Tracheobronchial healing after lung and heart-lung transplantation A critical review of 64 anastomoses

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Abstract
The authors report on an analysis concerning the healing of tracheobronchial anastomoses after lung and heart-lung transplantation. Thepresent study includes 64 anastomoses selected from a total of 80. Sixteenwere excluded because of early postoperative death; none of these deathswas related to an airway complication. Bronchial healing was assessed withbronchoscopic follow-up; the aspect of the suture line was classifiedaccording to the grades of Couraud. The initial reference was theexamination at 2 weeks postoperatively, which was compared to subsequentfollow-ups. At the initial assessment, 42 anastomoses were grade I, 4 weregrade II, and 18 were grade III. The subsequent anatomic result wassatisfactory for 52 sutures (81%). The complications observed in theremaining patients were malacia in 2, stenosis treated with a stentingdevice in 4 and dehiscence in 6. The duration of ischemia and postoperativemechanical respiratory support, as well as the proximal or distal locationof the anastomosis appeared to be of significant prognostic value.