Deleterious effects of telescoped anastomosis in single and double lung transplantation
Evan S. Garfein, E. E. Milliken, C. C. McGregor, M. E. Galantowicz, L. L. Schulman
Purpose: It has been suggested that while the telescoped (T) anastomsis may protect against fatal airway dehiscence, the overall incidence of dehiscence is not different when compared to the end-to-end (EE) anastomosis, and the incidence of stenosis is considerably higher. Methods: In the present study, we retrospectively reviewed our experience in 152 patients in whom 205 anastomoses were performed. Thirty-six patients received 42 telescoped anastomoses. 116 patients received 163 end-to-end anastomoses. The mean age of T recipients was 53.3±10 yrs (range 26-67yrs) and EE recipients was 41.9±15.5 yrs (range 0.3-67yrs), the difference accounted for by the higher percentage of patients with CF who received EE. Ischemic times were not significantly different between the two groups (220.2±49.4 min in T vs. 246.8±62.4 min in EE). Results: Bronchial ischemia (defined as bronchoscopic visualization of dark, necrotic mucosa overlying more than 50% of the bronchial anastomosis) occurred more commonly in T than EE (31% vs. 15%, p=0.03). Dehiscence (defined as disruption of more than 25% of the circumferential suture line observed on bronchoscopy) also occured more commonly in T than in EE (24% vs. 9%, p=0.01). Severe stenosis (defined as narrowing of the bronchial lumen to less than 4.9mm in diameter, the outer diameter of the bronchoscope) occurred more commonly in T than EE (31% vs. 7%, p<0.0001). In addition, there was a trend towards shorter mean survival in T than in EE (641±541d vs. 799±726d). Conclusions: We conclude that in single and double lung transplantation, telescoped anastomoses are associated with a higher incidence of postoperative airway complications than end-to-end anastomoses, and there may be a detrimental effect of telescoped anastomoses on long-term survival.
Garfein, E. S., Milliken, E. E., McGregor, C. C., Galantowicz, M. E., & Schulman, L. L. (1998). Deleterious effects of telescoped anastomosis in single and double lung transplantation. Chest, 114(4 SUPPL.).
Deleterious effects of telescoped anastomosis in single and double lung transplantation. / Garfein, Evan S.; Milliken, E. E.; McGregor, C. C.; Galantowicz, M. E.; Schulman, L. L.
In: Chest, Vol. 114, No. 4 SUPPL., 10.1998.
Garfein, ES, Milliken, EE, McGregor, CC, Galantowicz, ME & Schulman, LL 1998, 'Deleterious effects of telescoped anastomosis in single and double lung transplantation', Chest, vol. 114, no. 4 SUPPL..
Garfein ES, Milliken EE, McGregor CC, Galantowicz ME, Schulman LL. Deleterious effects of telescoped anastomosis in single and double lung transplantation. Chest. 1998 Oct;114(4 SUPPL.).
Garfein, Evan S. ; Milliken, E. E. ; McGregor, C. C. ; Galantowicz, M. E. ; Schulman, L. L. / Deleterious effects of telescoped anastomosis in single and double lung transplantation. In: Chest. 1998 ; Vol. 114, No. 4 SUPPL.
@article{3e6ae7da7ee54a03bbecb67e816c8ef0,
title = "Deleterious effects of telescoped anastomosis in single and double lung transplantation",
abstract = "Purpose: It has been suggested that while the telescoped (T) anastomsis may protect against fatal airway dehiscence, the overall incidence of dehiscence is not different when compared to the end-to-end (EE) anastomosis, and the incidence of stenosis is considerably higher. Methods: In the present study, we retrospectively reviewed our experience in 152 patients in whom 205 anastomoses were performed. Thirty-six patients received 42 telescoped anastomoses. 116 patients received 163 end-to-end anastomoses. The mean age of T recipients was 53.3±10 yrs (range 26-67yrs) and EE recipients was 41.9±15.5 yrs (range 0.3-67yrs), the difference accounted for by the higher percentage of patients with CF who received EE. Ischemic times were not significantly different between the two groups (220.2±49.4 min in T vs. 246.8±62.4 min in EE). Results: Bronchial ischemia (defined as bronchoscopic visualization of dark, necrotic mucosa overlying more than 50{\%} of the bronchial anastomosis) occurred more commonly in T than EE (31{\%} vs. 15{\%}, p=0.03). Dehiscence (defined as disruption of more than 25{\%} of the circumferential suture line observed on bronchoscopy) also occured more commonly in T than in EE (24{\%} vs. 9{\%}, p=0.01). Severe stenosis (defined as narrowing of the bronchial lumen to less than 4.9mm in diameter, the outer diameter of the bronchoscope) occurred more commonly in T than EE (31{\%} vs. 7{\%}, p<0.0001). In addition, there was a trend towards shorter mean survival in T than in EE (641±541d vs. 799±726d). Conclusions: We conclude that in single and double lung transplantation, telescoped anastomoses are associated with a higher incidence of postoperative airway complications than end-to-end anastomoses, and there may be a detrimental effect of telescoped anastomoses on long-term survival.",
author = "Garfein, {Evan S.} and Milliken, {E. E.} and McGregor, {C. C.} and Galantowicz, {M. E.} and Schulman, {L. L.}",
journal = "Chest",
publisher = "American College of Chest Physicians",
number = "4 SUPPL.",
T1 - Deleterious effects of telescoped anastomosis in single and double lung transplantation
AU - Garfein, Evan S.
AU - Milliken, E. E.
AU - McGregor, C. C.
AU - Galantowicz, M. E.
AU - Schulman, L. L.
N2 - Purpose: It has been suggested that while the telescoped (T) anastomsis may protect against fatal airway dehiscence, the overall incidence of dehiscence is not different when compared to the end-to-end (EE) anastomosis, and the incidence of stenosis is considerably higher. Methods: In the present study, we retrospectively reviewed our experience in 152 patients in whom 205 anastomoses were performed. Thirty-six patients received 42 telescoped anastomoses. 116 patients received 163 end-to-end anastomoses. The mean age of T recipients was 53.3±10 yrs (range 26-67yrs) and EE recipients was 41.9±15.5 yrs (range 0.3-67yrs), the difference accounted for by the higher percentage of patients with CF who received EE. Ischemic times were not significantly different between the two groups (220.2±49.4 min in T vs. 246.8±62.4 min in EE). Results: Bronchial ischemia (defined as bronchoscopic visualization of dark, necrotic mucosa overlying more than 50% of the bronchial anastomosis) occurred more commonly in T than EE (31% vs. 15%, p=0.03). Dehiscence (defined as disruption of more than 25% of the circumferential suture line observed on bronchoscopy) also occured more commonly in T than in EE (24% vs. 9%, p=0.01). Severe stenosis (defined as narrowing of the bronchial lumen to less than 4.9mm in diameter, the outer diameter of the bronchoscope) occurred more commonly in T than EE (31% vs. 7%, p<0.0001). In addition, there was a trend towards shorter mean survival in T than in EE (641±541d vs. 799±726d). Conclusions: We conclude that in single and double lung transplantation, telescoped anastomoses are associated with a higher incidence of postoperative airway complications than end-to-end anastomoses, and there may be a detrimental effect of telescoped anastomoses on long-term survival.
AB - Purpose: It has been suggested that while the telescoped (T) anastomsis may protect against fatal airway dehiscence, the overall incidence of dehiscence is not different when compared to the end-to-end (EE) anastomosis, and the incidence of stenosis is considerably higher. Methods: In the present study, we retrospectively reviewed our experience in 152 patients in whom 205 anastomoses were performed. Thirty-six patients received 42 telescoped anastomoses. 116 patients received 163 end-to-end anastomoses. The mean age of T recipients was 53.3±10 yrs (range 26-67yrs) and EE recipients was 41.9±15.5 yrs (range 0.3-67yrs), the difference accounted for by the higher percentage of patients with CF who received EE. Ischemic times were not significantly different between the two groups (220.2±49.4 min in T vs. 246.8±62.4 min in EE). Results: Bronchial ischemia (defined as bronchoscopic visualization of dark, necrotic mucosa overlying more than 50% of the bronchial anastomosis) occurred more commonly in T than EE (31% vs. 15%, p=0.03). Dehiscence (defined as disruption of more than 25% of the circumferential suture line observed on bronchoscopy) also occured more commonly in T than in EE (24% vs. 9%, p=0.01). Severe stenosis (defined as narrowing of the bronchial lumen to less than 4.9mm in diameter, the outer diameter of the bronchoscope) occurred more commonly in T than EE (31% vs. 7%, p<0.0001). In addition, there was a trend towards shorter mean survival in T than in EE (641±541d vs. 799±726d). Conclusions: We conclude that in single and double lung transplantation, telescoped anastomoses are associated with a higher incidence of postoperative airway complications than end-to-end anastomoses, and there may be a detrimental effect of telescoped anastomoses on long-term survival.
JO - Chest
JF - Chest
IS - 4 SUPPL.