Extracorporeal Membrane Oxygenation as a Postoperative Left Ventricle Conditioning Tool After Lung Transplantation in Patients With Primary Pulmonary Artery Hypertension: First Polish Experience

Stącel, Tomasz; Antończyk, Remigiusz; Latos, Magdalena; Nęcki, Mirosław; Przybyłowski, Piotr; Zembala, Marian; Ochman, Marek; Urlik, Maciej

doi:10.1016/j.transproceed.2020.02.113

Cited by 5 publications

(9 citation statements)

References 18 publications

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“…Comparable data were reported in our previous study [ 21 ]. The 30-day survival rate was 100% in our patients.…”

Section: Surgical Modalitiessupporting

confidence: 89%

“…VA-ECMO was also proven to be superior to standard CPB as well as the modality of choice during Ltx. The authors of this review also presented results consistent with the aforementioned studies as all of the patients transplanted due to end-stage PAH were treated with intraoperative use of VA-ECMO [ 21 ]. In most cases, ECMO was introduced as described in the previous paragraph entitled Methods of ECMO implantation, point a).…”

Section: Surgical Modalitiessupporting

confidence: 72%

“…AS followed by AFR implantation can be a feasible way to bridge Ltx among patients with severe pulmonary hypertension on the maximal available pharmacological treatment. This was the treatment of the first Polish patient who underwent AFR implantation [ 20 ] and became a double lung recipient in our center shortly thereafter [ 21 ].…”

Section: Right-to-left Shuntingmentioning

confidence: 99%

“…One of the patients underwent a concomitant procedure as he developed severe tricuspid regurgitation due to right heart insufficiency that had to be addressed. For this procedure, we used our technique of incorporating the use of ECMO and CPB during the same complex procedure and achieved good outcomes with respect to 30-day mortality [ 21 ].…”

Section: Surgical Modalitiesmentioning

confidence: 99%

“…Systematically performed echocardiography during the postoperative period revealed no flow through the device. He was discharged in a good general condition and remained under the supervision of the cardiology department; the decision of whether to explant or close it will be made later [ 20 , 21 ] There is an issue if the AFR and AS remain intact after Ltx, as these factors increase the risk of neurological complications such as stroke. The question remains whether persistent left-right shunt after Ltx increases the risk of PAH recurrence.…”

Section: Thoracic Organ Transplantationmentioning

confidence: 99%

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Interventional and Surgical Treatments for Pulmonary Arterial Hypertension

Stącel

Latos

Urlik

et al. 2021

JCM

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Despite significant advancements in pharmacological treatment, interventional and surgical options are still viable treatments for patients with pulmonary arterial hypertension (PAH), particularly idiopathic PAH. Herein, we review the interventional and surgical treatments for PAH. Atrial septostomy and the Potts shunt can be useful bridging tools for lung transplantation (Ltx), which remains the final surgical treatment among patients who are refractory to any other kind of therapy. Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) remains the ultimate bridging therapy for patients with severe PAH. More importantly, VA-ECMO plays a crucial role during Ltx and provides necessary left ventricular conditioning during the initial postoperative period. Pulmonary denervation may potentially be a new way to ensure better transplant-free survival among patients with the aforementioned disease. However, high-quality randomized controlled trials are needed. As established, obtaining the Eisenmenger physiology among patients with severe pulmonary hypertension by creating artificial defects is associated with improved survival. However, right-to-left shunting may be harmful after Ltx. Closure of the artificially created defects may carry some risk associated with cardiac surgery, especially among patients with Potts shunts. In conclusion, PAH requires an interdisciplinary approach using pharmacological, interventional, and surgical modalities.

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“…Comparable data were reported in our previous study [ 21 ]. The 30-day survival rate was 100% in our patients.…”

Section: Surgical Modalitiessupporting

confidence: 89%

Section: Surgical Modalitiessupporting

confidence: 72%

Section: Right-to-left Shuntingmentioning

confidence: 99%

Section: Surgical Modalitiesmentioning

confidence: 99%

Section: Thoracic Organ Transplantationmentioning

confidence: 99%

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Interventional and Surgical Treatments for Pulmonary Arterial Hypertension

Stącel

Latos

Urlik

et al. 2021

JCM

Self Cite

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Connective tissue disease‐associated pulmonary hypertension: A comprehensive review

Khangoora,

Bernstein,

King

et al. 2023

Pulm. circ.

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Connective tissue diseases (CTDs) can be associated with various forms of pulmonary hypertension, including pulmonary arterial hypertension (PAH), pulmonary veno‐occlusive disease, pulmonary venous hypertension, interstitial lung disease‐associated pulmonary hypertension, chronic thromboembolic pulmonary hypertension, and sometimes a combination of several processes. The prevalence of PAH varies among the different CTDs, with systemic sclerosis (SSc) having the highest at 8%–12%. The most recent European Society of Cardiology/European Respiratory Society guidelines recommend routine annual screening for PAH in SSc and CTDs with SSc features. As CTDs can be associated with a myriad of presentations of pulmonary hypertension, a thorough evaluation to include a right heart catheterization to clearly delineate the hemodynamic profile is essential in developing an appropriate treatment plan. Treatment strategies will depend on the predominant phenotype of pulmonary vasculopathy. In general, management approach to CTD‐PAH mirrors that of idiopathic PAH. Despite this, outcomes of CTD‐PAH are inferior to those of idiopathic PAH, with those of SSc‐PAH being particularly poor. Reasons for this may include extrapulmonary manifestations of CTDs, including renal disease and gastrointestinal involvement, concurrent interstitial lung disease, and differences in the innate response of the right ventricle to increased pulmonary vascular resistance. Early referral for lung transplant evaluation of patients with CTD‐PAH, particularly SSc‐PAH, is recommended. It is hoped that in the near future, additional therapies may be added to the armamentarium of effective treatments for CTD‐PAH. Ultimately, a better understanding of the pathogenesis of CTD‐PAH will be required to develop targeted therapies for this morbid condition.

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Managing pulmonary arterial hypertension: how to select and facilitate successful transplantation

Khangoora

King

Shlobin

2022

Current Opinion in Organ Transplantation

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Purpose of reviewDespite improvements in available medical therapies, pulmonary arterial hypertension (PAH) remains a progressive, ultimately fatal disorder. Lung transplantation is a viable treatment option for PAH patients with advanced disease. Recent findingsRecent guidelines from the International Society of Heart and Lung Transplantation (ISHLT) have updated recommendations regarding time of referral and listing for lung transplantation in PAH. The new guidelines emphasize earlier referral for transplant evaluation to ensure adequate time for proper evaluation and listing. They also incorporate objective risk stratification criteria to assist in decision-making regarding timing of referral and listing. With regards to the transplant procedure, bilateral lung transplantation has largely supplanted heart--lung transplantation as the procedure of choice for transplantation for advanced PAH. Exceptions to this include patients with PAH because of congenital heart disease and those with concurrent LV dysfunction. Use of mechanical support via venoarterial ECMO initiated before transplantation and continued into the early postoperative period is emerging as a standard of care and may help to reduce early posttransplant mortality in this population. There has been increased recognition of the importance of WHO Group 3 pulmonary hypertension. Many of the lessons learned from PAH may be applied when transplanting patients with severe WHO Group 3 pulmonary hypertension. SummaryPatients with PAH present unique challenges with regards to transplantation that require a therapeutic approach distinct from other lung disorders. Lung transplantations for PAH are high-risk endeavors best performed at centers with expertise in management of both PAH and extracorporeal support.

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Extracorporeal Membrane Oxygenation as a Postoperative Left Ventricle Conditioning Tool After Lung Transplantation in Patients With Primary Pulmonary Artery Hypertension: First Polish Experience

Cited by 5 publications

References 18 publications

Interventional and Surgical Treatments for Pulmonary Arterial Hypertension

Interventional and Surgical Treatments for Pulmonary Arterial Hypertension

Connective tissue disease‐associated pulmonary hypertension: A comprehensive review

Managing pulmonary arterial hypertension: how to select and facilitate successful transplantation

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