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Franklin Rosenfeldt
Donald S. Esmore
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Right arrow Lung - transplantation

J Thorac Cardiovasc Surg 2005;129:466-467
© 2005 The American Association for Thoracic Surgery

Brief Communications

Extended pericardiotomy avoids cardiopulmonary bypass during bilateral sequential lung transplantation

Takahiro Oto, MD*, Marc Rabinov, FRACS, Franklin Rosenfeldt, FRACS, Donald S. Esmore, FRACS

Department of Cardiothoracic Surgery, The Alfred Hospital, Monash University, Melbourne, Australia

Received for publication June 16, 2004; revisions received June 24, 2004; accepted for publication June 30, 2004.

* Address for reprints: Takahiro Oto, MD, Heart and Lung Transplant Unit, The Alfred Hospital, Commercial Road, Melbourne 3004, Australia (E-mail: takahirooto@aol.com).

The first 20% of the full text of this article appears below.


Dr Oto


Bilateral-sequential lung transplantation (BSLTx) through a clamshell thoracotomy has made the procedure of double-lung replacement possible without the use of cardiopulmonary bypass (CPB).1 Avoiding CPB has the potential advantages of reducing early allograft dysfunction2 and coagulopathy, as well as lessening the amount of blood transfusion.3 CPB is always required during lung transplantation for pulmonary hypertensive lung diseases or nonpulmonary hypertensive lung diseases with concomitant cardiac repair. However, CPB is also occasionally required during lung transplantation for inadequate gas exchange, right-heart dysfunction, or hemodynamic instability caused by mediastinal manipulation during single-lung ventilation.2 For patients with pulmonary fibrosis (PF) undergoing BSLTx, adhesions and reduced size of the pleural space might necessitate forceful mediastinal manipulation to access the left hilum. This might cause severe hemodynamic compromise, despite inotropic support and inhaled nitric oxide. Unplanned CPB might be required, especially when the patients with PF have preexisting pulmonary hypertension (PH). To avoid hemodynamic instability during mediastinal . . . [Full Text of this Article]




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