Nandor Marczin1, Aron-Frederik Popov2, Bartlomiej Zych2, Rosalba Romano3, Rudolf Kiss3, Anton Sabashnikov4, Simona Soresi2, Fabio De Robertis2, Toufan Bahrami2, Mohamed Amrani2, Alexander Weymann2, Grainne McDermott3, Heike Krueger2, Martin Carby2, Paras Dalal2, André Ruediger Simon2. 1. Department of Anaesthetics, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, UK Department of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK Department of Anaesthesia and Intensive Therapy, Semmelweis University, Budapest, Hungary. 2. Department of Cardiothoracic Transplantation and Mechanical Circulatory Support. Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Harefield, Middlesex, UK. 3. Department of Anaesthetics, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, Middlesex, UK Department of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. 4. Department of Cardiothoracic Transplantation and Mechanical Circulatory Support. Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, Harefield, Middlesex, UK a.sabashnikov@gmail.com.
Abstract
OBJECTIVES: Minimally invasive lung transplantation (MILT) via bilateral anterior thoracotomies has emerged as a novel surgical strategy with potential patient benefits when compared with transverse thoracosternotomy (clamshell incision, CS). The aim of this study is to compare MILT with CS by focusing on operative characteristics, postoperative organ function and support and mid-term clinical outcomes at Harefield Hospital. METHODS: It was a retrospective observational study evaluating all bilateral sequential lung transplants between April 2010 and November 2013. RESULTS: CS was performed in 124 patients and MILT in 70 patients. Skin-to-skin surgical time was less in the MILT group [285 (265, 339) min] compared with CS [380 (306, 565) min] and MILT-cardiopulmonary bypass [426 (360, 478) min]. Ischaemic time was significantly longer (502 ± 116 vs 395 ± 145 min) in the MILT group compared with CS (P < 0.01). Early postoperative physiological variables were similar between groups. Patients in the MILT group required less blood [2 (0, 4) vs 3 (1, 5) units, P = 0.16] and platelet transfusion [0 (0, 1) vs 1 (0, 2) units, P < 0.01]. The median duration of mechanical ventilation was shorter (26 vs 44 h, P < 0.01) and intensive therapy unit stay was 2 days shorter (5 vs 7) in the MILT group. While overall survival was similar, fraction of expired volume in 1 s (FEV1) and forced vital capacity (FVC) were consistently higher in the MILT group compared with CS during mid-term follow-up after transplantation. Specifically, FEV1 and FVC were, respectively, 86 ± 21 and 88 ± 18% predicted in the MILT group compared with 74 ± 21 and 74 ± 19% predicted in the CS group (P < 0.01) at the 6-month follow-up. CONCLUSIONS: MILT was successfully introduced at our centre as a novel operative strategy. Despite longer ischaemic times and a more complex operation and management, MILT appears to offer early postoperative and mid-term clinical benefits compared with our traditional approach of clamshell operations. These observations warrant larger definite studies to further evaluate the impact of MILT on physiological, clinical and patient-reported outcomes.
OBJECTIVES: Minimally invasive lung transplantation (MILT) via bilateral anterior thoracotomies has emerged as a novel surgical strategy with potential patient benefits when compared with transverse thoracosternotomy (clamshell incision, CS). The aim of this study is to compare MILT with CS by focusing on operative characteristics, postoperative organ function and support and mid-term clinical outcomes at Harefield Hospital. METHODS: It was a retrospective observational study evaluating all bilateral sequential lung transplants between April 2010 and November 2013. RESULTS:CS was performed in 124 patients and MILT in 70 patients. Skin-to-skin surgical time was less in the MILT group [285 (265, 339) min] compared with CS [380 (306, 565) min] and MILT-cardiopulmonary bypass [426 (360, 478) min]. Ischaemic time was significantly longer (502 ± 116 vs 395 ± 145 min) in the MILT group compared with CS (P < 0.01). Early postoperative physiological variables were similar between groups. Patients in the MILT group required less blood [2 (0, 4) vs 3 (1, 5) units, P = 0.16] and platelet transfusion [0 (0, 1) vs 1 (0, 2) units, P < 0.01]. The median duration of mechanical ventilation was shorter (26 vs 44 h, P < 0.01) and intensive therapy unit stay was 2 days shorter (5 vs 7) in the MILT group. While overall survival was similar, fraction of expired volume in 1 s (FEV1) and forced vital capacity (FVC) were consistently higher in the MILT group compared with CS during mid-term follow-up after transplantation. Specifically, FEV1 and FVC were, respectively, 86 ± 21 and 88 ± 18% predicted in the MILT group compared with 74 ± 21 and 74 ± 19% predicted in the CS group (P < 0.01) at the 6-month follow-up. CONCLUSIONS: MILT was successfully introduced at our centre as a novel operative strategy. Despite longer ischaemic times and a more complex operation and management, MILT appears to offer early postoperative and mid-term clinical benefits compared with our traditional approach of clamshell operations. These observations warrant larger definite studies to further evaluate the impact of MILT on physiological, clinical and patient-reported outcomes.
Authors: S Fischer; M Strüber; A R Simon; M Anssar; M Wilhelmi; R G Leyh; W Harringer; A Haverich Journal: J Thorac Cardiovasc Surg Date: 2001-12 Impact factor: 5.209
Authors: Hartmuth Bruno Bittner; Sven Lehmann; Christian Binner; Jens Garbade; Markus Barten; Friedrich Wilhelm Mohr Journal: Innovations (Phila) Date: 2011-03
Authors: Jason D Christie; Leah B Edwards; Anna Y Kucheryavaya; Christian Benden; Fabienne Dobbels; Richard Kirk; Axel O Rahmel; Josef Stehlik; Marshall I Hertz Journal: J Heart Lung Transplant Date: 2011-10 Impact factor: 10.247
Authors: Jason D Christie; Martin Carby; Remzi Bag; Paul Corris; Marshall Hertz; David Weill Journal: J Heart Lung Transplant Date: 2005-06-04 Impact factor: 10.247
Authors: Pierre-Hugues Stefanuto; Rosalba Romano; Christiaan A Rees; Mavra Nasir; Louit Thakuria; Andre Simon; Anna K Reed; Nandor Marczin; Jane E Hill Journal: Sci Rep Date: 2022-02-08 Impact factor: 4.379