Long Term Outcomes of Minimally Invasive Lung Transplantation Compared to Clamshell Approach

Abstract

<h3>Purpose</h3> Bilateral lung transplantation is traditionally performed via a clamshell incision (CS). Minimally invasive lung transplantation (MILT) is increasingly propagated via bilateral thoracotomies. However, the clinical benefits of (MILT) have not been conclusively established. This study compares a decade of experience with MILT with CS in the same institution. <h3>Methods</h3> The retrospective observational study between January 2010 and January 2020 evaluated short and long term outcome bilateral sequential lung transplants (296 patients with CS = 204 and MILT = 92). <h3>Results</h3> Skin-to-skin surgical time tended to be less in the MILT group [394 ± 122 vs 447 ± 287 min, p=0.15). Ischaemic time for both lungs was longer in the MILT group (right lung: 423.07 ± 157.3 vs 369.4± 152.8 min, p=0.3; left lung 535.5 ± 174.3.9 vs 480.8± 163.9 min, p=0.06). There was no significant difference between the two groups regarding administration of blood product (p=0.78) or blood drainage (p=0.22). Patients requiring renal replacement therapy were significantly less in the MILT group [25%vs 35.3%, P = 0.05] . There were no between-group differences in ventilation time (1.6 vs 1.8 days, P < 0.4) or hospital stay (34 vs 41 days, p=0.11). No significant difference between the two groups regarding 30 days mortality (p=0.55) Fraction of expired volume in 1 s (FEV₁) at 3 months was significantly higher in the MILT group compared with CS (2.5 vs 2.2 l, p=0.01), although the difference was no longer significant at 6 months (2.6 vs 2.4L, p=0.08). 5-year survival tended to be higher (66.8%) in MILT compared to CS group (59.7%, p=0.5.) Multivariate regression analysis found surgical approach (MILT) to be the main predictor of improved FEV1 at 3 months (coef 0.266, 95% CI 0.165 - 0.742, p=0.002). <h3>Conclusion</h3> MILT is a safe alternative to conventional approaches for lung transplantation and offers an earlier improvement in patient respiratory function. This may have important implications for enhanced recovery in transplant recipients.