Effect of Surgical Exposure on Short-Term Outcomes after Bilateral Lung Transplantation

PurposeTo clarify the effect of surgical exposure on outcome after lung transplantation (LTx), we analyzed the international multicenter ECLS in LTx registry.MethodsThe ECLS registry collects data from 7 US and 2 European centers. We analyzed adult LTx performed between 01/2016 and 09/2021 and formed three groups according to surgical access (Clamshell Group; Sternotomy Group; Thoracotomy Group). Categorical and continuous variables were reported as % and mean value and compared between groups with the Chi 2 Test and the Kruskal-Wallis Test, respectively. Patients with re- and multiorgan transplantation and missing data were excluded.ResultsOf the 1004 included patients out of 1,171 (85.7%), 447 (45%) patients were transplanted with a clamshell access, 84 (8%) patients with a median sternotomy, and 473 (47%) patients with bilateral thoracotomies. Intra-operative use of ECLS (61%, 99%, 30%, p<0.001), total ischemic time for right (321, 284, 340 min., p<0.001) and left lung (349, 279, 457 min., p<0.001), and skin-to-skin time (398, 349, 333 min., p<0.001) significantly differed between the clamshell, sternotomy and thoracotomy groups, respectively. Post-transplant need for tracheostomy (24%, 14%, 12%, p<0.001), re-intubation (21%, 25%, 14%, p=0.004), take back for bleeding (8%, 17%, 8%, p=0.019), the prevalence of pneumonia (12%, 35%, 18 %, p<0.001) and of limb complications (1%, 4%, 6 %, p<0.001) and the length of stay (22, 19, 23 days, p<0.001) significantly differed between groups. In-hospital mortality (p=0.089) and at 1 year (p=0.40) did not differ between groups. Figure 1 reports the results of the adjusted multivariate logistic regression analysis for each surgical approach.ConclusionIn the ECLS registry, the choice of surgical access did not adversely affect survival. Each exposure was associated with a unique complication profile. Each of these profiles should be considered along with the recipient's unique anatomy and intraoperative support requirements when deciding on the operative approach. To clarify the effect of surgical exposure on outcome after lung transplantation (LTx), we analyzed the international multicenter ECLS in LTx registry. The ECLS registry collects data from 7 US and 2 European centers. We analyzed adult LTx performed between 01/2016 and 09/2021 and formed three groups according to surgical access (Clamshell Group; Sternotomy Group; Thoracotomy Group). Categorical and continuous variables were reported as % and mean value and compared between groups with the Chi 2 Test and the Kruskal-Wallis Test, respectively. Patients with re- and multiorgan transplantation and missing data were excluded. Of the 1004 included patients out of 1,171 (85.7%), 447 (45%) patients were transplanted with a clamshell access, 84 (8%) patients with a median sternotomy, and 473 (47%) patients with bilateral thoracotomies. Intra-operative use of ECLS (61%, 99%, 30%, p<0.001), total ischemic time for right (321, 284, 340 min., p<0.001) and left lung (349, 279, 457 min., p<0.001), and skin-to-skin time (398, 349, 333 min., p<0.001) significantly differed between the clamshell, sternotomy and thoracotomy groups, respectively. Post-transplant need for tracheostomy (24%, 14%, 12%, p<0.001), re-intubation (21%, 25%, 14%, p=0.004), take back for bleeding (8%, 17%, 8%, p=0.019), the prevalence of pneumonia (12%, 35%, 18 %, p<0.001) and of limb complications (1%, 4%, 6 %, p<0.001) and the length of stay (22, 19, 23 days, p<0.001) significantly differed between groups. In-hospital mortality (p=0.089) and at 1 year (p=0.40) did not differ between groups. Figure 1 reports the results of the adjusted multivariate logistic regression analysis for each surgical approach. In the ECLS registry, the choice of surgical access did not adversely affect survival. Each exposure was associated with a unique complication profile. Each of these profiles should be considered along with the recipient's unique anatomy and intraoperative support requirements when deciding on the operative approach.