A Comparative Study of a Sternum-Sparing Procedure and Clamshell Incision in Bilateral Lung Transplantation

다국어 초록 (Multilingual Abstract)

Purpose: Clamshell incision offers excellent exposure and access to the pleural spaces and is a standard incision for lung trans plantation. However, due to its high sternal complication rate, the clamshell incision is considered a procedure that requires im provement. In this study, we aimed to investigate the outcomes of transverse sternotomy with clamshell incision in comparison to sternum-sparing bilateral anterolateral thoracotomy (BAT).
Materials and Methods: In total, 134 bilateral sequential lung transplants were performed from May 2013 to June 2022. The clam shell incision was used between May 2013 and December 2017, and the BAT was introduced in January 2018. Thirty-four patients underwent clamshell surgery, and 100 patients underwent BAT. We retrospectively compared patient characteristics and periop erative and postoperative outcomes between the two groups.
Results: The clamshell group required an operation time of 745.18±101.76 min, which was significantly longer than that of the BAT group at 669.90±134.09 min (p=0.003). The mechanical ventilation period after surgery was 17.26±16.04 days in the clamshell group, significantly longer than the 11.35±12.42 days in the BAT group (p=0.028). Intensive care unit stay was also significantly longer in the clamshell group (21.54±15.23 days vs. 15.03± 14.28 days; p=0.033). In-hospital mortality rates were 26.5% in the clam shell group and 22.0% in the BAT group.
Conclusion: Less-invasive lung transplantation via sternum-sparing BAT is a safe procedure with low morbidity and favorable outcomes. Preventing sternal instability enables more stable breathing after surgery, earlier weaning from mechanical ventila tion, and faster recovery to routine activities.