Various Anastomotic Techniques for Size Mismatch in Pulmonary Artery during Lung Implantation

Purpose In lung transplantation, pulmonary anastomosis sometimes requires adjustment for size mismatch between donor and recipient pulmonary arteries (PAs). It is particulary important in living-donor lobar lung transplantation (LDLLT) in which a donor lobar PA is anastomosed to a recipient main PA. Even in cadaveric lung transplantation (CLT), PA plasty may be needed for patients with pulmonary hypertension.We retrospectively reviewed our surgical techniques of PA plasty during lung implantation. Methods Between 2002 and 2017, we performed 183 lung transplants including 84 LDLLTs and 99 CLTs. PA plasty was required in 15 cases (8.2%) during implantation. We retrospectively evaluated surgical techniques and outcomes of these 15 patients. Results In LDLLT, 13 patients underwent PA plasty, and 2 underwent PA plasty in CLT. Direct plication was used in 4 cases (3 in LDLLT and 1 in CLT, Fig. 1A). Tack suture method was used in 6 cases (all LDLLT, Fig. 1B). Auto-pericardial patching method was used in 9 cases (all LDLLT, Fig. 1C, all on the left side). Linear stapler was used in 1 case (CLT, Fig. 1D). After transplantation, 1 recipient of the tack suture method group developed left PA kinking, requiring a stent insertion on postoperative day 1. The remaining 14 recipients developed no complications. There were no PA anastomosis-related deaths. The 5-year survival rate was similar between the non-PA plasty group and the PA plasty group (73.9% vs 68.5%, p=0.889: Fig. 2). Conclusion Various surgical techniques for size mismatch in PA were useful and safe both in LDLLT and CLT.