Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation |
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Authors: | Konrad Hoetzenecker Stefan Schwarz Moritz Muckenhuber Alberto Benazzo Florian Frommlet Thomas Schweiger Orsolya Bata Peter Jaksch Negar Ahmadi Gabriella Muraközy Helmut Prosch Helmut Hager Georg Roth György Lang Shahrokh Taghavi Walter Klepetko |
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Affiliation: | 1. Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria;2. Department of Medical Statistics, Medical University of Vienna, Vienna, Austria;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;3. Department of Radiology, National Institute of Oncology, Budapest, Hungary;4. Department of General Surgery, University of Ottawa, Ottawa, Ontario, Canada;7. Department of Thoracic Surgery, Semmelweis University, Budapest, Hungary |
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Abstract: | ObjectivesThe 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.MethodsAll 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.ResultsThe 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.ConclusionsIntraoperative 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. |
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Keywords: | ECMO extracorporeal membrane oxygenation lung transplantation primary graft function mechanical support BOS bronchiolitis obliterans syndrome CPB cardiopulmonary bypass ECLS extracorporeal life support ECMO extracorporeal membrane oxygenation EVLP ex vivo lung perfusion Fr French ICU intensive care unit PGD primary graft dysfunction PPH primary pulmonary hypertension v/a venoarterial |
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