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J Thorac Cardiovasc Surg 2001;121:587-588
© 2001 The American Association for Thoracic Surgery

Brief Communications

Aortic homograft interposition for management of complete tracheal anastomotic disruption after heart-lung transplantation

Timothy M. Hoffman, MDa, J. William Gaynor, MDb, Nancy D. Bridges, MDa, Stephen M. Paridon, MDa, Thomas L. Spray, MDb, Philadelphia, Pa

From the Divisions of Cardiologya and Cardiothoracic Surgery,b The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, Pa.

Supported in part by a grant from the Daniel M. Tabas Endowed Chair in Cardiothoracic Surgery.

Received for publication July 26, 2000. Accepted for publication Aug 1, 2000. Address for reprints: Thomas L. Spray, MD, Professor and Chief, Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104.

Airway complications after heart-lung transplantation include poor tracheal healing, mucosal slough, stricture, partial disruption, and complete dehiscence of the anastomosis.Go Go 1-3 Complete dehiscence or disruption of the tracheal anastomosis is a rare but often lethal complication.Go 2 We describe the treatment of a patient with acute graft failure and complete tracheal anastomotic disruption after heart-lung transplantation.

Clinical summary
A 38-year-old woman had pulmonary hypertension after a ventricular septal defect closure at 5 years of age. She was hospitalized for 3 months before transplantation with severe right-sided heart failure with ascites, hepatomegaly, weight loss, and marked muscle wasting, despite therapy with epoprostenol (Flotan) and inotropic medications. Orthotopic heart-lung transplantation was performed with a graft ischemic time of 305 minutes. The donor trachea was divided 2 rings above the carina, and the recipient's trachea was divided at the level of the carina. An end-to-end tracheal anastomosis was performed with a continuous Prolene suture (Ethicon, Inc, Somerville, NJ) for the membranous portion and interrupted Prolene sutures for the anterior cartilaginous portion. The donor-recipient size match was excellent, and no air leak was noted intraoperatively. Tissue was tacked around the tracheal suture line to separate the anastomosis from the aorta.

Postoperatively, she was maintained on triple immunosuppression therapy consisting of intravenous cyclosporine (Sandimmune; INN: ciclosporin), azathioprine, and steroids; once she was able to tolerate enteral medications, cyclosporine was changed to tacrolimus. She was extubated on postoperative day 4 but required reintubation within 30 hours because of muscle weakness and an inability . . . [Full Text of this Article]






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