Off-Pump Bilateral Lung Transplantation via Median Sternotomy: A Novel Approach With Potential Benefits.

The clamshell incision is the standard approach for bilateral lung transplantation. There is limited experience with bilateral lung transplantation via median sternotomy, and the use of cardiopulmonary bypass seems to be mandatory in all cases while accepting the potential disadvantages of the extracorporeal circulation. We describe a novel approach for bilateral lung transplantation as an off-pump technique via median sternotomy. This approach has the potential to combine the advantages of median sternotomy with less postoperative pain, better chest wall function, and reduced risk of primary graft dysfunction and bleeding complications.