Daly R C, McGregor C G
Section of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Ann Thorac Surg. 1994 Jun;57(6):1446-52. doi: 10.1016/0003-4975(94)90099-x.
Ischemia of the donor airway remains a significant cause of morbidity after single-lung transplantation; serious manifestations may occur early (anastomotic dehiscence) or late (stricture). Direct, immediate revascularization of the donor bronchial arteries, using the recipient internal thoracic artery, was performed in 10 consecutive recipients of single-lung transplants for whom we procured the organs. Mean recipient age was 52.6 years (range, 43 to 59 years); 6 were male and 4 female. Recipient diagnoses were emphysema (6), obliterative bronchiolitis (2), pulmonary fibrosis (1), and primary pulmonary hypertension (1). Bronchial artery revascularization initially prolonged the ischemic time by only 15 to 20 minutes; this improved with experience. There was one early death and two late deaths in the series. Internal thoracic arteriography was performed 7 to 10 days postoperatively in all 9 surviving patients. There was excellent perfusion of the donor bronchial arteries in 7 of these 9 patients. Bronchoscopy was performed when clinically indicated. No patient had early or late airway healing complications at a median follow-up of 13 months (range, 6 to 16 months). We conclude that direct, immediate bronchial artery revascularization is feasible on a routine basis for single-lung transplantation, and airway healing has been excellent.
供体气道缺血仍然是单肺移植后发病的一个重要原因；严重表现可能在早期（吻合口裂开）或晚期（狭窄）出现。我们为10例连续接受单肺移植的受者进行了直接、即刻的供体支气管动脉血管重建，所用材料为受者的胸廓内动脉。受者的平均年龄为52.6岁（范围43至59岁）；6例为男性，4例为女性。受者的诊断为肺气肿（6例）、闭塞性细支气管炎（2例）、肺纤维化（1例）和原发性肺动脉高压（1例）。支气管动脉血管重建最初仅使缺血时间延长了15至20分钟；随着经验的积累，情况有所改善。该系列中有1例早期死亡和2例晚期死亡。9例存活患者均在术后7至10天进行了胸廓内动脉造影。这9例患者中有7例供体支气管动脉灌注良好。在有临床指征时进行支气管镜检查。在中位随访13个月（范围6至16个月）时，没有患者出现早期或晚期气道愈合并发症。我们得出结论，对于单肺移植，直接、即刻的支气管动脉血管重建在常规情况下是可行的，并且气道愈合情况良好。
