Ventilation strategies in reconstructive surgery of the tracheal bifurcation and bronchi: a 40-year retrospective institutional experience of 1,345 procedures

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ID: 338252
2026
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Abstract
OBJECTIVES: To evaluate the feasibility, procedural safety, and clinical outcomes of differentiated intraoperative ventilation strategies tailored to the level and complexity of reconstructive surgery on the tracheal bifurcation and bronchi. METHODS: A retrospective descriptive institutional study of 1,345 consecutive reconstructive procedures performed between 1986 and 2025 across four specialized thoracic centers by a single surgical team was conducted. Surgeries were categorized into five procedural groups: circumferential carinal resection (n = 142), partial carinal resection (n = 5), bronchial sleeve resection (n = 231), pneumonectomy with stump-less carinal closure (n = 815), and bronchopleural/tracheopleural fistula repair (n = 152). Intraoperative airway management included selective one-lung volume-controlled ventilation (OLV), catheter-based high-frequency jet ventilation (HFJV), and combined/apnoeic techniques. RESULTS: No intraoperative deaths occurred, and no complications were directly attributable to ventilation failure. Five transient intraoperative anesthetic incidents occurred in patients with severe cardiopulmonary comorbidities: arterial hypotension (n = 1), supraventricular arrhythmias (n = 2), and asystole/cardiac arrest (n = 2), all successfully resolved. Major postoperative complications occurred in 109 patients (8.1%); 18 patients (1.3%) had complications potentially related to airway management (atelectasis, n = 4; pneumonia, n = 6; acute respiratory distress syndrome, n = 8). Overall 30-day mortality was 0.9% (13/1,345). Mortality was 0% in isolated bronchial resections (0/231), 2.1% after circumferential carinal resection (3/142), 1.3% in post-pneumonectomy fistula repairs (2/152), and 0.98% in stump-less carinal closures (8/815). CONCLUSIONS: A procedure-tailored ventilation strategy provides safe and reliable intraoperative gas exchange. For carinal reconstructions, catheter-based HFJV is technically advantageous by avoiding bulky tubes in the operative field. For isolated bronchial sleeve resections, conventional selective OLV is sufficient. Managing post-pneumonectomy fistulas requires adaptable maneuvers to maintain gas exchange during induction and airway transection.
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Authors Д Б Гиллер, Arina A Arzamasova, Boris Dmitrievich Giller, Alexander E Starozhinsky, Alexander Vladimirovich Ustinov, Igor V. Smirnov, Inga Igorevna Enilenis, Vadim Valerievich Koroev, Oleg Sh. Kesaev, Galina Vladimirovna Shcherbakova, Патимат Гаджиевна Гаджиева, Ludmila P Severova, Alexander D Chuischev, Darya N Kurakina, Ivan Ivanovich Martel
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Journal Interdisciplinary CardioVascular and Thoracic Surgery
Year 2026
DOI
10.1093/icvts/ivag303
URL
https://academic.oup.com/icvts/advance-article-pdf/doi/10.1093/icvts/ivag303/72682959/ivag303.pdf
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