BACKGROUND: Bilateral lung transplantation (BLTx) is an established treatment for end-stage pulmonary hypertension (PH). Ventilator weaning failure and death are more common as in BLTx for other indications. We hypothesized that left ventricular (LV) dysfunction is the main cause of early postoperative morbidity or mortality and investigated a weaning strategy using awake venoarterial extracorporeal membrane oxygenation (ECMO). METHODS: In 23 BLTx for severe PH, ECMO used during BLTx was continued for a minimum of 5 days (BLTx-ECMO group). Echocardiography, left atrial (LA) and Swan-Ganz catheters were used for monitoring. Early extubation after transplantation was attempted under continued ECMO. RESULTS: Preoperatively, all patients had severely reduced cardiac index (mean, 2.1 L/min/m2). On postoperative day 2, reduction of ECMO flow resulted in increasing LA and decreasing systemic blood pressures. On the day of ECMO explantation (median, postoperative day 8), LV diameter had increased; LA and blood pressures remained stable. Survival rates at 3 and 12 months were 100% and 96%, respectively. Data were compared to two historic control groups of BLTx without ECMO (BLTx ventilation) or combined heart-lung transplantation for severe PH. CONCLUSION: Early after BLTx for severe PH, the LV may be unable to handle normalized LV preload. This can be effectively bridged with awake venoarterial ECMO.
BACKGROUND: Bilateral lung transplantation (BLTx) is an established treatment for end-stage pulmonary hypertension (PH). Ventilator weaning failure and death are more common as in BLTx for other indications. We hypothesized that left ventricular (LV) dysfunction is the main cause of early postoperative morbidity or mortality and investigated a weaning strategy using awake venoarterial extracorporeal membrane oxygenation (ECMO). METHODS: In 23 BLTx for severe PH, ECMO used during BLTx was continued for a minimum of 5 days (BLTx-ECMO group). Echocardiography, left atrial (LA) and Swan-Ganz catheters were used for monitoring. Early extubation after transplantation was attempted under continued ECMO. RESULTS: Preoperatively, all patients had severely reduced cardiac index (mean, 2.1 L/min/m2). On postoperative day 2, reduction of ECMO flow resulted in increasing LA and decreasing systemic blood pressures. On the day of ECMO explantation (median, postoperative day 8), LV diameter had increased; LA and blood pressures remained stable. Survival rates at 3 and 12 months were 100% and 96%, respectively. Data were compared to two historic control groups of BLTx without ECMO (BLTx ventilation) or combined heart-lung transplantation for severe PH. CONCLUSION: Early after BLTx for severe PH, the LV may be unable to handle normalized LV preload. This can be effectively bridged with awake venoarterial ECMO.
Authors: Mary K Porteous; James C Lee; David J Lederer; Scott M Palmer; Edward Cantu; Rupal J Shah; Scarlett L Bellamy; Vibha N Lama; Sangeeta M Bhorade; Maria M Crespo; John F McDyer; Keith M Wille; A Russell Localio; Jonathan B Orens; Pali D Shah; Ann B Weinacker; Selim Arcasoy; David S Wilkes; Lorraine B Ware; Jason D Christie; Steven M Kawut; Joshua M Diamond Journal: Ann Am Thorac Soc Date: 2017-10
Authors: F Schmidt; T Jack; M Sasse; T Kaussen; H Bertram; A Horke; K Seidemann; P Beerbaum; H Koeditz Journal: Pediatr Cardiol Date: 2015-06-07 Impact factor: 1.655
Authors: Marius M Hoeper; Hossein-Ardeschir Ghofrani; Ekkehard Grünig; Hans Klose; Horst Olschewski; Stephan Rosenkranz Journal: Dtsch Arztebl Int Date: 2017-02-03 Impact factor: 5.594
Authors: Mary K Porteous; Bonnie Ky; James N Kirkpatrick; Russell Shinohara; Joshua M Diamond; Rupal J Shah; James C Lee; Jason D Christie; Steven M Kawut Journal: Am J Respir Crit Care Med Date: 2016-06-15 Impact factor: 21.405