Summary
Large animal models are essential to pre-clinical trials of pulmonary transplantation and bronchial anastomosis poses a great technical challenge to the procedure. Presented here is a simplified continuous two-stitch suture technique into bronchial anastomosis during the course of left single lung transplantation in canine. Animals were divided into three groups with each group having 6 animals. Left single lung transplantation in canine was performed to assess the feasibility of using this technique for bronchial anastomosis. In the control groups, all anastomoses were done by using traditional technique. Allograft functions and hemodynamic parameters were monitored during a 3-h reperfusion period. Quality of bronchial healing and airway complications were assessed by bronchoscopic surveillance after transplantation. We successfully completed left lung transplantation in 18 dogs, and all the dogs survived the procedures. The new technique substantially simplified the procedures for bronchial anastomosis and greatly reduced the time for bronchial anastomosis (P<<0.01) and the ischemic time of the grafts (P<0.05) compared to the control group. The continuous two-stitch suture attenuated the tissue injury to allografts and led to better blood gas exchange function as compared to the control group (P<0.05). Good bronchial healing (Grade I) was observed in all the groups. A canine left single lung transplantation model is feasible by using the novel suture technique, and the new technique is as safe as the traditional method. The technique is easy to learn, particularly for less experienced operators. Simpler and time-saving, the technique has great potential to be widely employed in clinical lung transplantation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Cooper JD, Pearson FG, Patterson GA, et al. Technique of successful lung transplantation in humans. J Thorac Cardiovasc Surg, 1987, 93:173–181
Karimi A, Cobb JA, Staples ED, et al. Technical pearls for swine lung transplantation. J Surg Res, 2011,171(1): e107–111
Anderson MB, Kriett JM, Harrell J, et al. Techniques for bronchial anastomosis. J Heart Lung Transplant, 1995,14(6 Pt 1):1090–1094
Yunusov MY, Kuhr C, Georges GE, et al. Survival of small bowel transplants in canine mixed hematopoietic chimeras: preliminary results. Transplant Proc, 2002, 34(8):3366–3367
Lin X, Li W, Lai J, et al. Five-year update on the mouse model of orthotopic lung transplantation: scientific uses, tricks of the trade, and tips for success. J Thorac Dis, 2012, 4(3):247–258
Sato M, Keshavjee S, Liu M. Translational research: animal models of obliterative bronchiolitis after lung transplantation. Am J Transplant, 2009, 9(9):1981–1987
Iskender I, Sakamoto J, Nakajima D, et al. Human α1-antitrypsin improves early post-transplant lung function: Pre-clinical studies in a pig lung transplant model. J Heart Lung Transplant, 2016, 35(7):913–921
Gracon AS, Wilkes DS. Lung transplantation: chronic allograft dysfunction and establishing immune tolerance. Hum Immunol, 2014, 75(8):887–894
Farivar AS, Yunusov MY, Chen P, et al. Optimizing a Canine Survival Model of Orthotopic Lung Transplantation. Transplant Proc, 2006, 38(5):1638–1640
Weder W, Inci I, Korom S, et al. Airway complications after lung transplantation: risk factors, prevention and outcome. Eur J Cardiothorac Surg, 2009, 35(2):293–298
Yserbyt J, Dooms C, Vos R, et al. Anastomotic airway complications after lung transplantation: risk factors, treatment modalities and outcome-a single-centre experience. Eur J Cardiothorac Surg, 2016, 49(1):e1–8
Olland A, Reeb J, Puyraveau M, et al. Bronchial complications after lung transplantation are associated with primary lung graft dysfunction and surgical technique. J Heart Lung Transplant, 2017, 36(2):157–165
Dark JH. Pathophysiology and Predictors of Bronchial Complications After Lung Transplantation. Thorac Surg Clin, 2018, 28(3):357–363
FitzSullivan E, Gries CJ, Phelan P, et al. Reduction in airway complications after lung transplantation with novel anastomotic technique. Ann Thorac Surg, 2011, 92(1):309–315
Anile M, Diso D, Rendina EA, et al. Airway anastomosis for lungtransplantation. J Thorac Dis, 2016,8(Suppl 2):S197–203
Lau CL, Patterson GA. Technical considerations in lung transplantation. Chest Surg Clin N Am, 2003, 13(3):463–483
Kshettry VR, Shumway SJ, Gauthier RL, et al. Technique of single-lung transplantation. Ann Thorac Surg, 1993, 55:1019–1021
Schröder C, Scholl F, Daon E, et al. A modified bronchial anastomosis technique for lung transplantation. Ann Thorac Surg, 2003, 75(6):1697–1704
Aigner C, Jaksch P, Seebacher G, et al. Single running suture—the new standard technique for bronchial anastomoses in lung transplantation. Eur J Cardiothorac Surg, 2003, 23(4):488–493
Garfein ES, Ginsberg ME, Gorenstein L, et al. Superiority of end-to-end versus telescopedbronchial anastomosis in single lung transplantation for pulmonary emphysema. J Thorac Cardiovasc Surg, 2001,121(1):149–154
Puri V, Patterson GA. Adult lung transplantation: technical considerations. Semin Thorac Cardiovasc Surg, 2008, 20(2):152–164
Acknowledgment
The authors thank Dr. Xue-feng YANG for her statistical expertise in the data analysis.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The authors declare no conflicts of interest with regard to this work.
Additional information
This work was supported by a grant from the National Natural Science Foundation of China (No. 81570090).
Rights and permissions
About this article
Cite this article
Li, P., Zhu, L., Tang, Ff. et al. A Simplified Continuous Two-stitch Suture for Bronchial Anastomosis of Left Single Lung Transplant in Dogs. CURR MED SCI 40, 548–555 (2020). https://doi.org/10.1007/s11596-020-2212-2
Received:
Revised:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11596-020-2212-2