Julien Fessler1, Maxime Davignon1, Edouard Sage2, Antoine Roux3, Charles Cerf4, Elodie Feliot5, Etienne Gayat5, Francois Parquin2, Marc Fischler6, Morgan Le Guen1. 1. Department of Anesthesiology, Hôpital Foch, 9250 Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France. 2. Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France; Department of Thoracic Surgery, Hôpital Foch, 9250 Suresnes, France. 3. Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France; Department of Pneumology, Hôpital Foch, 9250 Suresnes, France. 4. Department of Intensive Care, Hôpital Foch, 9250 Suresnes, France. 5. Department of Anesthesiology and Critical Care Medicine, Hôpital Saint Louis - Lariboisière, 75010 Paris, France; Institut National de la Santé et de la Recherche Médicale, 75654 Paris, France. 6. Department of Anesthesiology, Hôpital Foch, 9250 Suresnes, France; Université Versailles-Saint-Quentin-en-Yvelines, 78646 Versailles, France. Electronic address: m.fischler@hopital-foch.com.
Abstract
OBJECTIVES: To compare intraoperative patterns among patients based on their primary pulmonary disease (cystic fibrosis [CF], chronic obstructive pulmonary disease [COPD]/emphysema [CE], and pulmonary fibrosis [PF]) during double- lung transplantation. The following 3 major outcomes were reported: blood transfusion, extracorporeal membrane oxygenation (ECMO) management, and the possibility of immediate extubation at the end of surgery. DESIGN: Retrospective analysis of a prospectively maintained database, including donor and recipient characteristics and intraoperative variables. SETTING: Foch Hospital, Suresnes, France (academic center performing 60-80 lung transplantations per year). PARTICIPANTS: Patients who underwent double- lung transplantation from 2012-2019. Patients with retransplantation, multiorgan transplantation, or surgery performed with cardiopulmonary bypass were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred forty-six patients had CF, 117 had CE, and 66 had PF. No patient had primary pulmonary arterial hypertension. Blood transfusion was higher in the CF group than in the other 2 groups (red blood cells [p < 0.001], fresh frozen plasma [p = 0.004]). The CF and CE groups were characterized by a lower intraoperative requirement of ECMO (p = 0.002), and the PF group more frequently required postoperative ECMO (p < 0.001). CF and CE patients were more frequently extubated in the operating room than were PF patients (37.4%, 50.4%, and 13.6%, respectively; p < 0.001). CONCLUSIONS: Intraoperative outcomes differed depending on the initial pathology. Such differences should be taken into account in specific clinical studies and in intraoperative management protocols.
OBJECTIVES: To compare intraoperative patterns among patients based on their primary pulmonary disease (cystic fibrosis [CF], chronic obstructive pulmonary disease [COPD]/emphysema [CE], and pulmonary fibrosis [PF]) during double- lung transplantation. The following 3 major outcomes were reported: blood transfusion, extracorporeal membrane oxygenation (ECMO) management, and the possibility of immediate extubation at the end of surgery. DESIGN: Retrospective analysis of a prospectively maintained database, including donor and recipient characteristics and intraoperative variables. SETTING: Foch Hospital, Suresnes, France (academic center performing 60-80 lung transplantations per year). PARTICIPANTS: Patients who underwent double- lung transplantation from 2012-2019. Patients with retransplantation, multiorgan transplantation, or surgery performed with cardiopulmonary bypass were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two hundred forty-six patients had CF, 117 had CE, and 66 had PF. No patient had primary pulmonary arterial hypertension. Blood transfusion was higher in the CF group than in the other 2 groups (red blood cells [p < 0.001], fresh frozen plasma [p = 0.004]). The CF and CE groups were characterized by a lower intraoperative requirement of ECMO (p = 0.002), and the PF group more frequently required postoperative ECMO (p < 0.001). CF and CE patients were more frequently extubated in the operating room than were PF patients (37.4%, 50.4%, and 13.6%, respectively; p < 0.001). CONCLUSIONS: Intraoperative outcomes differed depending on the initial pathology. Such differences should be taken into account in specific clinical studies and in intraoperative management protocols.