Oto Takahiro, Rabinov Marc, Negri Justin, Marasco Silvana, Rowland Michael, Pick Adrian, Snell Gregory, Rosenfeldt Franklin, Esmore Donald
Department of Cardiothoracic Surgery, The Alfred Hospital, Monash University, Melbourne, Australia.
Ann Thorac Surg. 2006 Apr;81(4):1199-204. doi: 10.1016/j.athoracsur.2005.11.057.
An inadequate donor left atrial (LA) cuff due to an anatomical abnormality of the pulmonary vasculature or technical errors at the time of procurement can exclude the lungs from transplant. This study aims to describe the incidence, efficacy, and various techniques of LA cuff reconstruction in lung transplantation.
A total of 637 pulmonary venous anastomosis in 405 consecutive lung transplants from January 1995 to July 2005 were reviewed. Comparison between the patients who required LA cuff reconstruction (reconstruction group) or who did not (no-reconstruction group) was made in posttransplant outcomes.
An overall incidence of requirement of LA cuff reconstruction was 2.7% (4% on the right, 1% on the left, p = 0.03). Seventy-one percent of LA inadequacy was corrected using a pericardial patch on the anterior LA cuff wall; the remainder required complicated reconstruction for separated/short pulmonary veins to create a new LA cuff. There was no significant difference between the reconstruction and no-reconstruction groups, respectively, in oxygenation (329 +/- 28, 337 +/- 10, p = 0.81), duration of intubation and intensive care unit stay (p = 0.54, p = 0.89, respectively), 30-day mortality (12%, 6%, p = 0.30), and 5-year survival (57%, 52%, p = 0.80).
Inadequate donor LA cuff is an infrequent but potentially serious complication in lung transplantation. Donor LA cuff reconstruction using donor pericardium or pulmonary artery remnant is a useful technique to salvage surgically marginal lungs without affecting early and late posttransplant outcomes. These lungs should not be excluded from transplantation.
由于肺血管解剖异常或获取时的技术失误导致供体左心房（LA）袖带不足，可能会使肺无法用于移植。本研究旨在描述肺移植中LA袖带重建的发生率、疗效及各种技术。
回顾了1995年1月至2005年7月连续405例肺移植中的637例肺静脉吻合情况。比较了需要LA袖带重建的患者（重建组）和不需要重建的患者（非重建组）的移植后结局。
LA袖带重建的总体发生率为2.7%（右侧4%，左侧1%，p = 0.03）。71%的LA不足通过在LA袖带前壁使用心包补片得到纠正；其余患者因肺静脉分离/短小需要进行复杂重建以创建新的LA袖带。重建组和非重建组在氧合（329±28，337±10，p = 0.81）、插管时间和重症监护病房停留时间（分别为p = 0.54，p = 0.89）、30天死亡率（12%，6%，p = 0.30）和5年生存率（57%，52%，p = 0.80）方面均无显著差异。
供体LA袖带不足是肺移植中一种罕见但潜在严重的并发症。使用供体心包或肺动脉残端进行供体LA袖带重建是挽救手术边缘肺的有用技术，且不影响移植后的早期和晚期结局。这些肺不应被排除在移植之外。
