The Journal of Thoracic and Cardiovascular Surgery, Vol 98, 343-349, Copyright © 1989 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Heart and unilateral lung transplantation in patients with end-stage cardiopulmonary disease and previous thoracic operations
A Kawaguchi, I Gandjbakhch, A Pavie, V Bors, P Leger, A Cabrol, M Eugene, A Delcourt and C Cabrol
Department of Thoracic and Cardiovascular Surgery, Hopital de la Pitie, Paris, France.
Orthotopic en bloc transplantation of the heart and one lung has been done
in two patients with end-stage cardiopulmonary disease and a prior thoracic
operation. The first patient had undergone right pulmonary
thromboembolectomy with caval ligation 5 years earlier, and the second had
had left lower lobectomy for bronchiectasis 15 years before the heart and
contralateral lung transplantation. Surgical procedures followed the
techniques that had been developed in animals. Transplantation of the
unoperated contralateral lung made it possible to avoid dissection in the
obliterated pleural space and to minimize bleeding, which simplified the
procedure considerably. Dramatic reduction in pulmonary artery pressure and
improved respiratory function allowed both patients to be weaned from
cardiopulmonary bypass without problems. Although the first patient died of
liver and renal failure soon after the operation, an intact cough reflex
facilitated recovery in the second patient, who has been discharged with
essentially normal respiratory function. This report describes heart and
unilateral lung transplantation as a procedure of choice for patients with
extensive pleural adhesions that made total cardiopulmonary replacement
unfeasible.
