Abstract:MILT was successfully introduced at our centre as a novel operative strategy. Despite longer ischaemic times and a more complex operation and management, MILT appears to offer early postoperative and mid-term clinical benefits compared with our traditional approach of clamshell operations. These observations warrant larger definite studies to further evaluate the impact of MILT on physiological, clinical and patient-reported outcomes.
“…Patients treated with the minimally invasive lung transplantation (MILT) approach (n = 70) were compared with those treated with the clamshell operative approach (n = 124) in a single-center study of LTXs performed between 2010 and 2013. 48 The MILT approach was associated with longer ischemic times; however, the number of blood transfusions, duration of mechanical ventilation, and ICU stay were significantly less and PFTs were significantly better with the MILT approach. Overall survival rates were similar, and the author concluded that the MILT approach may offer potential benefits on early outcomes for LTX.…”
Section: Intraoperative Interventions and Outcomesmentioning
This article is first in the series to review the published literature on perioperative issues in patients undergoing thoracic solid organ transplantations. We present recent literature from 2016 on preoperative considerations, organ preservation, intraoperative anesthesia management, surgical techniques, postoperative complications, and the impact of perioperative management on short- and long-term outcomes that are pertinent to thoracic transplantation anesthesiologists.
“…Patients treated with the minimally invasive lung transplantation (MILT) approach (n = 70) were compared with those treated with the clamshell operative approach (n = 124) in a single-center study of LTXs performed between 2010 and 2013. 48 The MILT approach was associated with longer ischemic times; however, the number of blood transfusions, duration of mechanical ventilation, and ICU stay were significantly less and PFTs were significantly better with the MILT approach. Overall survival rates were similar, and the author concluded that the MILT approach may offer potential benefits on early outcomes for LTX.…”
Section: Intraoperative Interventions and Outcomesmentioning
This article is first in the series to review the published literature on perioperative issues in patients undergoing thoracic solid organ transplantations. We present recent literature from 2016 on preoperative considerations, organ preservation, intraoperative anesthesia management, surgical techniques, postoperative complications, and the impact of perioperative management on short- and long-term outcomes that are pertinent to thoracic transplantation anesthesiologists.
“…The study was not designed to elucidate the clinical determinants of PGD, however, no obvious donor or recipient characteristic was associated with the development of PGD. Intraoperative factors such as cardiopulmonary bypass and invasiveness of surgery were investigated, as these aspects have been suggested as potential risk factors 5 , 36 . Though not statistically significant, there was a tendency for higher use of cardiopulmonary bypass (CPB) in the severe PGD group, which is in-line with previous literature data 5 and our own wider experience 36 , 37 .…”
Primary graft dysfunction (PGD) is a major determinant of morbidity and mortality following lung transplantation. Delineating basic mechanisms and molecular signatures of PGD remain a fundamental challenge. This pilot study examines if the pulmonary volatile organic compound (VOC) spectrum relate to PGD and postoperative outcomes. The VOC profiles of 58 bronchoalveolar lavage fluid (BALF) and blind bronchial aspirate samples from 35 transplant patients were extracted using solid-phase-microextraction and analyzed with comprehensive two-dimensional gas chromatography coupled to time-of-flight mass spectrometry. The support vector machine algorithm was used to identify VOCs that could differentiate patients with severe from lower grade PGD. Using 20 statistically significant VOCs from the sample headspace collected immediately after transplantation (< 6 h), severe PGD was differentiable from low PGD with an AUROC of 0.90 and an accuracy of 0.83 on test set samples. The model was somewhat effective for later time points with an AUROC of 0.80. Three major chemical classes in the model were dominated by alkylated hydrocarbons, linear hydrocarbons, and aldehydes in severe PGD samples. These VOCs may have important clinical and mechanistic implications, therefore large-scale study and potential translation to breath analysis is recommended.
“…3 a). Marczin et al also conclude that patients receiving minimally invasive lung transplantation (MILT) seem to have better lung function in the early postoperative duration than those undergoing traditional transverse sternotomy, although the operation and management may be more complex 11 . Figure 3 Life images of child patients.…”
Lung transplantation (LT) has been an effective treatment for carefully selected children with end-stage lung diseases. The aim of this retrospective study is to introduce our experience at the largest LT center in Wuxi, China and to compare the outcomes of pediatric LT between children with idiopathic pulmonary arterial hypertension (IPAH) and other end-stage lung diseases. Ten pediatric patients undergoing LT from 2007 to 2019 were included. Sequential bilateral lung transplantation (BLT) with bilateral anterior thoracotomies was performed in all patients, seven of whom also underwent reduced size LT. Eight children survived until the end of our follow-up period on July 31st, 2019, with the longest survival of 11 years. Extracorporeal membrane oxygenation (ECMO) was intraoperatively used in all IPAH children and one non-IPAH child. Left heart function of IPAH children, though initially compromised, recovered after surgery. Statistically significant differences in operation time and post-operative mechanical ventilation between IPAH group and non-IPAH group were observed without discernible impact on post-LT survival. Pediatric LT appears to be a safe treatment for IPAH children to improve longevity and quality of life and ECMO may help reduce the risk of surgery and the postoperative complications.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
