Bilateral lobar lung transplantation and size mismatch by pTLC-ratio.

tionale for our recently proposed technique [1]. When many different procedures are described for the treatment of the same disease, it is clear that the ideal technique has not been identified yet. In our opinion, the method devised by Actis Dato et al. [2] has a valid theoretical basis and has, in their hands, proved to be safe and effective. Furthermore, the authors have such a considerable experience in this field that their opinion has to be taken into the utmost consideration by the scientific community. In conceiving our technique, we aimed to avoid some drawbacks associated with the use of metallic retrosternal bars while trying to maintain similar long-term results. In fact, a transverse posterior bar limits the thoracic compliance, causes exposures to serious damage in the case of trauma, can be painful and requires a second operation for removal. We think that such disadvantages may justify the research on novel methods. The use of new titanium plates specifically built for sternal stabilization avoids the need for a posterior support, while ensuring the same solidity of the reconstructed sternum. These results can be achieved thanks to the highest strength-to-weight ratio of titanium: the Synthes struts (Synthes, Canada Ltd.) modelled on the anatomical sternal shape are so thin and light that their removal is not required. As correctly noted by Actis Dato et al., the procedure is relatively expensive [3]. This disadvantage is undoubtedly more than offset by the avoidance of a second surgery for the bar removal. Finally, the economic impact of the procedure is limited, as it is indicated in a carefully selected group of patients, with a condition difficult to correct such as the severe asymmetric pectus excavatum.