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Published ahead of print on June 3, 2005, doi:10.1164/rccm.200410-1388OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 6, September 2005, 768-771

A more recent version of this article appeared on September 15, 2005
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Submitted on October 19, 2004
Accepted on May 18, 2005

SHORT TERM DEPLOYMENT OF SELF-EXPANDING METALLIC STENTS FACILITATES HEALING OF BRONCHIAL DEHISCENCE

Majid M Mughal1, Thomas R Gildea1, Sudish Murthy2, Gosta Pettersson2, Malcom DeCamp2, and Atul C Mehta1*

1 Department of Pulmonary and Critical Care, The Cleveland Clinic Foundation, Cleveland, OH, USA, 2 Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA

* To whom correspondence should be addressed. E-mail: mehtaa1{at}ccf.org.

RATIONALE: Bronchial dehiscence after lung transplantation is difficult to treat and associated with high mortality. We describe our experience utilizing self-expanding metallic stents to treat post lung transplant bronchial dehiscence. METHODS: Retrospective analysis of the course and outcome of patients with high- grade bronchial dehiscence treated with self-expanding metallic stents. RESULTS: From January 1995 to June 2004, 89 single and 118 double lung transplants were performed in our institution, totaling 425 at-risk bronchial anastomoses. Seven (1.6%) incidents of life threatening bronchial dehiscence were treated with self-expanding metallic stents. The interval between transplant and diagnosis of dehiscence was 29.1 ± 18.5 days. All patients presented with respiratory distress and 3 required mechanical ventilation. Self-expanding metallic stents placement resulted in complete bronchial healing. All three patients with respiratory failure requiring mechanical ventilation were successfully weaned following stent placement. In 2 later cases the stents were electively removed after adequate healing of the dehiscence. Complications included stent migration (1 patient) and in-stent stenosis (3 patients). Two of these patients required repeat stent insertion after removal, due to bronchomalacia. CONCLUSIONS: In patients with life threatening bronchial dehiscence self-expanding metallic stents offer prospects for a successful outcome. Self-expanding metallic stents are known to be associated with significant granulation tissue formation and this property provides a platform for healing of dehiscence and in time, peribronchial soft-tissue grows in to cover the defect allowing stent removal.
Key words: Lung transplantation, bronchial dehiscence, metallic stents




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