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J Thorac Cardiovasc Surg 1997;114:326-331
© 1997 Mosby, Inc.

CARDIAC AND PULMONARY REPLACEMENT

MEDIUM-TERM PATENCY AND ANATOMIC CHANGES AFTER DIRECT BRONCHIAL ARTERY REVASCULARIZATION IN LUNG AND HEART-LUNG TRANSPLANTATION WITH THE INTERNAL THORACIC ARTERY CONDUIT

Received for publication Jan. 20, 1997; revisions requested March 17, 1997; revisions received April 14, 1997; accepted for publication April 28, 1997. Address for reprints: Martin A. Nørgaard MD, Department of Cardiothoracic Surgery, RT, 2152, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.

Abstract

Objective: Our purpose was to study the 2-year patency of direct bronchial artery revascularization in lung transplantation. We wanted to clarify whether the revascularized bronchial artery system is functional after 2 years, whether bronchial artery vascularity changes with time, and whether posttransplantation bronchial artery disease is arteriographically evident after 2 years. Methods: Bronchial artery revascularization is performed by anastomosing the internal thoracic artery to as many bronchial artery orifices in the donor descending aorta as possible. Twenty-three patients surviving 2 years or more have had internal thoracic artery-bronchial arteriography performed 1 month and 2 years after transplantation. One-month and 2-year arteriograms have been compared. Results: Two-year patency of the internal thoracic artery conduit was 100%. The appearance of the bronchial arteries was unchanged after 2 years in 11 patients. A unilateral or bilateral increase in vascularity was found in two and seven patients, respectively. In three patients new vessels, not visible on the first arteriogram, had appeared. In four patients one or more small vessels visible on the first arteriogram had disappeared on the second arteriogram. We have found no arteriographic signs of bronchial artery disease, such as stenosis of the bronchial arteries, and no arteriographic evidence of arteriosclerotic disease in the internal thoracic artery. Conclusion: The internal thoracic artery is an excellent conduit for bronchial artery revascularization, with a 2-year patency of 100% in 23 patients. Only minor changes in the bronchial arteriograms have been found.

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