Initial experience with two sequential anterolateral thoracotomies for bilateral lung transplantation

Background. Bilateral transsternal thoracotomy (clam-shell incision) is the standard approach used for bilateral sequential lung transplantation (BLTX ). The morbidity of this large incision can be considerable. Two separate s equential anterolateral thoracotomies represent a less invasive approach. M ethods. The value of this approach was investigated in a prospective series of 13 consecutive patients with the underlying diagnosis of COPD or cystic fibrosis (group A). Results were compared to 8 consecutive patients with similar indications wh o had undergone BLTX via clam-shell incision during the last year prior to this new technique (group B). Results. No intraoperative complications occurred in either group. The diff erence between the cold ischemic time of the 1st and 2nd transplanted lung was comparable between the 2 groups (81 min +/- 17 min in group A vs 79 min +/- 14 min in group B, p = 0.783). Postoperative restriction was significa ntly less in the group operated through 2 separate thoracotoinies, as prove n by the vital capacity in the first spirometry performed during the 3rd po stoperative week (VC group A 55% +/- 16% predicted vs 41% +/- 11% predicted in group B; p = 0.013). Conclusion. The bilateral sequential anterolateral thoracotomy represents a safe and less invasive approach fur BLTX in patients with large chest volu mes. It minimizes the operative trauma, improves postoperative functional r ecovery and prevents the potential spread of unilateral complications to th e other pleural cavity. (Ann Thorac Surg 1999;67:1440-3) (C) 1999 by The So ciety of Thoracic Surgeons.