Intraoperative Support for Primary Bilateral Lung Transplantation: A Propensity-Matched Analysis |
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| Institution: | 1. Division of Pulmonary and Critical Care Medicine, Department of Medicine;2. Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, New York;1. Ted Rogers Centre for Heart Research, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada;2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;3. Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;4. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada;5. New York City Department of Health and Mental Hygiene, New York City Government, New York City, New York;6. Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia;7. Facultad de Medicina, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia;8. Ajmera Transplant Program, University Health Network, Toronto, Ontario, Canada |
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| Abstract: | BackgroundSingle-center studies support benefits of venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a method of intraoperative support. Propensity-matched data from a large cohort, however, are currently lacking. Therefore, our goal was to compare outcomes of intraoperative VA-ECMO and cardiopulmonary bypass (CPB) during bilateral lung transplantation (LTx) with a propensity analysis.MethodsWe performed a retrospective analysis of 795 consecutive primary adult LTx patients (June 1, 2011-December 26, 2020) using no intraoperative support (n = 210), VA-ECMO (n = 150), or CPB (n = 197). Exclusion criteria included LTx on venovenous-ECMO, single/redo LTx, ex vivo lung perfusion, and concomitant solid-organ transplantation or cardiac procedure. Propensity analysis was performed comparing patients who underwent intraoperative CPB or VA-ECMO.ResultsThe propensity CPB group required more blood products at 72 hours (P = .02) and longer intensive care unit length of stay (P < .001) and ventilator dependence days (P < .001). There were no differences in cerebrovascular accident (P = 1), reintubation (P = .4), dialysis (P = .068), in-hospital mortality (P = .33), and 1-year (P = .67) and 3-year (P = .32) survival. The CPB group had a higher incidence of grade 3 primary graft dysfunction at 72 hours (P < .001). Neither support strategy was a predictor of 1- and 3-year mortality in our multivariable model (VA-ECMO, P = .72 and P = .57; CPB, P = .45 and P = .91, respectively).ConclusionsIntraoperative VA-ECMO during lung transplantation was associated with fewer postoperative blood transfusions, shorter length of mechanical ventilation, and lower incidence of a grade 3 primary graft dysfunction at 72 hours. Although there were some differences in the postoperative course between the VA-ECMO and CPB groups, support type was not associated with differences in survival. |
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| Keywords: | CCI"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"Charlson Comorbidity Index CPB"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"cardiopulmonary bypass ICU"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"intensive care unit LAS"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"lung allocation score LTx"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"lung transplantation NIS"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"no intraoperative support PGD"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"primary graft dysfunction VA-ECMO"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"venoarterial extracorporeal membrane oxygenation VV-ECMO"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"venovenous extracorporeal membrane oxygenation |
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