Abstract
BackgroundLung transplantation (LTx) is widely accepted as a therapeutic option for end-stage respiratory failure in cystic fibrosis. However, airway complications remain a major cause of morbidity and mortality in these patients, serious airway complications like bronchopleural fistula (BPF) are rare, and their management is very difficult.Case presentationA 47-year-old man with end-stage respiratory failure due to cystic fibrosis underwent bilateral sequential lung transplantation. Severe post-operative bleeding occurred due to dense intrapleural adhesions of the native lungs. He was re-explored and packed leading to satisfactory haemostasis. He developed a bronchopleural fistula on the 14th post-operative day. The fistula was successfully repaired using pericardial and intercostal vascular flaps with veno-venous extracorporeal membrane oxygenator (VV-ECMO) support. Subsequently his recovery was uneventful.ConclusionThe combination of pedicled intercostal and pericardial flaps provide adequate vascular tissue for sealing a large BPF following LTx. Veno-venous ECMO allows a feasible bridge to recovery.
Highlights
Lung transplantation (LTx) is widely accepted as a therapeutic option for end-stage respiratory failure in cystic fibrosis
While the overall incidence of such complications can be as high as 15%, bronchopleural fistulas (BPF) are very uncommon
We report successful surgical repair of bronchopleural fistula in the donor bronchus employing a Levitronix Centrimag® [Waltham, Massachusetts]-based veno-venous extracorporeal membrane oxygenator support with 6 days bridge to recovery
Summary
Lung transplantation (LTx) is widely accepted as a therapeutic option for end-stage respiratory failure in cystic fibrosis. We report successful surgical repair of bronchopleural fistula in the donor bronchus employing a Levitronix Centrimag® [Waltham, Massachusetts]-based veno-venous extracorporeal membrane oxygenator support with 6 days bridge to recovery. A percutaneous tracheostomy was performed on the 9th post-operative day due to prolonged requirement for ventilatory support and to aid in bronchial toilet, and the patient weaned successfully from mechanical ventilation.
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