Meticulous closure of collateral vessels in the perihilar mediastinal pleura to control intraoperative bleeding during lung transplantation for pulmonary hypertension

Haruchika Yamamoto; Seiichiro Sugimoto; Kentaro Imanishi; Kohei Hashimoto; Kentaroh Miyoshi; Shinji Otani; Masaomi Yamane; Shinichi Toyooka

doi:10.21037/jtd-21-1119

Meticulous closure of collateral vessels in the perihilar mediastinal pleura to control intraoperative bleeding during lung transplantation for pulmonary hypertension

J Thorac Dis. 2021 Oct;13(10):5658-5669. doi: 10.21037/jtd-21-1119.

Authors

Haruchika Yamamoto¹, Seiichiro Sugimoto¹, Kentaro Imanishi¹, Kohei Hashimoto¹, Kentaroh Miyoshi¹, Shinji Otani¹, Masaomi Yamane¹, Shinichi Toyooka¹

Affiliation

¹ Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Okayama, Japan.

Abstract

Background: Massive blood transfusion compensating hemorrhage during lung transplantation (LT) results in primary graft dysfunction (PGD) and worse outcomes after LT. Collateral vessels in the perihilar mediastinal pleura could be the source of hemorrhage during LT in patients with pulmonary hypertension (PH). The purpose of this study was to examine the effect of closure with hemoclips of the vessels in the perihilar mediastinal pleura on the risk of intraoperative hemorrhage and outcomes after LT in patients with PH.

Methods: We retrospectively reviewed 80 patients who underwent LT, including 13 patients with primary PH, 29 patients with secondary PH, and 38 patients with non-PH.

Results: The median number of hemoclips was significantly higher in the primary PH group than in the non-PH group (P=0.0045) or secondary PH group (P=0.0060). The intraoperative blood loss, transfusion volume, maximum PGD grade, and the 30-day and 90-day mortality rates in the primary PH group were equivalent to those in the other two groups.

Conclusions: Meticulous closure of collateral vessels in the perihilar mediastinal pleura during LT in patients with primary PH allowed intraoperative hemorrhage to be controlled and might be associated with acceptable mortality rate in these patients similar to that of LT in patients with other diseases.

Keywords: Lung transplantation (LT); bleeding; collateral vessel; mortality; pulmonary hypertension (PH).