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Fig. 12.4. The pulmonary artery anastomosis is performed with running 5-0 prolene suture. In the example depicted, the recipient pulmonary artery has been divided distal to the first branch to the right upper lobe. If a larger donor artery requires a larger recipient vessel, the recipient artery can be divided centrally to improve size matching.

Fig. 12.4. The pulmonary artery anastomosis is performed with running 5-0 prolene suture. In the example depicted, the recipient pulmonary artery has been divided distal to the first branch to the right upper lobe. If a larger donor artery requires a larger recipient vessel, the recipient artery can be divided centrally to improve size matching.

The left atrial anastomosis is performed last. Lateral traction on the pulmonary vein stumps facilitates application of a Satinsky clamp centrally on the recipient left atrium. A large recipient atrial cuff is created by amputating the pulmonary vein stumps and excising the bridge of tissue between the two stumps (Fig. 12.5). The anastomosis is then created using a continuous 4-0 polypropylene suture, which is also interrupted, at two sites around the anastomosis (Fig. 12.5). Following completion of this anastomosis, but before tightening and tying the final stitch, the lung is gently inflated while the pulmonary artery clamp is temporarily removed, enabling the lung to be de-aired through the open left atrial anastomosis. All suture lines are then secured and the vascular clamps removed. Before restoring perfusion of the graft, 500-1000 mg of methylprednisolone is administered. Two pleural drains are inserted into the pleural space, and a standard closure is performed. Finally, the double lumen endotracheal tube is exchanged for a regular single lumen tube. Fiberoptic bronchoscopy is then performed to inspect the bronchial anastomosis, and to evacuate the airway of any blood and secretions.

Bilateral lung transplantation is performed utilizing bilateral anterior thorac-otomies without sternotomy. The anastomoses for the second allograft are constructed in the same way as for the first allograft.

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