Bilateral Lung Transplantation in Severe Chest Asymmetry: Case Series from a Single Center

Abstract

<h3>Purpose</h3> Suppurative lung disease, such as bronchiectasis and cystic fibrosis, are typical indications for bilateral lung transplantation. Some cases may present a severe chest asymmetry as a sign of recurrent infections. To treat this condition, pneumonectomy and a single lung transplantation is a feasible option, even if this type of surgery is associated with a high complication risk. A second option is bilateral lung transplant with surgical reduction of the graft implanted in the smaller pleural cavity. <h3>Methods</h3> From 2017 to 2021 five patients with significant pleural cavities asymmetry where referred to our centre and underwent bilateral lung transplantation. One patient was affected by bronchiectasis and four by cystic fibrosis. Table 1 shows patients data. <h3>Results</h3> Surgery was performed by means of a clamshell incision through the fourth intercostal space. Three patients where bridged to transplant on VV-ECMO. Graft reduction was not necessary due to median realignment of the mediastinum. All patients were extubated within the second postoperative day. Mean ICU stay was 4 days. Postoperative radiological evaluation did not show clustering or atelectasis of graft implanted in the smaller hemithorax (picture). No major complications were recorded and the average length of hospital stay was 23.8 days. Patients are currently alive at 4,8,12,17 and 40 months after transplantation with excellent functional recovery (mean best FEV1 88.4%). <h3>Conclusion</h3> Bilateral lung transplantation in patients with severe chest asymmetry is a possible procedure, with good functional results even without sacrificing part of graft parenchyma.