*Purpose: Destroyed lungs can cause mediastinal displacement, asymmetric chest deformity, and high risk and difficulty of surgery. Until now, there are few reports about bilateral lung transplantation for destroyed lungs with asymmetric thorax. In this paper, we report two methods of bilateral lung transplantation for destroyed lungs with asymmetric thorax and introduce our clinical experience.

*Methods: A total of six patients with destroyed lungs from 2005-2020 were included in the study. Six candidates received bilateral LT in this period of time at Wuxi Center. Clinical data of the three patients were collected to investigate the safety and feasibility of the surgery.

*Results: Three patients used the anterolateral incision in the lateral position without transecting the sternum while three patients used the clam-shell incision in the supine position with transecting the sternum. Only one patient in the lateral position group was assisted by V-A ECMO during the operation; three patients in the lateral position group underwent size-matched lung transplantation. The right upper lobe, right lower lobe, and left upper lobe were removed respectively. In the supine position group, only one patient underwent size-matched lung transplantation, with the right middle lobe removing. For the other two patients, we separated mediastinal adhesions to promote mediastinal reposition. All patients were successfully transferred to ICU for monitoring and treatment.Patients in the lateral position group had more blood loss, operation time, and postoperative hospital stay compared to the supine position group. However, there was no significant statistical difference. One month after the operation, CT illustrated that the donor’s lung was well expanded, and the mediastinum was reset.

*Conclusions: It is safe and feasible with sufficient preoperative preparation and evaluation for patients with destroyed lungs. The surgical method in the supine position can restore the mediastinum by loosening the mediastinal adhesions, contributing to preserving the lung function of the donor’s lung to the greatest extent. The surgical method in the lateral position has a better field of vision and is easier to remove the destroyed lung, especially for patients with old tuberculosis.

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