Extracorporeal life support during and after bilateral sequential lung transplantation in patients with pulmonary artery hypertension

Autor: Guido Frascaroli, Giampiero Dolci, Massimo Baiocchi, Alessio Campisi, Sara Mazzarra, Andrea Dell’Amore, Saverio Pastore, Stefano Congiu
Rok vydání: 2020
Předmět:
Male
medicine.medical_treatment
Medicine (miscellaneous)
02 engineering and technology
030204 cardiovascular system & hematology
law.invention
0302 clinical medicine
law
pulmonary hypertension
Medicine
Hospital Mortality
Pulmonary Arterial Hypertension
Cardiopulmonary Bypass
Incidence
General Medicine
Middle Aged
Treatment Outcome
surgical procedures
operative
Female
Lung Transplantation
Adult
medicine.medical_specialty
0206 medical engineering
Biomedical Engineering
Primary Graft Dysfunction
Bioengineering
Extracorporeal
Biomaterials
Young Adult
03 medical and health sciences
Extracorporeal Membrane Oxygenation
medicine.artery
Cardiopulmonary bypass
Extracorporeal membrane oxygenation
Humans
Lung transplantation
Retrospective Studies
Postoperative Care
Intraoperative Care
business.industry
extracorporeal support technique
medicine.disease
020601 biomedical engineering
Pulmonary hypertension
Surgery
cardiopulmonary bypass
extracorporeal membrane oxygenation
lung transplantation
Life support
Pulmonary artery
business
Follow-Up Studies
Zdroj: Artificial Organs. 44:628-637
ISSN: 1525-1594
0160-564X
DOI: 10.1111/aor.13628
Popis: The use of extracorporeal membrane oxygenator instead of standard cardiopulmonary bypass during lung transplantation is debatable. Moreover, recently, the concept of prolonged postoperative extracorporeal membrane oxygenator (ECMO) support has been introduced in many transplant centers to prevent primary graft dysfunction (PGD) and improve early and long-term results. The objective of this study was to review the results of our extracorporeal life support strategy during and after bilateral sequential lung transplantation (BSLT) for pulmonary artery hypertension. We review retrospectively our experience in BSLT for pulmonary artery hypertension between January 2010 and August 2018. A total of 38 patients were identified. Nine patients were transplanted using cardiopulmonary bypass (CPB), in eight cases CPB was followed by a prolonged ECMO (pECMO) support, 14 patients were transplanted on central ECMO support, and seven patients were transplanted with central ECMO support followed by a pECMO assistance. The effects of different support strategies were evaluated, in particular in-hospital morbidity, mortality, incidence of PGD, and long-term follow-up. The use of CPB was associated with poor postoperative results and worse long-term survival compared with ECMO-supported patients. Predictive preoperative factors for the need of intraoperative CPB instead of ECMO were identified. The pECMO strategy had a favorable effect to mitigate postoperative morbidity and mortality, not only in intraoperative ECMO-supported patients, but even in CPB-supported cases. In our experience, ECMO may be considered as the first choice circulatory support for lung transplantation. Sometimes, in very complex cases, CBP is still necessary. The pECMO strategy is very effective to reduce incidence of PGD even in CPB-supported patients.
Databáze: OpenAIRE
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