Effect of surgical exposure on outcomes in bilateral lung transplantation: insight from the international…

Cohort studyThe Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation· Jul 2026

Effect of surgical exposure on outcomes in bilateral lung transplantation: insight from the international multicenter extracorporeal life support (ECLS) in lung transplantation registry.

Nunzio Davide de Manna, Sophie Kruszona, Andres Leon-Pena … Fabio Ius

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SurgeryCohort studyTreatmentQ1IF 5.5

Isolated bilateral thoracotomy linked to higher 1-year graft survival than clamshell incision

Effect of surgical exposure on outcomes in bilateral lung transplantation: insight from the international multicenter extracorporeal life support (ECLS) in lung transplantation registry.

Nunzio Davide de Manna … Fabio Ius

The Journal of heart and lung transplantation · Jul 2026 · Q1 in Surgery

Background

Surgical access for bilateral lung transplantation (bilateral lung transplantation) including clamshell, sternotomy, and isolated bilateral thoracotomies (isolated bilateral thoracotomies) may influence perioperative outcomes.

Methods

Were grouped as being transplanted through clamshell (n=451, 37.6%), isolated bilateral thoracotomies (n=624, 52.0%), or sternotomy (n=125, 10.4%).

n = 451,

Results

Isolated bilateral thoracotomies patients more often had their graft still working at 1 year

91%

IBT

86%

Clamshell

More results

After matching, isolated bilateral thoracotomies patients showed longer ischemic times (p<0.001), but less intraoperative extracorporeal life support use, shorter ventilation and ICU stays (p<0.001), lower reintubation (p=0.021 vs clamshell; p=0.045 vs sternotomy), fewer reoperations for bleeding (p=0.190 vs clamshell; p=0.018 vs sternotomy) and lower transfusion needs (p<0.001).

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Conclusion · 1 of 2

Surgical access in bilateral lung transplantation affects perioperative morbidity and recovery, isolated bilateral thoracotomies was associated with improved early/intermediate graft survival compared with clamshell incision, although the absolute difference was attenuated at 5 years.

Conclusion · 2 of 2

Incision choice should be tailored to patient profile, procedural demands, and institutional expertise.

Effect of surgical exposure on outcomes in bilateral lung transplantation: insight from the international multicenter extracorporeal life support (ECLS) in lung transplantation registry.

Effect of surgical exposure on outcomes in bilateral lung transplantation: insight from the international multicenter extracorporeal life support (ECLS) in lung transplantation registry.

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