Bronchial Artery Revascularization: Surgical Technique

Abstract

The lung transplant community has long ignored the importance of bronchial arterial blood supply. We review relevant history, published articles addressing post-transplant ischemia, and single-center reports of lung transplant with bronchial artery revascularization (BAR), followed by details of surgical technique. In our experience, although BAR requires cardiopulmonary bypass (CPB) and there is increased risk of bleeding, ischemic time was shorter and length of ICU and hospital stays were similar. Technical success was achieved in > 95% of cases, which guarantees normal airway healing. Lung transplant with BAR is safe, reproducible, and may provide benefits beyond airway healing, with potential for decreasing BOS/CLAD and improving long-term survival. Multicenter study and long-term follow-up are needed.