Initial experience with two sequential anterolateral thoracotomies for bilateral lung transplantation

Background. Bilateral transsternal thoracotomy (clamshell incision) is the standard approach used for bilateral sequential lung transplantation (BLTX). The morbidity of this large incision can be considerable. Two separate sequential anterolateral thoracotomies represent a less invasive approach. Methods. The value of this approach was investigated in a prospective series of 13 consecutive patients with the underlying diagnosis of COPD or cystic fibrosis (group A). Results were compared to 8 consecutive patients with similar indications who had undergone BLTX via clamshell incision during the last year prior to this new technique (group B). Results. No intraoperative complications occurred in either group. The difference between the cold ischemic time of the 1st and 2nd transplanted lung was comparable between the 2 groups (81 min±17 min in group A vs 79 min ±14 min in group B, p = 0.783). Postoperative restriction was significantly less in the group operated through 2 separate thoracotomies, as proven by the vital capacity in the first spirometry performed during the 3rd postoperative week (VC group A 55%±16% predicted vs 41%±11 % predicted in group B; p= 0.043). Conclusion. The bilateral sequential anterolateral thoracotomy represents a safe and less invasive approach for BLTX in patients with large chest volumes. It minimizes the operative trauma, improves postoperative functional recovery and prevents the potential spread of unilateral complications to the other pleural cavity.