Deleterious effects of telescoped anastomosis in single and double lung transplantation

Purpose: It has been suggested that while the telescoped (T) anastomsis may protect against fatal airway dehiscence, the overall incidence of dehiscence is not different when compared to the end-to-end (EE) anastomosis, and the incidence of stenosis is considerably higher. Methods: In the present study, we retrospectively reviewed our experience in 152 patients in whom 205 anastomoses were performed. Thirty-six patients received 42 telescoped anastomoses. 116 patients received 163 end-to-end anastomoses. The mean age of T recipients was 53.3±10 yrs (range 26-67yrs) and EE recipients was 41.9±15.5 yrs (range 0.3-67yrs), the difference accounted for by the higher percentage of patients with CF who received EE. Ischemic times were not significantly different between the two groups (220.2±49.4 min in T vs. 246.8±62.4 min in EE). Results: Bronchial ischemia (defined as bronchoscopic visualization of dark, necrotic mucosa overlying more than 50% of the bronchial anastomosis) occurred more commonly in T than EE (31% vs. 15%, p=0.03). Dehiscence (defined as disruption of more than 25% of the circumferential suture line observed on bronchoscopy) also occured more commonly in T than in EE (24% vs. 9%, p=0.01). Severe stenosis (defined as narrowing of the bronchial lumen to less than 4.9mm in diameter, the outer diameter of the bronchoscope) occurred more commonly in T than EE (31% vs. 7%, p<0.0001). In addition, there was a trend towards shorter mean survival in T than in EE (641±541d vs. 799±726d). Conclusions: We conclude that in single and double lung transplantation, telescoped anastomoses are associated with a higher incidence of postoperative airway complications than end-to-end anastomoses, and there may be a detrimental effect of telescoped anastomoses on long-term survival.