Lung Transplant with Pulmonary Artery Reconstruction using Donor Aorta for Pulmonary Hypertension with a Giant Pulmonary Arterial Aneurysm

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Standard lung transplantation is not feasible for patients with pulmonary arterial hypertension (PAH) complicated with a giant pulmonary arterial aneurysm (PAA). We describe our experiences of lung transplantation with pulmonary artery reconstruction (PAR) using donor aorta in five patients from 2010 through 2020. All patients had a substantial PAA size (median pulmonary artery trunk diameter of 69.9mm) and were classified as NYHA III in terms of functional status.The operation times were long and intraoperative blood loss was profuse in all cases. Four patients required post-operative ECMO support. Despite these challenges, all patients survived throughout the follow-up period, with a median observation time of 94 months. Importantly, no complications associated with the donor aortic graft, such as dilatation, constriction, or infection of the aortic grafts were recorded. Based on these findings, we suggest that lung transplantation with PAR using a donor aorta can be considered as a viable surgical approach for PAH patients with a giant PAA. However, it is crucial to acknowledge the substantial perioperative risks associated with this procedure.