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  • Print publication year: 2011
  • Online publication date: September 2011

Chapter 16 - Surgical procedure

from Section 3 - Lung

Summary

Advances in surgical techniques, postoperative care, and immunosuppression have led to greatly improved survival following cardiac transplantation in the past two decades. Patients expiring from overwhelming infection have traditionally been excluded from donor evaluation due to potential transmission of pathogens. Studies of donor-related tumor transmission to transplant recipients usually distinguish between central nervous system (CNS) and non-CNS donor malignancies. Case reports have described the transplantation of hearts from donors poisoned with tricyclic antidepressants with satisfactory graft function. Recent case series report a 15-30 percentage prevalence of left ventricular hypertrophy (LVH) in donor hearts accepted for transplantation. LV dysfunction is the most frequently cited reason for non-utilization of potential cardiac allografts. Due to the severe donor organ shortage, with long recipient waiting times, non-standard or marginal donor hearts are increasingly being used for higher risk recipients and critically ill patients, leading to an expansion of both the donor and recipient pools.

Further reading

AignerC, JakschP, SeebacherG, et al. Single running suture – the new standard technique for bronchial anastomoses in lung transplantation. Eur J Cardiothorac Surg 2003; 23: 488–93.
GammieJS, Cheul LeeJ, PhamSM, et al. Cardiopulmonary bypass is associated with early allograft dysfunction but not death after double-lung transplantation. Thorac Cardiovasc Surg 1998; 115: 990–4.
GarfeinES, McGregorCC, GalantowiczME, et al. Deleterious effects of telescoped bronchial anastomosis in single and bilateral lung transplantation. Ann Transplant 2000; 5: 5–11.
HlozekC, SmediraNG, KirbyTJ, et al. Cardiopulmonary bypass for lung transplantation. Perfusion 1997; 12: 107–12.
MacchiariniP, LadurieFL, CerrinaJ, et al. Clamshell or sternotomy for double lung or heart-lung transplantation? Eur J Cardiothorac Surg 1999; 15: 333–9.
PochettinoA, BavariaJE. Anterior axillary muscle-sparing thoracotomy for lung transplantation. Ann Thorac Surg 1997; 64: 1846–8.