Between May 1989 and March 1990, 36 patients undergoing a first single lung transplantation were randomized to three groups. In the omentum group the bronchial anastomosis was wrapped with an omental pedicle. In the internal mammary artery group, the anastomosis was wrapped in a pedicle of tissue surrounding the internal mammary artery. In the no wrap group, no attempt was made to revascularize the anastomosis. No significant differences were found in the indications for transplantation, recipient age, organ ischemic time, or preoperative steroid use in the three groups. There were two early deaths: one in the omentum group as a result of infection and one in the internal mammary artery group as a result of multiorgan failure. During a mean follow-up period of 21 months (range 9 to 32), there were two additional deaths in the no wrap group and four in the omentum group, one of which involved an anastomotic complication. Actuarial survival at 1 year was 75%, 92%, and 80% in the omentum, internal mammary artery, and no wrap groups, respectively (p = 0.25). Granulation tissue at the site of the anastomosis requiring cryotherapy or bronchial dilatation occurred in two patients in the omentum group, three in the internal mammary artery group, and three in the no wrap group. Bronchial stents were required in one patient in the omentum group and one in the internal mammary artery group. Actuarial survival free of anastomotic complications was similar in the three groups. The incidence of bronchial anastomotic complications after single lung transplantation is not affected by wrapping the anastomosis with either omentum or an internal mammary artery pedicle.

Actuarial Analysis↗

PubMedDate not supplied

Evaluation of the long-term results of single lung versus heart-lung transplantation for emphysema.

BACKGROUND: Heart and lung transplantation used to be the standard operation for patients with emphysema. Because of the shortage of donors, more patients are having single lung transplantation with satisfactory short-term results. METHODS: This study was performed to evaluate the long-term results of both groups. During the period between December 1985 and December 1993, 89 patients underwent lung transplantation, and 68 patients (43 male and 25 female) underwent single lung transplantation. There were 31 right and 37 left single lung transplantations with 24 bronchial revascularization procedures. RESULTS: The actuarial 5-year survival was 67% +/- 0.3% in single lung and 60% +/- 0.2% in heart-lung groups (p = 0.947). In the single lung group, two patients required a second single lung for air trapping and 11 patients (16%) had obliterative bronchiolitis, two of whom required retransplantation. In the heart-lung group, four patients (19%) had obliterative bronchiolitis, two of whom required retransplantation. The cumulative probability of developing obliterative brochiolitis at 3 and 5 years was 17% and 38% in the heart-lung transplantation group and 23% and 48% in the single lung transplantation group, respectively. The average forced expiratory volumes in 1 second at 3 and 5 years were 1.6 and 1.4 (L/min) (standard error +/- L/min) for single lung and 3 and 2.9 (L/min) standard error +/- 0.25) for heart-lung transplant recipients, respectively. The percentage of the predicted maximum oxygen consumption was 42% and 58% in single lung and heart lung groups, respectively. CONCLUSIONS: The long-term results in respiratory function, exercise capacity, and the quality of life of heart-lung transplant recipients are significantly better with survival compared with single lung transplant recipients. Although single lung transplantation for patients with emphysema makes better use of organs, the long-term results when compared with those of the heart-lung group needs to be evaluated further.

Adult↗

PubMedDate not supplied

Valve conserving operation for aortic regurgitation.

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Aortic Dissection↗

PubMedDate not supplied

Primary pulmonary hypertension: pathologist as patient.

We describe the case of Julia Polak, an internationally known pathologist with an interest in primary pulmonary hypertension, a condition which she was subsequently diagnosed to have. This was successfully treated by heart/lung transplantation and she was then in the unique position to study and present her own pulmonary pathology. Professor Polak's case illustrates the difficulty in diagnosis, the frequent failure of medical treatment and an excellent outcome from heart/lung transplantation. Based on a presentation to a clinico-pathological conference at Hammersmith Hospital.

Adult↗