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SURGERY AND TRANSPLANTATION 
Figure 1. — Operative technique of lung transplantation. 
atrial cuff into which flow the pulmonary veins 
to be the appropriate level for venous anasto- 
mosis, though anastomoses of the two pulmo- 
nary veins were used in our two human cases. In 
addition to the left atrial anastomosis, the op- 
eration is completed by anastomosis of the pul- 
monary artery and the bronchus (Figures 1 and 
2). No effort is made to restore continuity of 
the bronchial arteries, lymphatics and nerves. 
A continuous suture technique is usually satis- 
factory, and we have commonly employed 5-0 
silk. The bronchus is sutured by placing the 
posterior row first, achieving an everted suture 
line. In the experiments involving young pup- 
pies, an interrupted suture technique was used 
to permit growth of the anastomosed structures 
as the animals enlarged. Although the left lung 
is technically somewhat more easily trans- 
planted, the right lung provides a greater 
mass of functioning lung tissue. This is an 
important consideration in perfecting a model 
where the animal must survive entirely on a 
replanted or allotransplanted lung. There is 
a certain incidence of thrombosis of the vascular 
structures postoperatively, but this is uncom- 
mon after the technique of lung reimplantation 
has been mastered. 
With considerable experience in the actual 
operative technique and physiological manage- 
ment of the thoracotomy, a skillful operator can 
achieve successful replantation in about 75% 
of the animals operated upon. As noted pre- 
viously, a major cause of death is stenosis or 
thrombosis of the pulmonary veins, or both. 
These complications are minimized by using an 
atrial cuff with careful intima to intima ap- 
proximation, instead of attempting to anasto- 
mose the veins individually. An additional per- 
centage of dogs will die from postoperative 
hemorrhage into the pleural cavity, pneumoni- 
