Impact of preoperative right-ventricular function and platelet transfusion on outcome after lung transplantation
| Autor: | Caroline Thalmann, Annette Boehler, Burkhardt Seifert, Donat R. Spahn, Jaya D’cunja, Walter Weder, Marco P. Zalunardo |
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| Přispěvatelé: | University of Zurich, Zalunardo, M P |
| Jazyk: | angličtina |
| Rok vydání: | 2011 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Lung Diseases Male medicine.medical_specialty 10216 Institute of Anesthesiology 10255 Clinic for Thoracic Surgery medicine.medical_treatment Ventricular Dysfunction Right 610 Medicine & health Platelet Transfusion 2705 Cardiology and Cardiovascular Medicine law.invention Postoperative Complications law Intensive care medicine Lung transplantation Humans Hospital Mortality Retrospective Studies Mechanical ventilation business.industry General Medicine Perioperative 10060 Epidemiology Biostatistics and Prevention Institute (EBPI) Length of Stay Middle Aged Intensive care unit Survival Analysis Surgery 2746 Surgery Transplantation Platelet transfusion Treatment Outcome 2740 Pulmonary and Respiratory Medicine Anesthesia Preoperative Period Female Fresh frozen plasma 10178 Clinic for Pneumology Cardiology and Cardiovascular Medicine business Lung Transplantation |
| Popis: | Objective: Lung transplantation has become an established treatment option for end-stage pulmonary diseases. However, outcome depends on preoperative condition and co-morbidity. Furthermore, perioperative blood-product use is known to be associated with worse outcome even in transplant surgery. We investigated the impact of poor preoperative right-ventricular function and blood-product use on outcome after lung transplantation. Methods: The medical records of 169 lung-transplant recipients from 1996 to 2006 were examined. Duration of hospital stay, hours on mechanical ventilation, duration of stay in the intensive care unit, perioperative complications, death during hospital stay, and long-term survival were recorded. These outcome parameters were analyzed regarding coherence with right-ventricular function and the perioperative administration of crystalloids, colloids, allogeneic red blood cells, fresh frozen plasma, and platelets. Results: Patients with poor preoperative right-ventricular function had a significant increase in postoperative hours on ventilation (p=0.005), intensive care stay (p=0.003), and in-hospital death (p=0.012). The hours on ventilation increased also with high intra-operative fluid administration (p=0.026). Blood-product use was associated with prolonged mechanical ventilation and intensive care stay. After multivariate analysis, transfusion of platelets (p=0.022) was an independent prognostic factor for in-hospital death. Hours of mechanical ventilation was the only independent prognostic factor for long-term mortality (p=0.014). Conclusions: Perioperative transfusion of platelets is an independent prognostic factor for perioperative mortality. Furthermore, the study indicated that poor preoperative right-ventricular function might worsen perioperatively after lung transplantation. Therefore, pre-transplant treatment of pulmonary hypertension to protract right-ventricular failure and a restrictive use of allogeneic blood products may be options to improve outcome. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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