Comparisson between techniques for bronchial anastomosis in pulmonary transplant with tridimensional CT-scan data: a retrospective study using propensity score match

• Grant number: 19/05394-3
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: August 01, 2019
• End date: July 31, 2020
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Marcos Naoyuki Samano
• Grantee: Guilherme Carvalhal Gnipper Cirillo
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil

Abstract

Over the last thirty-five years, the pulmonary transplant has become an accepted treatment for a variety of end-stage lung diseases. Considerable dispute, however, still exists among surgeons on aspects of surgical technique. The anastomosis of the airway has been the focus of much of the debate, as the vasculature of the area makes it particularly prone to the development of postoperative complications, and no anastomotic method has yet been deemed optimal. Most of the literature agrees that joining the posterior membranous wall of the bronchi should be done end-to-end by means of a running suture with unobservable material. The anterior cartilaginous portion is now the focus of inquiry. Last year, a study was conducted at this institution that found a statistically significant difference between the degree of airway narrowing experienced by patients subject to continuous suture and those subjected to interrupted suture. That study was awarded the first place of the Oswaldo Cruz Award - Surgical Category in 2018. The present research project aims at comparing both techniques, establishing whether there has been a significant change in the incidence of airway complications in patients three months post-transplant using Propensity Score Matching to select groups, and including almost four times the number of patients on the previous study, to generate more reliable data. In order to accomplish that, CT scans of the patients, obtained three months after the surgery will be used to determine the occurrence of, particularly, bronchial stenosis. The data from the scans will be used by software to compare the cross-section area of the airway at the point of the anastomosis with an average of the areas of cross-sections of the bronchus 5 mm proximal and distal to the point of the anastomosis. The number of patients that displayed clinically diagnosed complications will also be subject of analysis, as will the number of such patients that require intervention, such as stent placement, to be treated. Also, the difference in size between donor and recipient, the time of ischemia and pulmonary function tests will be analyzed.