transplant airway perfusion. Concl usions. This study has documented that revascularization with the inte rnal thoracic artery supplies the transplanted airway with additional oxygenated blood. (C) 1997 by The Society of Thoracic Surgeons.