| Abstract
| - During heart-lung or double lung transplantation, the airway anastomosisis usually made at the tracheal level. Healing of this anastomosis is onesource of postoperative complications especially after double lungtransplantation (DLT). In this series of 10 patients with cystic fibrosisundergoing DLT, the tracheas of donor and recipient were anastomosed withomental wrapping in 2 cases while the two main stem bronchi were joinedwithout omental wrapping in 8. Endoscopy disclosed no sign of ischaemia inthe patients with bilateral bronchial anastomoses. Three patients died onday 20, 21 and 35, respectively, after DLT. Two of these patients (one witha tracheal and the other with bronchial anastomoses) showed no complicationat the level of the suture line. The third patient (with bronchial suture)suffered dehiscence of both anastomoses which was attributed to a misdosageof corticosteroids. Of the 6 patients alive after bronchial anastomosis, 3recovered uneventfully and 3 who had required prolonged postoperativemechanical ventilation developed bronchomalacia. Bronchomalacia was treatedby laser resection and stenting. Dehiscence did not occur in any of thesesix cases. This technique was based on the findings of 12 fresh cadaverdissections showing that collaterals between the bronchial arteries and thepulmonary arteries and veins extend up to the origin of the main stembronchus. Bronchial suture without omental wrap may be used for double lungand heart-lung transplantation instead of tracheal suture.
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