Julien Guinde1, Jeremy Bismuth2, Sophie Laroumagne1, Benjamin Coiffard2, Philippe Astoul1, Pascal Alexandre Thomas3, Martine Reynaud-Gaubert2, Hervé Dutau1. 1. Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, North Hospital of Marseille, Aix-Marseille University, Marseille, France. 2. Department of Respiratory Medicine and Lung Transplantation, North Hospital of Marseille, Aix Marseille University, Marseille, France. 3. Departement of Thoracic Surgery, North Hospital of Marseille, Aix-Marseille University, Marseille, France.
Abstract
BACKGROUND: In lung transplantation (LT), the actual surgical practice is to cut the donor bronchus as short as possible in order to reduce anastomotic complications (AC). Consequently, the anastomosis is very close to the secondary carina. If AC occur, regular straight stents may be unsatisfactory and on-site modified bifurcated stents may represent an alternative. OBJECTIVES: This retrospective study sought to assess the short- and long-term outcomes of patients treated with customized bifurcated stent (CBS) for the management of AC following LT. METHODS: Data from patients with AC following LT requiring CBS placement between June 2010 and June 2020 were analyzed. RESULTS: Four hundred patients underwent lung transplant. AC requiring airway stenting occurred in 32 patients (8%), and CBS were inserted in 15 patients (3.5%). Indications were stenosis (n = 12; 80%) and bronchial dehiscence (n = 3; 20%). CBS were successfully deployed in 14 patients and failed in 1 patient. No migration was recorded during the follow-up. The median number of complication was 1 per patient (0-5). CBS could be removed in 11 patients (78.6%), and 3 died with their stents in place. AC recurrence or complications requiring new stenting occurred in 4/11 patients (36.3%), with a median time of 7 days (0-29). Seven patients (63.7%) had no AC recurrence, with a median follow-up of 925 days (118-3,249). CONCLUSIONS: The actual surgical anastomotic technique in LT provides new endoscopic challenges. CBS seem ideally positioned to address these difficulties safely and effectively but are associated with stent related complications requiring further endoscopic management.
BACKGROUND: In lung transplantation (LT), the actual surgical practice is to cut the donor bronchus as short as possible in order to reduce anastomotic complications (AC). Consequently, the anastomosis is very close to the secondary carina. If AC occur, regular straight stents may be unsatisfactory and on-site modified bifurcated stents may represent an alternative. OBJECTIVES: This retrospective study sought to assess the short- and long-term outcomes of patients treated with customized bifurcated stent (CBS) for the management of AC following LT. METHODS: Data from patients with AC following LT requiring CBS placement between June 2010 and June 2020 were analyzed. RESULTS: Four hundred patients underwent lung transplant. AC requiring airway stenting occurred in 32 patients (8%), and CBS were inserted in 15 patients (3.5%). Indications were stenosis (n = 12; 80%) and bronchial dehiscence (n = 3; 20%). CBS were successfully deployed in 14 patients and failed in 1 patient. No migration was recorded during the follow-up. The median number of complication was 1 per patient (0-5). CBS could be removed in 11 patients (78.6%), and 3 died with their stents in place. AC recurrence or complications requiring new stenting occurred in 4/11 patients (36.3%), with a median time of 7 days (0-29). Seven patients (63.7%) had no AC recurrence, with a median follow-up of 925 days (118-3,249). CONCLUSIONS: The actual surgical anastomotic technique in LT provides new endoscopic challenges. CBS seem ideally positioned to address these difficulties safely and effectively but are associated with stent related complications requiring further endoscopic management.