Secondary lung transplantation for bronchial anastomosis dehiscence in one patient
Objective To investigate the outcome and safety of secondary lung transplantation for bronchial anastomosis dehiscence after lung transplantation in one patient.Methods A male 66-year-old patient with bronchoalveolar cell carcinoma was performed sequential allograft orthotopic double lung transplantation in the First Affiliated Hospital of Zhengzhou University on May 21,2023,and was recovered and discharged 2 weeks after operation.On June 14,2023,he developed suddenly chest pain,chest distress,dyspnea,decreased blood pressure and consciousness disorder during hospitalization review,and was transferred to ICU after tracheal intubation and other rescue treatment.Four hours later,he was found right tension pneumothorax burst,and emergency closed thoracic drainage was given to drain a large amount of gas.CT examination and tracheoscopy confirmed the right bronchial anastomosis dehiscence.The multidisciplinary consultation suggested the medical treatment and interventional treatment were ineffective.After his family members agreed,he was enrolled in the lung transplant waiting system for secondary lung transplantation.On June 21,2023,allogeneic orthotopic right lung transplantation was performed under general anesthesia assisted by veno-arterial extracorporeal membrane oxygenation.The procedures of the scondary lung transplantation and the postoperative recovery were recorded.Results The operation lasted for 230 min,with the bronchial anastomosis and embedding time of 45 min,arterial anastomosis time of 18 min,left atrial sleeve anastomosis time of 12 min,intraoperative blood loss of 400 mL,and cold ischemia time of 315 min.Veno-arterial extracorporeal membrane oxygenation was withdrawn on postoperative day 1,the mechanical ventilation was weaned on postoperative day 2,and high-flow oxygen was continuously given.The patient was transferred to the regular ward on postoperative day 11,and was discharged on postoperative day 38.No postoperative complications occurred.The chest CT scan 2 and 3 months after operation showed good lung expansion.He was followed up till May,2024,and had kept recovering.Conclusion The secondary lung transplantation is effective and safe for bronchial anastomosis dehiscence after lung transplantation.
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