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Bronchial Artery Revascularization in Lung Transplantation |
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The lungs have a dual blood supply. The pulmonary arteries provide desaturated blood under low pressure, while the bronchial arteries provide oxygenated blood under arterial pressure. Lung transplantation has stimulated an interest in the role and importance of the bronchial artery blood supply. In the beginning of the lung transplantation era (late 1980’s) it was clear that mortality due to bronchial complications presented a major cause of death in the early postoperative period. Out of the first 38 clinical cases of lung transplantation reported in the literature only one patient survived more than three weeks. The single dominating cause of death was dehiscence of the bronchial anastomosis, due to the absence of sufficient blood supply to the airways through the bronchial arteries. The idea of performing BAR is almost as old as the idea of lung transplantation. Even though experimental studies have been made since 1950, the first clinical experiences could not be reported until 1992. When Professor Gösta Pettersson started the lung transplantation program at Copenhagen University Hospital in 1992, BAR was applied from the beginning, and the results of the first 14 operations were reported in 1993. Until today 66 en-bloc double lung transplantations, 20 single lung transplantations, 9 heart-lung transplantations and one bilateral lung transplantation with BAR have been performed at Rigshospitalet, Copenhagen. This represents by far the worlds largest experience with BAR. The main indications for lung transplantation were end stage lung disase or Chronic Obstructive Pulmonary Disease (COPD), Alpha-1 Antitrypsin Deficiency, and other types of lung emphysema. Martin A. Nørgaard was studying the anatomy of the bronchial arteries, the surgical resultst of BAR, the patency of the revascularization, the physiological consequenses and the prognostic impact of BAR from 1994 to 2002. May 31'st 2002 Martin Agge Nørgaard defended his Doctor of Medical Science thesis entitled: DIRECT BRONCHIAL ARTERY REVASCULARIZATION IN LUNG TRANSPLANTATION. Surgical, anatomical, physiological, and clinical aspects. You can DOWNLOAD the thesis (2.4 Mb) In the period 1995-2000 we published a number of scientific articles on the clinical and physiologic results of BAR, as well as our attempts to set up an experimental animal model for studying the effects of BAR 1. U.G. Svendsen, H. Arendrup, M. Nørgaard, P. Olsen, J. Thiis, S. Mortensen and G. Pettersson Double lung transplantation with bronchial artery revascularization using mammary artery. Transplant Proc 1995; 27(6); 3485. 2. Nørgaard MA, Olsen PS, Svendsen UG, Pettersson G. Revascularization of the bronchial arteries in lung transplantation - an overview. Ann Thorac Surg 1996; 62:1215-21. 3. Nørgaard MA, Efsen F, Olsen P, Svendsen U, Pettersson G. Surgical and Arteriographic Results of bronchial artery revascularization in lung- and heart-lung transplantation. J Heart Lung Transplant 1997;16(3):302-12. 4. Pettersson G, Nørgaard MA, Arendrup H, Brandenhof P, Helvind M, Joyce F, Stentoft P, Olesen PS, Thiis JJ, Efsen F, Mortensen SA, Svendsen UG. Direct bronchial artery revascularization and en-bloc double lung transplantation -surgical techniques and early outcome. J Heart Lung Transplant 1997;16(3):320-33. 5. Svendsen U.G., Nørgaard M.A., Andersen C.B., Arendrup H., Efsen F., Mortensen S.A., Thiis, J.J., Pettersson G. Kliniske resultater efter én-bloc dobbelt lungetransplantation med direkte bronkiel revaskularisering [Clinical results of én-bloc double lung transplantation with direct bronchial artery revascularization]. Ugeskrift for læger 1997; 159: 3592-97. 6. Nørgaard M.A., Efsen F., Andersen C.B., Svendsen U.G., Pettersson G. Medium term patency and anatomic changes after direct bronchial artery revascularization in lung and heart-lung transplantation with the internal thoracic artery conduit. J Thorac Cardiovasc Surg 1997; 114:326-31.
Bronchial artery perfusion scintigraphy in én-bloc double lung transplantation (DLTX) with bronchial artery-internal mammary artery anastomosis (BA-IMA). Journal of Nuclear Medicine 1997;suppl 38(5): 5P. 8. Nørgaard MA, Andersen CB, Pettersson G Does bronchial artery revascularization influence results concerning bronchiolitis obliterans syndrome and/or obliterative bronchiolitis after lung transplantation ? European Journal of Cardio-Thoracic Surgery 1998; 14:311-318. 9. Martin A. Nørgaard, Claus B. Andersen, and Gösta Pettersson. Airway Epithelium of Transplanted Lungs with and without Direct Bronchial Artery Revascularization. European Journal of Cardio-Thoracic Surgery 1999; 15:37-44. 10. Nørgaard MA, Gadsbøll N, Efsen F, Hesse B, Rabøl A, and Pettersson G Bronchial artery perfusion scintigraphy to assess bronchial artery blood flow after lung transplantation. Journal of Nuclear Medicine 1999; 40:290-295. 11. John Gade, Martin A. Nørgaard, Claus B. Andersen, Gösta Pettersson, Ulrik G. Svendsen, and Peter S. Olsen. The porcine bronchial arteries - surgical and angiographic anatomy. Journal of Anatomy 1999; 194 (Pt 2):241-247. 12. Pettersson G, Nørgaard MA, Andersen CB, Arendrup H, Efsen F, Mortensen SA, Olsen PS, Svendsen UG; Chapter 6 (p51-69): Lung and heart-lung transplantation with direct bronchial artery revascularization. In: Hetzer, Roland, eds. Lung Transplantation (1st edition) Darmstadt: Steinkopff; Berlin: Springer 2003. ISBN: 3798510628 13. Nørgaard MA, Efsen F, Hove J, Saunamäki K, Hesse B, and Pettersson G. Human bronchial artery blood flow after lung-Tx with direct bronchial artery revascularization. J Appl Physiol 1999;87:1234-1239. 14. Gade J, Nørgaard MA, Andersen CB, Jakobsen H, Breitowicz B, Svendsen UG, Olsen PS. The porcine bronchial artery. Anastomoses with esophageal, coronary and intercostal arteries. Journal of Anatomy 1999; 195:65-73. 15. Nørgaard MA. Direct bronchial artery revascularization in lung transplantation. Surgical, anatomical, physiological, and clinical aspects. Dr. Med. Science thesis. Faculty of health science, University of Copenhagen. ISBN 87-988951-0-9 Four years after Martin A. Nørgaard had stopped studying the bronchial arteries in in transplanted lungs, he stumbled upon them while studying children with congenital heart disease: 16. Martin A. Nørgaard, Nelson Alphonso, Andrew D. Cochrane, Christian P. Brizard, Samuel Menahem, Yves d'Udekem MAPCAs of patients with pulmonary atresia and VSD are dilated bronchial arteries European Journal of Cardiothoracic Surgery 2006 May;29(5):653-8. Epub 2006 Feb 17. Some of the articles are available as free full text through PubMed. The articles can be found in most medical libraries. If, however, you have trouble finding the articles please feel free to ask for a copy. |