How are double-lung transplantations performed?

Updated: Aug 19, 2019
  • Author: Bryan A Whitson, MD, PhD; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

The most frequently performed double-lung transplantation (DLT) procedure actually is bilateral sequential SLT. This procedure is associated with a significantly lower incidence of bronchial complications than the en-bloc DLT procedure and is technically less difficult to perform than en-bloc DLT.

The exposure for bilateral sequential lung transplantation is via bilateral anterolateral thoracotomies through the fourth or fifth intercostal space. These can be connected by a transverse sternotomy, ie, the "clam-shell" incision. For patients with emphysema who undergo DLT, the contralateral hemithorax may be left closed until after the first lung graft is completed. Mobilization and pneumonectomy of the native lung and the implantation of the lung graft are conducted in the same manner as described for SLT. Thymic and anterior mediastinal tissue may be mobilized to cover the bronchial anastomosis.


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