Comparing Right- Versus Left-First Implantation in Off-Pump Sequential Double-Lung Transplantation: An Observational Cohort Study

The article evaluates the outcomes of a paradigm shift in lung transplantation. Traditionally, the lung with the lowest perfusion was implanted first to minimize intraoperative hemodynamic instability. However, this single-center study of 696 cases from 2008 to 2021 investigated the impact of consistently implanting the right lung first, irrespective of perfusion.  The main findings revealed that the right-first strategy significantly reduced the need for intraoperative extracorporeal membrane oxygenation (ECMO) during second-lung implantation and showed a trend toward reduced incidence of primary graft dysfunction (PGD) grade 3. Secondary outcomes, including survival and ICU stays, did not differ between groups.