Deleterious effects of telescoped anastomosis in single and double lung transplantation

Evan S. Garfein, E. E. Milliken, C. C. McGregor, M. E. Galantowicz, L. L. Schulman

Research output: Contribution to journalArticle

Abstract

Purpose: It has been suggested that while the telescoped (T) anastomsis may protect against fatal airway dehiscence, the overall incidence of dehiscence is not different when compared to the end-to-end (EE) anastomosis, and the incidence of stenosis is considerably higher. Methods: In the present study, we retrospectively reviewed our experience in 152 patients in whom 205 anastomoses were performed. Thirty-six patients received 42 telescoped anastomoses. 116 patients received 163 end-to-end anastomoses. The mean age of T recipients was 53.3±10 yrs (range 26-67yrs) and EE recipients was 41.9±15.5 yrs (range 0.3-67yrs), the difference accounted for by the higher percentage of patients with CF who received EE. Ischemic times were not significantly different between the two groups (220.2±49.4 min in T vs. 246.8±62.4 min in EE). Results: Bronchial ischemia (defined as bronchoscopic visualization of dark, necrotic mucosa overlying more than 50% of the bronchial anastomosis) occurred more commonly in T than EE (31% vs. 15%, p=0.03). Dehiscence (defined as disruption of more than 25% of the circumferential suture line observed on bronchoscopy) also occured more commonly in T than in EE (24% vs. 9%, p=0.01). Severe stenosis (defined as narrowing of the bronchial lumen to less than 4.9mm in diameter, the outer diameter of the bronchoscope) occurred more commonly in T than EE (31% vs. 7%, p<0.0001). In addition, there was a trend towards shorter mean survival in T than in EE (641±541d vs. 799±726d). Conclusions: We conclude that in single and double lung transplantation, telescoped anastomoses are associated with a higher incidence of postoperative airway complications than end-to-end anastomoses, and there may be a detrimental effect of telescoped anastomoses on long-term survival.

Original languageEnglish (US)
Pages (from-to)283S
JournalChest
Volume114
Issue number4 SUPPL.
StatePublished - Oct 1 1998
Externally publishedYes

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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    Garfein, E. S., Milliken, E. E., McGregor, C. C., Galantowicz, M. E., & Schulman, L. L. (1998). Deleterious effects of telescoped anastomosis in single and double lung transplantation. Chest, 114(4 SUPPL.), 283S.