Impact of Surgical Approach in Double Lung Transplantation: Median Sternotomy Decreases Operative and Cardiopulmonary Bypass Time Compared to Clamshell Thoracotomy

Abstract

Purpose Double lung transplantation (DLT) remains the gold standard for end-stage lung disease. While DLT was historically performed via clamshell thoracotomy, recently the median sternotomy has emerged as a viable alternative. As the ideal surgical approach remains unclear, the aim of our study was to compare the short and long-term outcomes of these two surgical approaches in DLT. Methods We retrospectively reviewed 192 consecutive adult patients who underwent primary DLT at our institution between 2012 and 2017 (Sternotomy, n=147; Clamshell, n=45). The impact of each surgical approach on post-transplant morbidity and overall survival probability analysis was performed. Results There were no significant differences in recipients’ baseline and donors’ characteristics and bilateral allograft ischemic time (Table). Freedom from primary graft dysfunction, acute rejection episode, post-operative prolonged ventilator support, tracheostomy, postoperative stroke, and airway dehiscence was comparable between these two groups (p=NS for all). However, the durations of cardiopulmonary bypass (p=0.01) and operative time (p Conclusion The median sternotomy approach in DLT decreases operative time and more importantly leads to a shorter duration of cardiopulmonary bypass. The type of surgical approach did not show any statistically significant impact on adult DLT recipients’ morbidity and survival probability.