How are heart-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

Either a standard median sternotomy or a clam-shell incision may be used for heart-lung transplantation. Following the institution of CPB, the lungs are removed by an extrapericardial approach, ie, incising and stapling of the bronchovascular structures at the pulmonary hila. The donor right atrium is incised from the inferior vena cava to the right atrial appendage. The right atrium is examined to exclude an atrial septal defect and for adequate closure of the superior vena cava. If a tracheal anastomosis is used, the posterior pericardium is incised between the ascending aorta and the superior vena cava to expose the distal trachea.

Some centers prefer bilateral bronchial anastomosis using a telescoping technique as described for SLT. This approach avoids dissection in the posterior mediastinum and may be associated with fewer anastomotic complications. After the right atrial anastomosis is completed, the aortic anastomosis is performed. The aortic cross clamp is removed, and, after reinflation of the lungs, the heart is de-aired via the pulmonary artery and the left ventricle. The heart is defibrillated to begin circulation, and the patient is weaned from CPB.


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