Impact of Extracorporeal Membrane Oxygenation or Mechanical Ventilation as Bridge to Combined Heart-Lung Transplantation on Short-Term and Long-Term Survival

Jayarajan, Senthil N.; Taghavi, Sharven; Komaroff, Eugene; Brann, Stacey; Horai, Tetsuya; Cordova, Francis; Patel, Namrata; Guy, T. Sloane; Toyoda, Yoshiya

doi:10.1097/tp.0b013e3182a860b8

Cited by 18 publications

(9 citation statements)

References 12 publications

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“…[1][2][3][4] It can be used for temporary support of critically ill patients. 2,[5][6][7] Although outcomes in patients supported by ECMO are poor, [8][9][10] they have improved in recent years. 11,12 As more and more patients are supported with these temporary devices, 13 many will go on to develop noncardiac surgical problems.…”

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confidence: 98%

Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

Taghavi¹,

Jayarajan²,

Mangi³

et al. 2015

ASAIO Journal

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As extracorporeal membrane oxygenation (ECMO) is increasingly used for patients with cardiac and/or pulmonary failure, the need for noncardiac surgical procedures (NCSPs) in these patients will continue to increase. This study examined the NCSP required in patients supported with ECMO and determined which variables affect outcomes. The National Inpatient Sample Database was examined for patients supported with ECMO from 2007 to 2010. There were 563 patients requiring ECMO during the study period. Of these, 269 (47.8%) required 380 NCSPs. There were 149 (39.2%) general surgical procedures, with abdominal exploration/bowel resection (18.2%) being most common. Vascular (29.5%) and thoracic procedures (23.4%) were also common. Patients requiring NCSP had longer median length of stay (15.5 vs. 9.2 days, p = 0.001), more wound infections (7.4% vs. 3.7%, p = 0.02), and more bleeding complications (27.9% vs. 17.3%, p = 0.01). The incidences of other complications and inpatient mortality (54.3% vs. 58.2%, p = 0.54) were similar. On logistic regression, the requirement of NCSPs was not associated with mortality (odds ratio [OR]: 0.91, 95% confidence interval [CI]: 0.68-1.23, p = 0.17). However, requirement of blood transfusion was associated with mortality (OR: 1.70, 95% CI: 1.06-2.74, p = 0.03). Although NCSPs in patients supported with ECMO does not increase mortality, it results in increased morbidity and longer hospital stay.

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confidence: 98%

Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

Taghavi¹,

Jayarajan²,

Mangi³

et al. 2015

ASAIO Journal

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“…The survival benefits of ECMO use as a bridge for lung transplantation have long been debated. It has been reported that lung transplant recipients undergoing ECMO have increased short- and long-term mortality23, particularly those who receive a transplant after waiting for >14 days24. However, some recent reports showed that a combination of mechanical ventilation and ECMO is a viable bridging strategy, leading to acceptable patient outcomes25.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Adult Lung Transplantation Recipients: A Single-Center Experience in South Korea

Hong

Kim

et al. 2019

Tuberc Respir Dis

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BackgroundRecently, the number of lung transplants in South Korea has increased. However, the long-term outcome data is limited. In this study, we aimed to investigate the long-term outcomes of adult lung transplantation recipients.MethodsAmong the patients that underwent lung transplantation at a tertiary referral center in South Korea between 2008 and 2017, adults patient who underwent deceased-donor lung transplantation with available follow-up data were enrolled. Their medical records were retrospectively reviewed.ResultsThrough eligibility screening, we identified 60 adult patients that underwent lung (n=51) or heart-lung transplantation (n=9) during the observation period. Idiopathic pulmonary fibrosis (46.7%, 28/60) was the most frequent cause of lung transplantation. For all the 60 patients, the median follow-up duration for post-transplantation was 2.6 years (range, 0.01–7.6). During the post-transplantation follow-up period, 19 patients (31.7%) died at a median duration of 194 days. The survival rates were 75.5%, 67.6%, and 61.8% at 1 year, 3 years, and 5 years, respectively. Out of the 60 patients, 8 (13.3%) were diagnosed with chronic lung allograft dysfunction (CLAD), after a mean duration of 3.3±2.8 years post-transplantation. The CLAD development rate was 0%, 17.7%, and 25.8% at 1 year, 3 years, and 5 years, respectively. The most common newly developed post-transplantation comorbidity was the chronic kidney disease (CKD; 54.0%), followed by diabetes mellitus (25.9%).ConclusionAmong the adult lung transplantation recipients at a South Korea tertiary referral center, the long-term survival rates were favorable. The proportion of patients who developed CLAD was not substantial. CKD was the most common post-transplantation comorbidity.

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“…In HLT patients, recipients bridged by MV or ECMO have been shown to have increased short- term. Long-term mortality, and longer hospital stays [ 16 ]. However, in our study, we could not confirm significant difference of survival outcomes of the patients who required ECMO support (n=6) and MV (n=8) before HLT when compared to unsupported group.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Heart-Lung Transplantation: Review of 10 Single-Center Consecutive Patients

Yun

Choi

Park

2016

Korean J Thorac Cardiovasc Surg

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BackgroundHeart-lung transplantation (HLT) has provided hope to patients with end-stage lung disease and irreversible heart dysfunction. We reviewed the clinical outcomes of 10 patients who underwent heart-lung transplantation at Asan Medical Center.MethodsBetween July 2010 and August 2014, a total of 11 patients underwent HLT at Asan Medical Center. After excluding one patient who underwent concomitant liver transplantation, 10 patients were enrolled in our study. We reviewed the demographics of the donors and the recipients’ baseline information, survival rate, cause of death, and postoperative complications. All patients underwent follow-up, with a mean duration of 26.1±16.7 months.ResultsEarly death occurred in two patients (20%) due to septic shock. Late death occurred in three patients (38%) due to bronchiolitis obliterans (n=2) and septic shock (n=1), although these patients survived for 22, 28, and 42 months, respectively. The actuarial survival rates at one year, two years, and three years after HLT were 80%, 67%, and 53%, respectively.ConclusionHLT is a procedure that is rarely performed in Korea, even in medical centers with large heart and lung transplant programs. In order to achieve acceptable clinical outcomes, it is critical to carefully choose the donor and the recipient and to be certain that all aspects of the transplant procedure are planned in advance with the greatest care.

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Impact of Extracorporeal Membrane Oxygenation or Mechanical Ventilation as Bridge to Combined Heart-Lung Transplantation on Short-Term and Long-Term Survival

Abstract: HLT recipients bridged by MV or ECMO have increased short-term and long-term mortality. Further studies are needed to optimize survival in these high-risk patients.

Cited by 18 publications

References 12 publications

Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

Examining Noncardiac Surgical Procedures in Patients on Extracorporeal Membrane Oxygenation

Long-Term Outcomes of Adult Lung Transplantation Recipients: A Single-Center Experience in South Korea

Clinical Outcomes of Heart-Lung Transplantation: Review of 10 Single-Center Consecutive Patients

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