Emily M Todd1, Sreeja Biswas Roy2, A Samad Hashimi3, Rosemarie Serrone4, Roshan Panchanathan5, Paul Kang6, Katherine E Varsch7, Barry E Steinbock1, Jasmine Huang3, Ashraf Omar8, Vipul Patel8, Rajat Walia8, Michael A Smith3, Ross M Bremner9. 1. Perfusion Department, St. Joseph's Hospital and Medical Center, Phoenix, Ariz. 2. Department of Research Grants, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz. 3. Division of Thoracic Surgery, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz. 4. Department of Surgery, St. Joseph's Hospital and Medical Center, Phoenix, Ariz. 5. University of Arizona College of Medicine, University of Arizona, Phoenix, Ariz. 6. University of Arizona College of Public Health, University of Arizona, Phoenix, Ariz. 7. Department of Lung Transplantation, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz. 8. Division of Pulmonology, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz. 9. Division of Thoracic Surgery, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Ariz. Electronic address: Ross.Bremner@dignityhealth.org.
Abstract
OBJECTIVE: Extracorporeal membrane oxygenation has been used as a bridge to lung transplantation in patients with rapid pulmonary function deterioration. The reported success of this modality and perioperative and functional outcomes are varied. METHODS: We retrospectively reviewed all patients who underwent lung transplantation at our institution over 1 year (January 1, 2015, to December 31, 2015). Patients were divided into 2 groups depending on whether they required extracorporeal membrane oxygenation support as a bridge to transplant; preoperative characteristics, lung transplantation outcomes, and survival were compared between groups. RESULTS: Of the 93 patients, 12 (13%) received bridge to transplant, and 81 (87%) did not. Patients receiving bridge to transplant were younger, had higher lung allocation scores, had lower functional status, and were more often on mechanical ventilation at listing. Most patients who received bridge to transplant (n = 10, 83.3%) had pulmonary fibrosis. Mean pretransplant extracorporeal membrane oxygenation support was 103.6 hours in duration (range, 16-395 hours). All patients who received bridge to transplant were decannulated immediately after lung transplantation but were more likely to return to the operating room for secondary chest closure or rethoracotomy. Grade 3 primary graft dysfunction within 72 hours was similar between groups. Lung transplantation success and hospital discharge were 100% in the bridge to transplant group; however, these patients experienced longer hospital stays and higher rates of discharge to acute rehabilitation. The 1-year survival was 100% in the bridge to transplant group and 91% in the non-bridge to transplant group (log-rank, P = .24). The 1-year functional status was excellent in both groups. CONCLUSIONS: Extracorporeal membrane oxygenation can be used to safely bridge high-acuity patients with end-stage lung disease to lung transplantation with good 30-day, 90-day, and 1-year survival and excellent 1-year functional status. Long-term outcomes are being studied.
OBJECTIVE: Extracorporeal membrane oxygenation has been used as a bridge to lung transplantation in patients with rapid pulmonary function deterioration. The reported success of this modality and perioperative and functional outcomes are varied. METHODS: We retrospectively reviewed all patients who underwent lung transplantation at our institution over 1 year (January 1, 2015, to December 31, 2015). Patients were divided into 2 groups depending on whether they required extracorporeal membrane oxygenation support as a bridge to transplant; preoperative characteristics, lung transplantation outcomes, and survival were compared between groups. RESULTS: Of the 93 patients, 12 (13%) received bridge to transplant, and 81 (87%) did not. Patients receiving bridge to transplant were younger, had higher lung allocation scores, had lower functional status, and were more often on mechanical ventilation at listing. Most patients who received bridge to transplant (n = 10, 83.3%) had pulmonary fibrosis. Mean pretransplant extracorporeal membrane oxygenation support was 103.6 hours in duration (range, 16-395 hours). All patients who received bridge to transplant were decannulated immediately after lung transplantation but were more likely to return to the operating room for secondary chest closure or rethoracotomy. Grade 3 primary graft dysfunction within 72 hours was similar between groups. Lung transplantation success and hospital discharge were 100% in the bridge to transplant group; however, these patients experienced longer hospital stays and higher rates of discharge to acute rehabilitation. The 1-year survival was 100% in the bridge to transplant group and 91% in the non-bridge to transplant group (log-rank, P = .24). The 1-year functional status was excellent in both groups. CONCLUSIONS: Extracorporeal membrane oxygenation can be used to safely bridge high-acuity patients with end-stage lung disease to lung transplantation with good 30-day, 90-day, and 1-year survival and excellent 1-year functional status. Long-term outcomes are being studied.
Authors: Nicholas A Kolaitis; Allison Soong; Pavan Shrestha; Hanjing Zhuo; John Neuhaus; Patti P Katz; John R Greenland; Jeffrey Golden; Lorriana E Leard; Rupal J Shah; Steven R Hays; Jasleen Kukreja; Mary Ellen Kleinhenz; Paul D Blanc; Jonathan P Singer Journal: J Thorac Cardiovasc Surg Date: 2018-02-22 Impact factor: 5.209
Authors: Pradnya D Patil; Samir Sultan; M Frances Hahn; Sreeja Biswas Roy; Mitchell D Ross; Hesham Abdelrazek; Ross M Bremner; Nitika Thawani; Rajat Walia; Tanmay S Panchabhai Journal: Respir Med Case Rep Date: 2018-06-12