Incision and Approach

SLT is accomplished through either a fifth intercostal space posterolateral thoracotomy or a muscle sparing incision as proposed by Pochettino.25 Alternatively, in patients with Eisenmenger's syndrome, a median sternotomy can be utilized to accomplish simultaneous cardiac repair along with right single lung transplantation or heart-lung transplant. When the thoracotomy approach is used, the ipsi-lateral groin is always prepped and draped within the field, so that femoral cannulation can be performed if necessary. Bilateral lung transplantation was initially performed through a median sternotomy and later by a bilateral transverse thoracosternotomy incision ("clam shell" approach, shown in Fig. 12.1A and B)

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