Bilateral sequential lung transplantation without sternal division.

OBJECTIVES The 'clamshell incision' is considered the standard approach for bilateral sequential lung transplantation (BSLT); however, a considerable morbidity may be related to this incision. The bilateral anterolateral thoracotomy without sternal division is an alternative approach that may contribute to avoid chest wall complications. METHODS We have employed this approach in a prospective series of 34 patients undergoing bilateral transplantation (Group I). The results were retrospectively compared with an historical control group of 37 patients (Group II) undergoing transplantation through the clamshell incision. RESULTS The operative time in Groups I and II were 228+/-32 and 293+/-37 min, respectively; the difference between the ischemic time of the first and second lungs were 68+/-20 and 73+/-15 min. Intensive care unit stay was 5+/-6 vs. 13+/-10 days and length of hospitalization was 25+/-16 vs. 32+/-10 days. Vital capacity measured 3 weeks after the transplant was significantly higher in Group I (65+/-13 vs. 45+/-8% predicted) as well as FEV(1) (71+/-8 vs. 58+/-7% predicted). No wound related complication was observed in Group I; in Group II, there were 17 chest wall complications: sternal osteomyelitis in three patients (surgical debridement and closure with a muscle flap), migration of the Kirshner wire in three (removal of the wire), sternal override in three (surgical correction) and prolonged pain in eight. CONCLUSIONS The bilateral anterolateral thoracotomy without sternal splitting is a safe and effective approach for BSLT; it allows to avoid sternal complications and contributes to improve respiratory function in the early postoperative period.