Left Atrial and Pulmonary Cuff Dissection After Heart and Lung En-Bloc Procurement

This video demonstrates pulmonary cuff dissection for combined heart and lung procurement, utilizing an approach in which the pulmonary and left atrial cuffs are carefully dissected and tailored to optimize organ suitability. Maximizing the length and integrity of the left atrial cuff is critical for successful lung transplantation. An inadequate cuff can cause severe technical difficulty, require reconstruction, or even lead to organ discard. The technique shown emphasizes dissection behind the pericardium to expose the intrapericardial pulmonary veins, following the plane toward the interatrial groove to ensure an adequate rim of atrial muscle around each vein orifice. Performing cuff dissection at the back table improves exposure and mobility, allowing the surgeon to rotate the organ and optimize the angle and control of the scissors during trimming—actions that help preserve cuff length and tissue integrity. 
 
When hearts and lungs are procured separately, the left atrial wall is divided to ensure that both grafts retain sufficient tissue. The incision is carried in a manner that balances cuff length for the lungs while preserving cardiac needs. Care is taken to avoid excessive traction or tearing of the atrial wall, as this could produce a marginal cuff requiring reconstruction with donor pericardium, a pulmonary artery remnant, or a biologic patch. Where feasible, the left atrial incision is positioned to preserve the medial margin near the pulmonary vein orifices, and the main pulmonary artery is transected at the planned cannulation level. Throughout the procedure, close coordination between the heart and lung procurement teams is essential. The lung surgeon should confirm the adequacy of the pulmonary venous cuff before the final cardiac division, and mutual understanding of priorities maximizes graft utility. This coordinated, technique-focused approach helps expand the pool of usable organs and reduces the need for intraoperative reconstructive surgery. 

This video submission is from the 2026 CTSNet Instructional Video Competition. Stay tuned to CTSNet.org and the CTSNet YouTube channel in the coming weeks to watch all entries from the competition, including the winning videos.  

References

1. Dalal AR, Rinewalt DE, MacArthur JW, Shudo Y, Woo YJ. Operative Techniques and Pitfalls in Donor Bilateral Lung Procurement. Transplant Proc. 2020;52(3):954-7.1.
2. Krishnan P, Saddoughi SS. Procurement of lungs from brain-dead donors. Indian J Thorac Cardiovasc Surg. 2021;37(Suppl 3):416-24.

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