Minimally Invasive Lung Transplantation Improves Post-Operative Pulmonary Function and Reduces Opiate Requirements

ABSTRACT

We evaluated the impact of a 6-8 cm minimally invasive (mini-) incision (Figure-A) on early outcomes after lung transplantation (LTx) compared to traditional incisions An institutional registry identified 37 mini-LTx and 106 traditional access (42 clamshells, 48 thoracotomies, 16 sternotomies) LTx patients (01/2017-06/2022), after excluding repeat/multiorgan transplants and those with COVID-19 acute respiratory distress syndrome who required pre-transplant extracorporeal membrane oxygenation (n=27). Propensity score matching by age, sex, body mass index, diagnosis, lung allocation score (LAS), double vs. single lung, hypertension, diabetes, and hospitalization status created 37 pairs Before matching, mini-LTx patients had similar LAS (39.2 [IQR 36.6-45.9] vs 41.1 [IQR 34.9-48.0]) compared to traditional LTx cohorts (both p>0.05). After matching, there was no difference between mini- and traditional LTx cohorts in warm ischemic time (66 [IQR 60-81] vs 62 [IQR 54-84] mins). Operative time was numerically shorter in mini-LTx patients for both double (399 [IQR 369-455] vs. 441 [IQR 373-545] mins, p=0.17) and single lung LTx (240 [IQR 208-272] vs. 272 [187-289] mins, p=0.57). After LTx, Mini-LTx was associated with similar mechanical ventilation duration (25.5 [IQR 19.5-38.7] vs 28.7 [IQR 19.0-69.5] hours, p=0.26), numerically lower rate of grade 3 primary graft dysfunction at 72 hours (3 vs. 15%, p=0.10), and shorter ICU and hospital length of stay (Figure-B). Among matched patients who survived to discharge, mini-LTx patients required less opiates prescription at discharge (38 vs 66%, p=0.02), and had improved pulmonary function at 3 months (FEV1 82 [IQR 72-102] vs 77 [52-88] % predicted;FVC 78 [IQR 65-92] vs 70 [IQR 62-80] % predicted;both p<0.05). In selected patients, LTx using a minimally invasive incision is safe with improved postoperative pulmonary function, shorter length of stay, and reduced outpatient opiate use. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)