Bilateral lung transplantation with intra- and postoperatively prolonged ECMO support in patients with pulmonary hypertension

Abstract

BLTX with intraoperative and postoperatively prolonged ECMO support provides excellent initial organ function due to optimal controlled reperfusion and non-aggressive ventilation. This results in improved outcome even in advanced forms of PH.

"Treat-to-target" in pulmonary arterial hypertension and the use of extracorporeal membrane oxygenation as a bridge to transplantation

“…Thus, the data from that study are quite old. However, even in this paper the cause of EPE could be identified in 65% of patients and only 35% of cases were classified as ''idiopathic'' EPE [17]. Recently, some relevant articles on EPE epidemiology have been published.…”

“…Citing an article by ADELMAN et al [17], the authors state that a specific cause of EPE could be identified in only 25% of patients [1]. We would like to emphasise that, although the paper by ADELMAN et al [17] has long been one of the most important sources of our knowledge on epidemiology of EPE, it was based on analysis of 23 papers published between 1955 and 1982. Thus, the data from that study are quite old.…”

“…In the past, although increasingly used for adults with ventilationrefractory acute severe respiratory failure, ECMO has, in general, been considered to be a contraindication to lung transplantation [13,14]. However, there are an increasing number of reports in the literature on the use of this method as a bridge to lung transplantation in patients with a number of underlying conditions, including acute severe respiratory failure [13], acute respiratory distress syndrome [15], cystic fibrosis [16] and pulmonary hypertension [17][18][19][20]. A recent report of outcomes in 16 patients with end-stage pulmonary disease found that, in those who survived to transplantation, 1-yr post-transplant survival was 92% [21].…”

Extracorporeal membrane oxygenation in the pre and post lung transplant period

“…Others prefer to convert to a conventional cardiopulmonary bypass support intra-operatively. Continued post-operative ECMO in patients transplanted for pulmonary hypertension has been advocated by some to control reperfusion and provide non-aggressive ventilation after transplant (91). Additionally, ECMO support has been utilized for management of primary graft dysfunction after lung transplantation (36,37).…”

Advanced pulmonary arterial hypertension: mechanical support and lung transplantation

“…A retrospective comparison of outcomes for patients treated with CPB or ECMO during lung transplantation demonstrated that ECMO was associated with improved survival and reduced post-procedural complication rates compared with CPB. ECMO can also be extended to provide support during the post-operative period, to minimise haemodynamic instability during this critical phase [49,50]. For these reasons, ECMO has replaced CPB in lung transplantation and is now the standard cardiopulmonary support procedure used in most transplantation centres [49,[51][52][53].…”