Bronchoscopic management of bronchial anastomotic defects using acellular cadaveric dermal grafts.
Bedi H, Shaller BD, Duong DK, Free D, Chhatwani L, Mooney JJ, Dhillon G, and Simoff MJ. Bronchoscopic management of bronchial anastomotic defects using acellular cadaveric dermal grafts. J Heart Lung Transplant 2018; 37(4):S251-S252.
J Heart Lung Transplant
: Bronchial anastomotic fistulas and dehiscences are highly morbid and potentially fatal complications of lung transplantation. While no consensus exists, management of anastomotic defects ranges from conservative strategies to endobronchial stenting and surgical repair. We report our experience using an acellular cadaveric dermal graft in the bronchoscopic management of anastomotic defects. Methods: Retrospective review of lung transplant recipients with anastomotic defects managed by bronchoscopic graft implantation was performed. Customized grafts were implanted via rigid bronchoscopy and secured with uncovered metallic stents with or without application of human fibrin glue (Image). Results: Three patients underwent bronchoscopic graft implantation. Patient information, defect characteristics, and intervention details are summarized (Table). There were no procedural complications. Two patients were discharged; one patient died of complications unrelated to lung transplantation. Conclusion: Open surgical repair in this population is generally considered high-risk and is commonly deferred. Traditional stenting management relies on formation of granulation tissue to promote healing, however, this strategy does not address the immediate complications associated with these defects. The intended purpose of this novel technique is to restore airway anatomy, attenuate infection, and promote healing. Our experience suggests that this technique is safe and effective for the management of anastomotic defects, however, further study is required to determine its effects on long term outcomes (Figure presented).