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

Evan S. Garfein, Mark E. Ginsberg, Lyall Gorenstein, Carlton C. McGregor, Larry L. Schulman

Research output: Contribution to journalArticle

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Abstract

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 putmonary emphysema, telescoped anastomoses were associated with a higher incidence of bronchial anastomotic complications than end-to-end anastomoses.

Original languageEnglish (US)
Pages (from-to)149-154
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume121
Issue number1
DOIs
StatePublished - 2001
Externally publishedYes

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Telescopes
Pulmonary Emphysema
Lung Transplantation
Pathologic Constriction
Ischemia
Survival
Incidence
Emphysema
Stents
Pneumonia
Transplants
Lung
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Superiority of end-to-end versus telescoped bronchial anastomosis in single lung transplantation for pulmonary emphysema. / Garfein, Evan S.; Ginsberg, Mark E.; Gorenstein, Lyall; McGregor, Carlton C.; Schulman, Larry L.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 121, No. 1, 2001, p. 149-154.

Research output: Contribution to journalArticle

Garfein, Evan S. ; Ginsberg, Mark E. ; Gorenstein, Lyall ; McGregor, Carlton C. ; Schulman, Larry L. / Superiority of end-to-end versus telescoped bronchial anastomosis in single lung transplantation for pulmonary emphysema. In: Journal of Thoracic and Cardiovascular Surgery. 2001 ; Vol. 121, No. 1. pp. 149-154.
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abstract = "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 putmonary emphysema, telescoped anastomoses were associated with a higher incidence of bronchial anastomotic complications than end-to-end anastomoses.",
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AU - Garfein, Evan S.

AU - Ginsberg, Mark E.

AU - Gorenstein, Lyall

AU - McGregor, Carlton C.

AU - Schulman, Larry L.

PY - 2001

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N2 - 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 putmonary emphysema, telescoped anastomoses were associated with a higher incidence of bronchial anastomotic complications than end-to-end anastomoses.

AB - 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 putmonary emphysema, telescoped anastomoses were associated with a higher incidence of bronchial anastomotic complications than end-to-end anastomoses.

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