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Cardiothoracic Surgery |

Thoracoscopic Native Lung Pneumonectomy After Single Lung Transplant: A Report of Two Cases

Wassim Abi Jaoude, MD; Nicole Strieter, ARNP-C; James Maloney, MD
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University of Wisconsin Hospital and Clinics, Madison, WI


Chest. 2013;144(4_MeetingAbstracts):103A. doi:10.1378/chest.1703037
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Abstract

SESSION TITLE: Surgery Student/Resident Case Report Posters

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Single lung transplants (SLT) leave in place a diseased lung that can be the source of complications(1). Native lung pneumonectomy is occasionally indicated in their treatment. To our knowledge, thoracoscopic pneumonectomy has never been reported in this context before. We present 2 cases of native lung complications (NLC) managed with VATS pneumonectomy at our institution and review the appropriate literature.

CASE PRESENTATION: Case 1: A 59-year-old gentleman presented with invasive pulmonary aspergillosis of the native lung, refractory to medical treatment post SLT for idiopathic pulmonary fibrosis five years earlier. As the native lung was severely diseased in both lobes, a pneumonectomy was indicated. Case 2: A 66-year-old gentleman with a SLT for alpha-one anti-trypsin deficiency developed severe hemoptysis and intraparenchymal hemorrhage in the native lung 12 years after his original operation. He had also severe hyperinflation with compression of the transplant and mediastinal shift. Both patients underwent a VATS pneumonectomy via a standard 3 port and a 2 cm access incision approach with a pleural tent. For the second case, we had to volume-reduce the lung to create our operative space. They tolerated the procedure well and their post-operative course was only complicated by acute renal failure that improved before discharge.

DISCUSSION: The incidence of NLC after SLT ranges from 14-50%(1). Treatment has varied, with pneumonectomy performed occasionally. King showed an equal survival when a pneumonectomy was done for NLC compared to SLT without NLC(1). In both our patients a pneumonectomy was indicated: in the first case because of severe infection and diseased NL; in the second because of diffuse intraparenchymal hemorrhage. A VATS pneumonectomy was deemed adequate in both cases because we believed that it might facilitate wound healing and hasten recovery in these immunosuppressed patients given its minimally invasive nature. Furthermore, its safety and adequacy have been demonstrated in the literature(2,3). Our short-term results were favorable.

CONCLUSIONS: VATS pneumonectomy is a feasible, adequate and safe procedure in this patient population; larger series are needed to draw definitive conclusions.

Reference #1: King CS, Khandhar S, Burton N et al. Native lung complications in single lung transplant recipients and the role of pneumonectomy. J Heart Lung Transplant 2009; 28:851-856

Reference #2: Sahai RK, Nwogu CE, Yendamuri S et al. Is thoracoscopic pneumonectomy safe? Ann Thorac Surg 2009; 88:1086-1092

Reference #3: Nwogu CE, Yendamuri S, Demmy TL. Does thoracoscopic pneumonectomy for lung cancer affect survival? Ann Thorac Surg 2010; 89:S2102-2106

DISCLOSURE: The following authors have nothing to disclose: Wassim Abi Jaoude, Nicole Strieter, James Maloney

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