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J Thorac Cardiovasc Surg 2001;121:0149-0154
© 2001 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Superiority of end-to-end versus telescoped bronchial anastomosis in single lung transplantation for pulmonary emphysema

From the Departments of Surgery^a and Medicine,^b Columbia University, College of Physicians & Surgeons, New York, NY.

Received for publication Feb 22, 2000. Revisions requested June 19, 2000; revisions received July 5, 2000. Accepted for publication July 18, 2000. Address for reprints: Larry L. Schulman, MD, Columbia University, College of Physicians & Surgeons, Cardiopulmonary Transplant, PH 14 West, 622 W 168th St, New York, NY 10032 (E-mail: LLS2{at}columbia.edu).

Objective: To assess the influence of surgical technique (telescoped versus end-to-end anastomosis) on the incidence of bronchial anastomotic complications in patients who underwent single lung transplantation for pulmonary emphysema.
Methods: Seventy-six adult recipients of single lung transplants for pulmonary emphysema were evaluated for the presence of 3 types of major bronchial anastomotic complications: ischemia, dehiscence, and severe stenosis. Surgical technique, clinical course, and mortality were reviewed retrospectively.
Results: The 3 major complications were observed in 11 (34%; ischemia), 8 (25%; dehiscence), and 11 (34%; severe stenosis) of 32 telescoped bronchial anastomoses. In contrast, ischemia, dehiscence, and severe stenosis occurred in only 4 (9%), 1 (2%), and 2 (5%) of 44 end-to-end anastomoses (P = .0087, P = .0034, and P = .0012, respectively). The relative risk of ischemia, dehiscence, and severe stenosis in telescoped anastomoses was 2.1, 2.5, and 2.5, respectively, compared with end-to-end anastomoses. Five (13%) telescoped anastomoses required stent placement as compared with only 2 (5%) end-to-end anastomoses (P = .1244). Early postoperative pneumonia was more common in the telescoped anastomosis group (56%) than in the end-to-end group (32%; P = .0380). There was a trend toward shorter survival in the telescoped anastomosis group (mean survival 1045 ± 145 days) as compared with the end-to-end group (mean survival 1289 ± 156 days), but these differences did not achieve statistical significance (P = .2410).
Conclusions: In patients who underwent single lung transplantation for pulmonary emphysema, telescoped anastomoses were associated with a higher incidence of bronchial anastomotic complications than end-to-end anastomoses.