Clamshell vs bilateral anterolateral thoracotomy for double lung transplantation : impact on vital capacity

Objectives:The bilateral anterolateral thoracotomy without sternal splitting is considered the preferable approach for bilateral lung transplantation, mainly for the reported lower rate of sternal complications and better respiratory function in the early postoperative period. We evaluate the influence of the incision on vital capacity within one-year follow up. Methods: 133 double lung transplantations were done since January 2013 (85 cystic fibrosis, 36 interstitial lung diseases, 12 COPD). We retrospectively analysed spirometry performed before (pre), one month (post1), 6 months (post 6) and one year (post 12) after the transplantation. Forced vital capacity (FVC) was considered both as percentage predicted and as absolute value. Results: The majority of patients received clamshell incision (64.6%, n=86). Age was similar between the clamshell (38.2 years) and the bilateral anterolateral thoracotomy (40.5 years, p= 0.365) groups, while the former was characterized by higher LAS (39.3 vs 35.1, p=0.035). FVC was similar between the two groups clamshell (38.2 years) and the bilateral anterolateral thoracotomy (40.5 years, p= 0.365) groups before surgery, but it was systematically lower in the clamshell group in the three considered follow-ups Conclusions: The clamshell incision results in more postoperative lung restriction as compared with bilateral anterolateral thoracotomy; we note that this effect persists throughout the first year.