Technique and Outcomes of Less Invasive Lung Retransplantation.

Background: Lung retransplantation is a demanding procedure with outcomes lagging primary transplantation. We implemented less invasive surgical techniques aiming at improving early outcomes. Here, we wish to describe these techniques and analyze clinical outcomes. Methods: Since April 2010 a protocol of less invasive techniques was applied to all lung retransplantations. This protocol comprises bilateral lung retransplantation via sternum-sparing anterolateral thoracotomies, off-pump surgery, and empiric administration of 2 g fibrinogen and 2 platelet concentrates. Patient charts were retrospectively reviewed starting in April 2010 until May 2016 for this study and compared to a cohort of patients undergoing lung retransplantation between January 2005 and March 2010. Results: From April 2010 through March 2016, 774 total lung transplantations were performed at our center, 49 were retransplantations. In the era 01/2005-03/2010, a total of 480 lung transplantations were performed, of those being 38 retransplantations. Mean operation time in the era 04/2010-05/2016 was significantly longer as compared to the era 01/2005-03/2010, median time until extubation was significantly shorter in the era 04/2010-05/2016 (1(1-2) days vs. 11.5(1-24) days, p=0.0009). Similarly, median intensive care unit stay time was shorter in the era 04/2010-05/2016 (4(2-5.5) days vs. 12.5(3-30.5) days, p=0.003). Patient survival was significantly better in the era starting in April 2010 at 30 days (98% vs. 76.3%, p=0.002) as well as at 1-year (80.6% vs. 63.2%, p=0.01). Conclusions: Less invasive retransplantation of the lung via sternum-sparing anterolateral thoracotomies and off-pump is a safe procedure with low associated morbidity and favorable mid-term survival. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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