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Review
. 2023 Sep 28;15(9):5195-5203.
doi: 10.21037/jtd-22-1720. Epub 2023 Aug 11.

Integrated cardiothoracic team approach for complex lung transplantation procedures in Japan-current status and future direction

Yasushi Shintani  1 , Soichiro Funaki  1 , Takashi Kanou  1 , Naoko Ose  1 , Toru Kimura  1 , Eriko Fukui  1 , Masato Minami  1 , Shigeru Miyagawa  2
Affiliations
Review

Integrated cardiothoracic team approach for complex lung transplantation procedures in Japan-current status and future direction

Yasushi Shintani et al. J Thorac Dis. .

Abstract

The first lung transplant procedure in the world was performed in 1983, while in Japan that was first accomplished in 1998. Over the following 25 years, lung transplantation has become a viable treatment option for Japanese patients with a variety of end-stage lung diseases. Seventy cadaveric-donor lung (41 single, 29 bilateral), 11 bilateral living-donor lobar lung, and three heart-lung transplants have been performed with use of an integrated cardiothoracic team approach at medical facilities associated with Osaka University. Extremely advanced clinical and surgical skill sets are required to complete a lung transplant procedure, including surgical knowledge and techniques, as well as management of cardiovascular surgery, especially in regard to mechanical circulatory support (MCS), vascular anastomosis in difficult cases, and concomitant cardiac surgery. We have found that a collaborative effort by general thoracic and cardiac surgeons is an important key for success with lung transplantation. Complex lung transplant surgery and management in Japan are performed by use of an integrated cardiothoracic team approach, which has led to a synergistic impact on successful lung transplantation cases by capitalizing greatly on the experiences, techniques, and expertise of cardiac and thoracic experts. The present review is focused on the role of cardiac surgeons from the viewpoint of our experience with these cases.

Keywords: Lung transplantation; cardiac surgery; cardiothoracic team; mechanical circulatory support (MCS); vascular anastomosis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-1720/coif). The special series “Why is the Outcome Good? Secrets of Lung Transplantation in Japan” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
A patient with idiopathic pulmonary arterial hypertension, giant pulmonary artery aneurysm, and ASD underwent ASD closure and vascular anastomosis performed by cardiac surgeons. (A) Chest X-ray. (B) Chest contrast-enhanced computed tomography at the level of the main pulmonary artery. (C) Intraoperative finding showing severe dilatation of the main pulmonary vessels. Arrowheads indicate a giant pulmonary artery aneurysm. (D) Intraoperative finding showing left atrial cuff reconstruction with a donor pericardial patch at the back table. Arrow indicates suture line. ASD, atrial septal defect.
Figure 2
Figure 2
A case of Eisenmenger syndrome with an AP window defect. (A) Chest contrast-enhanced CT at the level of the AP window defect, indicated by an asterisk. (B) 3D reconstruction of CT image. *, AP window. (C) Intraoperative finding showing closure of AP window defect with flap of anterior wall of main pulmonary artery, which was wrapped with felt to reinforce the aortic wall. AP, aortopulmonary; CT, computed tomography; 3D, three-dimensional.
Figure 3
Figure 3
Roles of multidisciplinary team for advancing lung transplantation in Japan.
See this image and copyright information in PMC

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