Lung Transplantation with Pulmonary Artery Reconstruction Using Donor Aorta for Pulmonary Hypertension with Giant Pulmonary Arterial Aneurysm: Intermediate-Term Result

Abstract

<h3>Purpose</h3> Giant pulmonary arterial aneurysm (PAA) is a rare but serious complication for patients with pulmonary hypertension (PH). Heart-lung transplantation or lung transplantation with a full length of donor pulmonary artery (PA) for pulmonary artery reconstruction (PAR) are options for PH complicated with a giant PAA involving PA trunk to main PAs. We have been using donor aorta for the reconstruction of PA for these lung transplant cases. This study aimed to describe our intermediate-term outcomes of lung transplantation with PAR using donor aorta for PH complicated with a giant PAA. <h3>Methods</h3> This is a single center retrospective review from March 2000 to May 2020. We reviewed cadaveric lung transplantations for PH and compared the outcomes of lung transplantation with PAR (PAR group) with those without PAR (non-PAR group). <h3>Results</h3> Twenty-five PH patients underwent cadaveric lung transplantation. Among them, 5 patients with a giant PAA underwent lung transplantation with PAR using donor aorta. Representative 3D-CT images of a giant PAA and the reconstructed PA are shown in Figure A. The diameter of the PA trunk was significantly larger in the PAR group compared to the non-PAR group (Figure B). As expected, operative time was significantly longer in the PAR group compared to the non-PAR group (PAR, 1204 minutes; non-PAR, 965 minutes, p=0.035). On the other hand, primary graft dysfunction grade, 30-day mortality (PAR, 0%; non-PAR, 5.0%), 5-year survival rate (PAR, 100%; non-PAR, 73.9%, Figure C), and 6 minutes walk distance at 1 year after lung transplantation (PAR, 522 m; non-PAR, 526m) were not significantly different between the groups. The donor aortas used for PAR did not show constriction, obstruction, enlargement, or infection during the observation period. <h3>Conclusion</h3> Our experience supports that lung transplantation with PAR using donor aorta is a feasible surgical option for PH complicated with a giant PAA.