Surgical Procedure

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After arriving in the operating room, you will receive general anesthesia and be put to sleep. You may be placed on a heart-lung machine (cardiopulmonary bypass) that will handle the functions of your heart and lungs while the surgeon is working on both your old and new lungs. You will also have a breathing tube in your throat, called an endotracheal tube. This tube is connected to a machine called a ventilator, which will breathe for you during and after the operation.

If you are having a single lung transplant, you will have a thoracotomy incision either on your right or your left side, depending on which lung is being replaced. After the donor lung arrives in the operating room, the surgeon will remove your diseased lung. You will be ventilated using your other lung. If your remaining lung is not able to exchange enough oxygen, the surgeon may place you on cardiopulmonary bypass. Your blood will be filtered through a machine outside your body which will put oxygen into your blood and remove carbon dioxide.

Three connections will be used to attach your new lung. These connections are called anastomoses. First, the main bronchus from the donor lung is attached to your bronchus. Then, the blood vessels are attached, first the pulmonary artery and then the pulmonary veins. Finally, the incision is closed and you will be taken to the intensive care unit, where you will be asleep for approximately 12-24 hours.

If both your lungs are transplanted (a bilateral transplant), the surgeon will make an incision below each breast, called an anterior thoracotomy, or an incision that goes from your right side to your left side at the base of your breasts. This is called a transverse sternotomy incision. In a bilateral lung transplant, each lung is replaced separately. The surgeon begins by removing the lung with the poorest function. You will be ventilated using your remaining lung unless partial cardiopulmonary bypass is needed. Once your first lung is removed, a donor lung will be attached using three connections — the donor bronchus is attached to your main bronchus, then the blood vessels are attached, first the pulmonary artery, then the pulmonary veins. Your second diseased lung is removed and the other new lung is attached just like the first one. Once the second lung is completely connected, blood flow is restored. Finally, your incision is closed and you are taken to the intensive care unit (ICU).

With either incision, nerves can be cut resulting in various degrees of decreased sensation. Various tubes and monitoring equipment will be used to monitor how well your lungs and body are recovering after surgery.

• IVs (intravenous tubes) will help you receive fluids and medications. A special IV called a pulmonary artery catheter (Swan Ganz catheter) in your neck vein will measure the pressures in your heart and lungs and tell the surgeon how well your new lungs are functioning.

• A heart monitor will record your heart rate and rhythm at all times.

• Tubes in your chest near the bottom of your incision and possibly on the sides of your chest will drain the blood and fluid that collect in your chest after the operation. They are usually removed several days after the surgery.

• A small tube, called a foley catheter, in your bladder will help us measure how well your kidneys are working. This tube will be taken out a couple of days after your surgery, and then you will urinate on your own.

• An epidural catheter may be placed to manage your pain. Later you will receive pain medication (through your IV tube) that you dose yourself through a special patient-controlled analgesia (PCA) device.