The Impact of Perioperative Bleeding on Long-Term Outcomes of Mechanical Circulatory Support
| Autor: | John M. Herre, A.C. Hoedt, B.H. Smith, U.M. Kelly, M.L. Mooney, C.J. Derber, P.W. Bourassa, K. Lietz, I. El Lakkis, M. McGrath, C.D. Wilson |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Pulmonary and Respiratory Medicine
Transplantation medicine.medical_specialty business.industry medicine.medical_treatment Hemodynamics Primary Graft Dysfunction Perioperative medicine.disease Surgery surgical procedures operative Concomitant medicine.artery Pulmonary fibrosis Pulmonary artery Medicine Lung transplantation Cardiology and Cardiovascular Medicine business Dialysis |
| Zdroj: | The Journal of Heart and Lung Transplantation. 34:S203-S204 |
| ISSN: | 1053-2498 |
| DOI: | 10.1016/j.healun.2015.01.558 |
| Popis: | s S203 since April 2010. ECMO may be instituted a priori or upon hemodynamic (or other) indication, which we aim to avoid if possible. Here we identify risk factors for intraoperative indication ECMO and compare results with those patients transplanted without ECMO support. Methods: Patients transplanted between April 2010 and February 2014 were retrospectively reviewed. Patients requiring intraoperative indication ECMO formed Group A, patients transplanted off-pump formed Group B. Patients with preoperative ECMO, idiopathic pulmonary artery hypertension or requiring a concomitant cardiac procedure, where intraoperative ECMO was employed a priori, were excluded. Results: Among 481 patients undergoing bilateral sequential lung transplantation, 67 (14%, Group A) underwent intraoperative indication ECMO implant and 328 (68%) patients (Group B) did not. Eighty-six (18%) patients, where ECMO was used a priori, were excluded from the study. Among group A patients, decision for using ECMO was set at clamping of the first (mostly right) pulmonary artery in 37 (55%) patients and later during the procedure in the remaining 30 (45%) patients. Veno-arterial ECMO was used in all 67 patients and was implanted emergently in only 10 (15%) of these. At multivariate analysis, pulmonary fibrosis (OR 2.5, 95%CI: 1.3-4.7, p= 0.004) and preoperative mean pulmonary artery pressure greater than 24mmHg (OR 2.3, 95%CI: 1.3-4.1, p= 0.005) were identified as risk factors for intraoperative indication ECMO. Postoperatively, more Group A than B patients showed primary graft dysfunction (35%vs.12%, p< 0.01), required revision for bleeding (13%vs.4%, p< 0.01), required intermittent dialysis (19%vs.4%, p< 0.01), or died in-hospital (13%vs.3%, p< 0.01). In Group A and B patients, at 1and 3-year follow-up, overall survival (%) was 82±5vs.92±1 and 73±6vs.78±3, respectively (p= 0.32). Conclusion: Pulmonary fibrosis and secondary pulmonary artery hypertension are predictors for the need of intraoperative indication ECMO. Of interest, 68% of the patients can safely be transplanted off-pump with excellent results and a further 18% may be assigned to an a priori ECMO cohort. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|