Lung transplant with bronchial arterial revascularization: review of surgical technique and clinical outcomes

Lung transplantation (LTx) is routinely performed with sacrifice of the bronchial arterial circulation. We review bronchial artery anatomy and surgical technique for LTx with direct bronchial arterial revascularization (BAR). We also update the published clinical experience, including from our center, of LTx with BAR. Published series of LTx with BAR are from single centers, and all cite high technical success rates and good short-term outcomes. Technically, double LTx (DLTx) with BAR is almost always possible if a deliberate review of bronchial artery anatomy is performed. For single LTx (SLTx), BAR is feasible in about 50% of cases. The combined Copenhagen and Cleveland Clinic experience (with BAR procedures performed or supervised by Dr. Gosta B. Pettersson) includes 131 LTx with BAR with a technical success rate >95%. Procedural success is uniformly associated with normal airway healing. Five-year survival in LTx with BAR is superior to the 5-year survival of LTx patients in the ISHLT registry. LTx with BAR is feasible and safe, and technical success ensures normal airway healing. The experience with BAR at experienced centers suggests possible long-term survival benefit. A multicenter study is needed to define the role of BAR in LTx.