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Razuk Filho M, dos Santos SL, dos Reis FP, Abdalla LG, Fernades LM, Pêgo-Fernandes PM. Use of Octopus™ Tissue Stabilizer for Minimal Manipulation Approach of Bronchial Anastomosis in Lung Transplant. Braz J Cardiovasc Surg 2023; 38:e20220413. [PMID: 37801400 PMCID: PMC10550104 DOI: 10.21470/1678-9741-2022-0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/16/2023] [Indexed: 10/08/2023] Open
Abstract
Bronchial anastomotic complications are a cause of grave concern for surgeons that perform lung transplantations. There are several risk factors that may lead to this complication, being inadequate surgical technique one of them, specifically regarding adequate exposure and manipulation of the bronchial stump and anastomosis. Here we report the use of Octopus™ Tissue Stabilizer as a mean to allow for a better exposure of the stump and facilitate a "no-touch" approach towards anastomosis. Systematic application of devices that facilitate the employment of the correct surgical techniques can have an effect in reducing the incidence of bronchial anastomotic complications.
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Affiliation(s)
- Mauro Razuk Filho
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
| | - Samuel Lucas dos Santos
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
| | - Flavio Pola dos Reis
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
| | - Luis Gustavo Abdalla
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
| | - Lucas Matos Fernades
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
| | - Paulo Manuel Pêgo-Fernandes
- Lung Transplant Group, Disciplina de Cirurgia Torácica,
Hospital das Clínicas, Faculdade de Medicina, Universidade de São
Paulo, São Paulo, São Paulo, Brazil
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Pola dos Reis F, Fernandes LM, Abdalla LG, Campos SV, de Camargo PCLB, dos Santos SL, de Aguiar IT, Pires JP, Costa AN, Carraro RM, Teixeira RHDOB, Pêgo-Fernandes PM. Brazilian initial experience with lung transplantation due to irreversible lung fibrosis post-COVID-19 in a national reference center: a cohort study. SAO PAULO MED J 2021; 140:S1516-31802021005030204. [PMID: 34932782 PMCID: PMC9623839 DOI: 10.1590/1516-3180.2021.0842.r1.13102021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. OBJECTIVES To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. DESIGN AND SETTING Cohort study conducted at a national reference center for lung transplantation. METHODS Medical charts were reviewed regarding patients' demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. RESULTS Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day. CONCLUSIONS LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.
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Affiliation(s)
- Flavio Pola dos Reis
- MD. Attending Surgeon, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Lucas Matos Fernandes
- MD, PhD. Attending Surgeon, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Luis Gustavo Abdalla
- MD. Attending Surgeon, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Silvia Vidal Campos
- MD. Attending Physician, Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Priscila Cilene Leon Bueno de Camargo
- MD, PhD. Attending Physician, Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Samuel Lucas dos Santos
- MD. Lung Transplant Resident, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Ivana Teixeira de Aguiar
- MD. Lung Transplant Fellow, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Juliana Patricia Pires
- MD. Lung Transplant Fellow. Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Andre Nathan Costa
- MD, PhD. Attending Physician, Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Rafael Medeiros Carraro
- MD. Attending Physician, Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Ricardo Henrique de Oliveira Braga Teixeira
- MD, PhD. Attending Physician, Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Paulo Manuel Pêgo-Fernandes
- MD, PhD. Full Professor, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR; Director, Scientific Department, Associação Paulista de Medicina, São Paulo (SP), Brazil.
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