Konrad Hoetzenecker1, Stefan Schwarz1, Moritz Muckenhuber1, Alberto Benazzo1, Florian Frommlet2, Thomas Schweiger1, Orsolya Bata3, Peter Jaksch1, Negar Ahmadi4, Gabriella Muraközy1, Helmut Prosch5, Helmut Hager6, Georg Roth6, György Lang7, Shahrokh Taghavi1, Walter Klepetko8. 1. Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria. 2. Department of Medical Statistics, Medical University of Vienna, Vienna, Austria. 3. Department of Radiology, National Institute of Oncology, Budapest, Hungary. 4. Department of General Surgery, University of Ottawa, Ottawa, Ontario, Canada. 5. Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria. 6. Department of Anaesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria. 7. Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria; Department of Thoracic Surgery, Semmelweis University, Budapest, Hungary. 8. Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria. Electronic address: walter.klepetko@meduniwien.ac.at.
Abstract
OBJECTIVES: The value of intraoperative extracorporeal membrane oxygenation (ECMO) in lung transplantation remains controversial. In our department, ECMO has been used routinely for intraoperatively unstable patients for more than 15 years. Recently, we have extended its indication to a preemptive application in almost all cases. In addition, we prolong ECMO into the early postoperative period whenever graft function does not meet certain quality criteria or in patients with primary pulmonary hypertension. The objective of this study was to review the results of this strategy. METHODS: All standard bilateral lung transplantations performed between January 2010 and June 2016 were included in this single-center, retrospective analysis. Patients were divided into 3 groups: group I-no ECMO (n = 116), group II-intraoperative ECMO (n = 343), and group III-intraoperative and prolonged postoperative ECMO (n = 123). The impact of different ECMO strategies on primary graft function, short-term outcomes, and patient survival were analyzed. RESULTS: The use of intraoperative ECMO was associated with improved 1-, 3-, and 5-year survival compared with non-ECMO patients (91% vs 82%, 85% vs 76%, and 80% vs 74%; log-rank P = .041). This effect was still evident after propensity score matching of both cohorts. Despite the high number of complex patients in group III, outcome was excellent with higher survival rates than in the non-ECMO group at all time points. CONCLUSIONS: Intraoperative ECMO results in superior survival when compared with transplantation without any extracorporeal support. The concept of prophylactic postoperative ECMO prolongation is associated with excellent outcomes in recipients with pulmonary hypertension and in patients with questionable graft function at the end of implantation.
OBJECTIVES: The value of intraoperative extracorporeal membrane oxygenation (ECMO) in lung transplantation remains controversial. In our department, ECMO has been used routinely for intraoperatively unstable patients for more than 15 years. Recently, we have extended its indication to a preemptive application in almost all cases. In addition, we prolong ECMO into the early postoperative period whenever graft function does not meet certain quality criteria or in patients with primary pulmonary hypertension. The objective of this study was to review the results of this strategy. METHODS: All standard bilateral lung transplantations performed between January 2010 and June 2016 were included in this single-center, retrospective analysis. Patients were divided into 3 groups: group I-no ECMO (n = 116), group II-intraoperative ECMO (n = 343), and group III-intraoperative and prolonged postoperative ECMO (n = 123). The impact of different ECMO strategies on primary graft function, short-term outcomes, and patient survival were analyzed. RESULTS: The use of intraoperative ECMO was associated with improved 1-, 3-, and 5-year survival compared with non-ECMO patients (91% vs 82%, 85% vs 76%, and 80% vs 74%; log-rank P = .041). This effect was still evident after propensity score matching of both cohorts. Despite the high number of complex patients in group III, outcome was excellent with higher survival rates than in the non-ECMO group at all time points. CONCLUSIONS: Intraoperative ECMO results in superior survival when compared with transplantation without any extracorporeal support. The concept of prophylactic postoperative ECMO prolongation is associated with excellent outcomes in recipients with pulmonary hypertension and in patients with questionable graft function at the end of implantation.
Authors: Marc de Perrot; Karen McRae; Laura Donahoe; Etienne Abdelnour-Berchtold; John Thenganatt; John Granton Journal: Ann Cardiothorac Surg Date: 2022-03
Authors: Alberto Benazzo; Nina Worel; Stefan Schwarz; Ulrike Just; Anna Nechay; Christoph Lambers; Georg Böhmig; Gottfried Fischer; Daniela Koren; Gabriela Muraközy; Robert Knobler; Walter Klepetko; Konrad Hoetzenecker; Peter Jaksch Journal: Transfus Med Hemother Date: 2020-05-05 Impact factor: 3.747
Authors: Marius M Hoeper; Raymond L Benza; Paul Corris; Marc de Perrot; Elie Fadel; Anne M Keogh; Christian Kühn; Laurent Savale; Walter Klepetko Journal: Eur Respir J Date: 2019-01-24 Impact factor: 16.671
Authors: Ahmed E Hozain; Yuliya Tipograf; Meghan R Pinezich; Katherine M Cunningham; Rachel Donocoff; Dawn Queen; Kenmond Fung; Charles C Marboe; Brandon A Guenthart; John D O'Neill; Gordana Vunjak-Novakovic; Matthew Bacchetta Journal: J Thorac Cardiovasc Surg Date: 2019-10-17 Impact factor: 6.439
Authors: Philipp Foessleitner; Konrad Hoetzenecker; Alberto Benazzo; Katrin Klebermass-Schrehof; Anke Scharrer; Herbert Kiss; Alex Farr Journal: Am J Transplant Date: 2021-08-09 Impact factor: 9.369
Authors: Johannes Gratz; André Pausch; Eva Schaden; Andreas Baierl; Peter Jaksch; Friedrich Erhart; Konrad Hoetzenecker; Marion Wiegele Journal: Artif Organs Date: 2020-02-18 Impact factor: 3.094