Importance of early recognition of vascular anastomotic complications in lung transplantation

Objectives: Lung transplant recipients were reviewed to compare our early and current experience of vascular complications and their management. Since 1995 we pursued a strategy of early identification and intervention. Methods: Vascular anastomotic complications were reviewed in two cohorts - before and after 1995 - with respect to imaging modality, management and outcome in 620 lung transplant recipients. Results: In 620 recipients, 13 had arterial or venous anastomotic obstruction (2.1%), nine females, four males, age 25-55 years. Complications were identi-fied in seven single, five bilateral and one lobar transplant. Anastomoses affected were 10 pulmonary artery, 1 pulmonary vein, 1 both right and left pulmonary vein and 1 left pulmonary artery and vein. Prior to 1995, five cases were identified postoperatively by isotope perfusion scan in four cases and transoesophageal echo (TOE) in one. Mean time for identification was 9.4 days (4–14). Revision of pulmonary artery stenoses occurred in three (warm ischaemia in one and cardiopulmonary bypass/cold flush in two), and angioplasty/ stent insertion in one venous anastomosis. Two died before intervention. All died between 5-630 days (mean 143). After 1995, four cases were identified per-operatively and corrected immediately. Four cases were identified later (1-17 days) by computed tomography pulmonary angiogram. One patient was managed conservatively, and three underwent surgery within 24 hours of diagnosis (cardiopulmonary bypass/cold flush). Three patients died within 30 days with five long-term survivors (mean 59 months). Conclusions: Vascular complications after lung transplantation carry a high mortality. Early identification and intervention improves outcome. Intraoperative TOE should be used routinely to facilitate this