Tracheobronchial healing after lung and heart-lung transplantation. A critical review of 64 anastomoses. The Joint Marseille-Montréal Lung Transplant Program.

The authors report on an analysis concerning the healing of tracheobronchial anastomoses after lung and heart-lung transplantation. The present study includes 64 anastomoses selected from a total of 80. Sixteen were excluded because of early postoperative death; none of these deaths was related to an airway complication. Bronchial healing was assessed with bronchoscopic follow-up; the aspect of the suture line was classified according to the grades of Couraud. The initial reference was the examination at 2 weeks postoperatively, which was compared to subsequent follow-ups. At the initial assessment, 42 anastomoses were grade I, 4 were grade II, and 18 were grade III. The subsequent anatomic result was satisfactory for 52 sutures (81%). The complications observed in the remaining patients were malacia in 2, stenosis treated with a stenting device in 4 and dehiscence in 6. The duration of ischemia and postoperative mechanical respiratory support, as well as the proximal or distal location of the anastomosis appeared to be of significant prognostic value.