Reduction in airway complications after lung transplantation with novel anastomotic technique

Elizabeth FitzSullivan; Cynthia J Gries; Patrick Phelan; Farhood Farjah; Erin Gilbert; John C Keech; Douglas E Wood; Ganesh Raghu; Michael S Mulligan

doi:10.1016/j.athoracsur.2011.01.077

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Reduction in airway complications after lung transplantation with novel anastomotic technique

Journal article

Peer reviewed

Reduction in airway complications after lung transplantation with novel anastomotic technique

Elizabeth FitzSullivan, Cynthia J Gries, Patrick Phelan, Farhood Farjah, Erin Gilbert, John C Keech, Douglas E Wood, Ganesh Raghu and Michael S Mulligan

The Annals of thoracic surgery, Vol.92(1), pp.309-315

07/2011

DOI: 10.1016/j.athoracsur.2011.01.077

PMCID: PMC3639125

PMID: 21511248

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https://www.ncbi.nlm.nih.gov/pmc/articles/3639125View

Open Access

Abstract

Bronchial anastomotic complications develop in 31% of lung transplant recipients, leading to additional operative procedures and increased morbidity. Advances in surgical technique have thus far resulted in only modestly improved outcomes. We hypothesized that creating the bronchial anastomosis at the secondary carina using a combination of running and figure-of-eight sutures would minimize donor bronchial ischemia and airway complications. This retrospective review of a single surgeon's operative experience from 2000 to 2007 compares a new bronchial anastomotic technique with the conventional technique. The primary outcome was the occurrence of bronchial anastomotic complications requiring invasive intervention. The secondary outcome was distal airway complications. Patients were monitored for 1 year after transplant. Recipient and donor demographic data as well as relevant variables from their preoperative, perioperative, and postoperative courses were collected for analysis. These data were compared using t tests for normally distributed continuous variables, Mann-Whitney tests for nonnormally distributed continuous variables, and χ2 tests or Fisher exact test for categoric variables. Logistic regression was used to control for covariates while comparing the primary outcome between the new and conventional bronchial anastomotic techniques. The analysis included 230 patients, representing 407 anastomoses. The occurrence of anastomotic complications requiring intervention and distal airway complications decreased from 18.1% to 2.3% of anastomoses and 12.2% to 4.4% of patients, respectively. After controlling for available risk factors, the new technique significantly reduced both anastomotic (p<0.001) and distal (p=0.03) airway complications. This new anastomotic technique dramatically reduces anastomotic and distal airway complications after lung transplantation.

Follow-Up Studies

Humans

Middle Aged

Postoperative Complications - prevention & control

Male

Reference Values

Bronchial Diseases - prevention & control

Statistics, Nonparametric

Adult

Female

Anastomosis, Surgical - methods

Retrospective Studies

Suture Techniques

Risk Assessment

Graft Rejection - prevention & control

Airway Obstruction - prevention & control

Graft Survival

Logistic Models

Survival Rate

Treatment Outcome

Postoperative Complications - epidemiology

Lung Transplantation - adverse effects

Bronchi - surgery

Lung Transplantation - methods

Cohort Studies

Details

Title: Subtitle: Reduction in airway complications after lung transplantation with novel anastomotic technique
Creators: Elizabeth FitzSullivan - Division of Thoracic Surgery, University of Washington, Seattle, Washington 98195, USA
Cynthia J Gries
Patrick Phelan
Farhood Farjah
Erin Gilbert
John C Keech
Douglas E Wood
Ganesh Raghu
Michael S Mulligan
Resource Type: Journal article
Publication Details: The Annals of thoracic surgery, Vol.92(1), pp.309-315
DOI: 10.1016/j.athoracsur.2011.01.077
PMID: 21511248
PMCID: PMC3639125
NLM abbreviation: Ann Thorac Surg
ISSN: 0003-4975
eISSN: 1552-6259
Publisher: Netherlands
Grant note: KL2 RR025015 / NCRR NIH HHS T32 HL007828 / NHLBI NIH HHS
Language: English
Date published: 07/2011
Academic Unit: Surgery; Cardiothoracic Surgery
Record Identifier: 9984051701402771

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