We are dedicated to conducting research on lung transplantation, which demands challenges by the scarcity of donors. In order to enhance the quality and the utilization of donor lungs, we employ the novel surgical techniques for reconstructing the commonly injured left atrial cuff. Cuff reconstruction requires the availability of page material.
Excess donor pericardial tissue is most commonly used, although excess atrial tissue can also be utilized. We described in detail a novel surgical technique for the repairing left atrial cuff defect by rotating the posterior atrial flab during lung transplantation. The key aspect of this new technique is retention of the intact posterior atrial wall of the donor lung.
By pruning the excess posterior atrial wall, it forms an actual flab, and the rotating of the atrial flab provides a page for the repair of the defective anterior wall. Compared to the other techniques, this new method can repair the anterior wall defect in vivo by using the excess left atrial tissue of the donor. The operation is more convenient, and the anastomosis time is effective reduce along with the cold ischemia time.
The posterior atrial flab rotating left atrial cuff repair technique provides a feasible strategy for the repair of left atrial cuff defects, and improves the effective utilization rate of the donor lung. To begin, position the patient horizontally with the back slightly elevated and hands spread horizontally in a cross position and securely fixed. Then, disinfect the patient's skin near the surgical area.
After removing the recipient's diseased lungs, treat the vascular and trachea residuals prior to anastomosis. Then, prepare the donor for lung extraction. Divide the posterior atrial wall of the donor lung, ensuring that the excess posterior atrial wall is included on the side with the anterior wall defect.
Sever the left and right pulmonary arteries at their junction. Free the left main bronchus, and sever it before separating the left and right donor lungs. Place the left donor lung in an organ preservation solution at four degrees Celsius.
Free the pulmonary artery and atrial cuff fully. Trim the right donor lung, ensuring the main bronchus has two to three cartilage rings. For the anastomosis of the primary bronchus and pulmonary artery, place the repaired right donor lung into the right chest.
Suture the bronchial membrane with a 4-0 polydioxanone suture line, and then the bronchial cartilage with a 4-0 poly line. Use a bronchoscope to confirm that the airway is clear and open after the bronchial anastomosis is completed. Then, suture the soft tissue around the bronchial anastomosis with 4-0 poly line.
Anastomose the pulmonary artery using a 5-0 poly line continuous suture. After preparing the recipient, clamp the left atrium at the proximal end of the intersection of the upper and lower pulmonary veins. Cut the excess posterior wall of the donor atrial cuff from the bottom upward by comparing the distance between the posterior atrial edge of the donor and recipient.
Trim the excess posterior wall to form an atrial flap connected to the upper edge of the donor atrial cuff by the pedicle. Using a continuous 4-0 PROLENE suture, anastomose the posterior edges of the atrial cuffs from the bottom to the top. Continue suturing upon reaching the posterior atrial flap to anastomose the edge of the flap near the lung with the anterior atrial edge of the recipient.
Ensure that the suture ends meet at the lower edge of the anastomosis and tie them off. Anastomose the other edge of the atrial flap and the anterior atrial edge of the donor from top to bottom with a 4-0 PROLENE line continuous suture. Leave the last two needles untightened to serve as exhaust holes.
Temporarily release the pulmonary artery-blocking forceps, allowing the blood to flow out from the exhaust hole of the atrial anastomosis. Clamp the pulmonary artery with blocking forceps, loosen and remove the atrial forceps, and then tighten the PROLENE suture of the atrial sleeve anastomosis after fully exhausting the air. Release and remove the pulmonary artery-blocking forceps to allow full blood flow.
Verify that the anterior wall of the anastomosis is wide and well-filled with no bleeding manifestations. After bilateral chest closure, monitor and record the flow rate of the bilateral pulmonary veins using an esophageal ultrasound. Postoperative pulmonary artery systolic blood pressure was significantly lower than preoperative values in all three groups.
No significant differences in pulmonary systolic blood pressure were found between the three surgical groups postoperatively. The pulmonary vein flow velocities showed no significant differences between the three groups of posterior atrial flap, aortic patch, and pericardial patch. Right atrial cuff anastomosis time was significantly shorter for the posterior atrial flap group compared to the aortic patch and pericardial patch groups.
No significant difference was observed in the left atrial cuff anastomosis time across the three groups.
