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Pulmonary Artery Trunk Transplantation
[edit]Pulmonary artery trunk transplantation is a surgical procedure in which the main pulmonary artery (including its bifurcation and often the pulmonary valve) is replaced with a cryopreserved homograft from a deceased donor. This is an extremely rare and innovative operation. In 2023, Cafarotti et al. reported the first known case of a complete en bloc resection of the pulmonary artery trunk and reconstruction using a homograft in a patient with locally advanced thymic carcinoma.[1]
An accompanying editorial by Ambrogi and Lucchi highlighted this approach as a potential paradigm shift in the surgical management of invasive mediastinal tumors.[2]
Indications
[edit]Pulmonary artery trunk transplantation is indicated in highly selected cases where the native trunk is irreversibly infiltrated by disease. The main clinical indication to date is for locally advanced thoracic tumors (especially thymic carcinoma) invading the pulmonary artery, in which radical resection would not otherwise be feasible.[1]
Other potential indications—though undocumented—may include large pulmonary artery aneurysms or complex congenital vascular malformations.
Surgical technique
[edit]The procedure is performed via median sternotomy under cardiopulmonary bypass. After neoadjuvant therapy when applicable, the tumor and involved artery segment are removed en bloc. A cryopreserved homograft from a tissue bank (including the pulmonary valve and sometimes adjacent right ventricular outflow tract) is then anastomosed to reestablish continuity between the right ventricle and distal pulmonary arteries.[1]
Risks and complications
[edit]Like other open-heart surgeries, this procedure carries significant risks:
- perioperative bleeding,
- arrhythmias and cardiac dysfunction,
- thrombosis or stenosis of the homograft,
- infection of the vascular graft or mediastinum.
In similar surgeries involving pulmonary artery reconstruction for central lung tumors, postoperative complication rates can be high, although operative mortality remains low.[3]
Outcomes
[edit]To date, only a single case of full pulmonary artery trunk transplantation has been published. The patient reportedly had an uneventful postoperative course and resumed normal daily activities.[1] Long-term data are not yet available.
Alternative treatments
[edit]Alternative options include:
- systemic oncologic therapy (chemotherapy, radiotherapy),
- arterial patch repair or synthetic graft reconstruction,
References
[edit]- ^ a b c d Cafarotti S, et al. Pulmonary artery homograft implantation for radical resection of thymic malignancy. Interact Cardiovasc Thorac Surg. 2023;37(1):ivac392. doi:[10.1093/icvts/ivac392](https://doi.org/10.1093/icvts/ivac392)
- ^ Ambrogi MC, Lucchi M. Breaking the wall: the future of thymic surgery. Interact Cardiovasc Thorac Surg. 2023;37(1):ivac394. doi:[10.1093/icvts/ivac394](https://doi.org/10.1093/icvts/ivac394)
- ^ Madariaga ML, et al. Outcomes after sleeve resection of the pulmonary artery during lung cancer surgery. J Thorac Cardiovasc Surg. 2022;163(4):e315–e323. doi:[10.1016/j.jtcvs.2020.11.017](https://doi.org/10.1016/j.jtcvs.2020.11.017)
Category:Cardiothoracic surgery Category:Surgical procedures and techniques
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