Fabio Ius1, Wiebke Sommer2, Igor Tudorache1, Murat Avsar1, Thierry Siemeni1, Jawad Salman1, Ulrich Molitoris1, Clemens Gras3, Bjoern Juettner3, Jakob Puntigam1, Joerg Optenhoefel1, Mark Greer4, Nicolaus Schwerk5, Jens Gottlieb6, Tobias Welte6, Marius M Hoeper6, Axel Haverich2, Christian Kuehn1, Gregor Warnecke7. 1. Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany. 2. Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany. 3. Department of Anaesthesiology. 4. Department of Respiratory Medicine. 5. Department of Paediatrics, Hanover Medical School, Hanover, Germany. 6. Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany; Department of Respiratory Medicine. 7. Department of Cardiothoracic, Transplant and Vascular Surgery, Hanover Medical School, Hanover, Germany; Biomedical Research in End-Stage and Obstructive Lung Disease Hanover (BREATH), Member of the German Center for Lung Research (DZL), Hanover, Germany. Electronic address: warnecke.gregor@mh-hannover.de.
Abstract
BACKGROUND: Since April 2010, extracorporeal membrane oxygenation (ECMO) has replaced cardiopulmonary bypass for intraoperative support during lung transplantation at our institution. The aim of this study was to present our 5-year experience with this technique. METHODS: Records of patients who underwent transplantation between April 2010 and January 2015 were retrospectively reviewed. Patients who underwent transplantation without ECMO formed Group A. Patients in whom the indication for ECMO support was set a priori before the beginning of the operation formed Group B. The remaining patients in whom the indication for ECMO support was set during transplantation formed Group C. RESULTS: Among 595 patients, 425 (71%) patients (Group A) did not require intraoperative ECMO; the remaining 170 (29%) patients did. Among these patients, 95 (56%) patients formed Group B, and the remaining 75 (44%) patients comprised Group C. Pulmonary fibrosis and pre-operative dilated or hypertrophied right ventricle emerged as risk factors for the indication of non-a priori intraoperative ECMO. Patients in Groups B and C showed a higher pre-operative risk profile and higher prevalence of post-operative complications than patients in Group A. Overall survival at 1 year was 93%, 83%, and 82% and at 4 years was 73%, 68%, and 69% in Groups A, B, and C (p = 0.11). The intraoperative use of ECMO did not emerge as a risk factor for in-hospital mortality or mortality after hospital discharge. CONCLUSIONS: Intraoperative ECMO filled the gap between pre-operative and post-operative ECMO in lung transplantation. Although complications and in-hospital mortality were higher in patients who received ECMO, survival was similar among patients who underwent transplantation with or without ECMO.
BACKGROUND: Since April 2010, extracorporeal membrane oxygenation (ECMO) has replaced cardiopulmonary bypass for intraoperative support during lung transplantation at our institution. The aim of this study was to present our 5-year experience with this technique. METHODS: Records of patients who underwent transplantation between April 2010 and January 2015 were retrospectively reviewed. Patients who underwent transplantation without ECMO formed Group A. Patients in whom the indication for ECMO support was set a priori before the beginning of the operation formed Group B. The remaining patients in whom the indication for ECMO support was set during transplantation formed Group C. RESULTS: Among 595 patients, 425 (71%) patients (Group A) did not require intraoperative ECMO; the remaining 170 (29%) patients did. Among these patients, 95 (56%) patients formed Group B, and the remaining 75 (44%) patients comprised Group C. Pulmonary fibrosis and pre-operative dilated or hypertrophied right ventricle emerged as risk factors for the indication of non-a priori intraoperative ECMO. Patients in Groups B and C showed a higher pre-operative risk profile and higher prevalence of post-operative complications than patients in Group A. Overall survival at 1 year was 93%, 83%, and 82% and at 4 years was 73%, 68%, and 69% in Groups A, B, and C (p = 0.11). The intraoperative use of ECMO did not emerge as a risk factor for in-hospital mortality or mortality after hospital discharge. CONCLUSIONS: Intraoperative ECMO filled the gap between pre-operative and post-operative ECMO in lung transplantation. Although complications and in-hospital mortality were higher in patients who received ECMO, survival was similar among patients who underwent transplantation with or without ECMO.
Authors: Woo Sik Yu; Hyo Chae Paik; Seok Jin Haam; Chang Young Lee; Kyung Sik Nam; Hee Suk Jung; Young Woo Do; Jee Won Shu; Jin Gu Lee Journal: J Thorac Dis Date: 2016-07 Impact factor: 2.895
Authors: Bernhard Moser; Peter Jaksch; Shahrokh Taghavi; Gabriella Muraközy; Georg Lang; Helmut Hager; Claus Krenn; Georg Roth; Peter Faybik; Andreas Bacher; Clemens Aigner; José R Matilla; Konrad Hoetzenecker; Philipp Hacker; Irene Lang; Walter Klepetko Journal: Eur J Cardiothorac Surg Date: 2018-01-01 Impact factor: 4.191