Exposure of difficult left hilum in bilateral sequential lung transplantation

Abstract

Left hilar exposure can be challenging during bilateral sequential lung transplantation, particularly in patients with idiopathic pulmonary fibrosis due to the overlying heart and limited space. We describe a cost-effective technique that has been used in off-pump cardiopulmonary bypass to retract the heart away from the left hilum, without causing hemodynamic instability, thereby allowing implantation of the left lung without the use of cardiopulmonary bypass.