Reduction in Bleeding after Heart-Lung Transplantation: Discussion (2)
Our most recent HLT recipient had undergone a previous left thoracotomy and had minimal blood loss perioperatively. Although increasing operative experience in HLT may play a role in improved results in our group B patients, this series represents the experience of several surgeons, each of whom noted a marked reduction in perioperative hemorrhage when the above-described techniques for the reduction of mediastinal bleeding were adopted. Similarly, although patients with Eisenmenger s syndrome may be considered to be at higher risk for hemorrhage due to more prominent posterior mediastinal collaterals, the two patients with this condition in our series had a mean perioperative blood loss and transfusion requirement that was not significantly different from others in group A. antibiotic levaquin
A description of the standard technique of HLT mentions the importance of securing the posterior mediastinal vessels with clips during resection of the recipients heart and lungs. In addition, the importance of including the entire interatrial septum, including all left atrial remnants, in the right atrial suture line has been emphasized. The Papworth group reinforced the tracheal anastomosis with remnants of the recipients pulmonary artery in their early experience; currently, as is our practice, they incorporate large bites of the posterior mediastinal tissue in the posterior aspect of the tracheal anastomosis to minimize the possibility of an air leak and to secure better hemostasis in the superior aspect of the posterior mediastinum. The technique of HLT has been modified by a number of surgeons to diminish the risk of uncontrollable perioperative hemorrhage. In a retrospective case report, Losman advocated leaving the recipient pulmonary artery bifurcation and posterior wall of the left atrium in place and oversewing the orifices of the pulmonary veins.