Textbook outcome in lung transplantation: Planned venoarterial extracorporeal membrane oxygenation versus off-pump support for patients without pulmonary hypertension

Halpern, Samantha E.; Wright, Mary Cooter; Madsen, Gabrielle; Chow, Bryan; Harris, Chelsea S.; Haney, John C.; Klapper, Jacob A.; Bottiger, Brandi; Hartwig, Matthew G.

doi:10.1016/j.healun.2022.07.015

Cited by 10 publications

(9 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, TO analysis has emerged as a composite quality metric based on the achievement of multiple postoperative mortality and morbidity endpoints. 6,7,19 Previous single-center studies of abdominal organ transplantation and lung cancer surgery have demonstrated TO rates ranging from 24% to 44% with 8 to 12 included endpoints, which is close to our Glenn rate of 51%. This methodology can be performed at the center level, for quality improvement purposes, as well as at the national level with case-mix adjustment to understand variations in quality of care.…”

Section: Commentsupporting

confidence: 83%

“…[2][3][4][5] An example is the textbook outcome (TO), which is a composite quality measure based on multiple postoperative endpoints which serve as benchmarks for the ideal postoperative course after a certain operation. [6][7][8][9][10] For instance, our group recently developed a TO for the Norwood operation consisting of eight postoperative endpoints and found that the TO was achieved in 30% of our institutional cohort. In addition, the Norwood TO was found to be an independent positive predictor of long-term survival and lower hospital costs, thus indicating that the outcome is a marker of both quality and value of care.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Textbook Outcome for Superior Cavopulmonary Connection: A Metric for Single Ventricle Heart Surgery

Prabhu,

Moya-Mendez,

Kang

et al. 2024

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Background: To develop a more holistic measure of congenital heart center performance beyond mortality, we created a composite “textbook outcome” (TO) for the Glenn operation. We hypothesized that meeting TO would have a positive prognostic and financial impact. Methods: This was a single center retrospective study of patients undergoing superior cavopulmonary connection (bidirectional Glenn or Kawashima ± concomitant procedures) from 2005 to 2021. Textbook outcome was defined as freedom from operative mortality, reintervention, 30-day readmission, extracorporeal membrane oxygenation, major thrombotic complication, length of stay (LOS) >75th percentile (17d), and mechanical ventilation duration >75th percentile (2d). Multivariable logistic regression and Cox proportional hazards modeling were used. Results: Fifty-one percent (137/269) of patients met TO. Common reasons for TO failure were prolonged LOS (78/132, 59%) and ventilator duration (67/132, 51%). In multivariable analysis, higher weight [odds ratio, OR: 1.44 (95% confidence interval, CI: 1.15-1.84), P = .002] was a positive predictor of TO achievement while right ventricular dominance [OR 0.47 (0.27-0.81), P = .007] and higher preoperative pulmonary vascular resistance [OR 0.58 (0.40-0.82), P = .003] were negative predictors. After controlling for preoperative factors and excluding operative mortalities, TO achievement was independently associated with a decreased risk of death over long-term follow-up [hazard ratio: 0.50 (0.25-0.99), P = .049]. Textbook outcome achievement was also associated with lower direct cost of care [$137,626 (59,333-167,523) vs $262,299 (114,200-358,844), P < .0001]. Conclusion: Achievement of the Glenn TO is associated with long-term survival and lower costs and can be predicted by certain risk factors. As outcomes continue to improve within congenital heart surgery, operative mortality will become a less informative metric. Textbook outcome analysis may represent a more balanced measure of a successful outcome.

show abstract

Section: Commentsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Textbook Outcome for Superior Cavopulmonary Connection: A Metric for Single Ventricle Heart Surgery

Prabhu,

Moya-Mendez,

Kang

et al. 2024

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

show abstract

“… 10 In the intraoperative setting, ECLS can be implemented for cardiopulmonary support with VA-ECMO or CPB. Single-center studies have shown improved PGD and morbidity rates when VA-ECMO is used compared to no support, 11 , 12 whereas a recent multicenter study reported superior off-pump results. 13 Magouliotis and colleagues 14 published a meta-analysis showing these improvements when VA-ECMO was compared to CPB, and a recent single-discipline consensus statement from the American Association for Thoracic Surgery concluded that VA-ECMO is the preferred method of intraoperative ECLS.…”

Section: Discussionmentioning

confidence: 99%

Initial experience and outcomes with a hybrid extracorporeal membrane oxygenation and cardiopulmonary bypass circuit for lung transplantation

Martin,

Fritz,

Pham

et al. 2023

JTCVS Open

View full text Add to dashboard Cite

“…However, no difference was reported between operative and ischemic time [47]. Recently, Halpern et al in their study on patients with no or mild pulmonary hypertension, who underwent bilateral lung transplantation, reported that planned VA ECMO was associated with higher odds of textbook outcomes than planned off-pump support [48].…”

Section: Intraoperative Use Of Cardiopulmonary Bypass (Cpb) Vs Ecmo F...mentioning

confidence: 99%

Recent Advances and Outcomes in Heart and Lung Transplantation

Kumar¹,

Thite²,

Wazarkar³

et al. 2023

Current Challenges and Advances in Organ Donation and Transplantation

View full text Add to dashboard Cite

Heart and lung transplantations are established treatments for patients with end-stage heart and lung failure, respectively. As mechanical circulatory devices, extracorporeal membrane oxygenation, organ perfusion, and transport systems advance, so do patient comorbidities and profiles of patients undergoing transplantation are becoming more complex. With the ever-increasing shortage of donor organs, marginal and high-risk donor utilization continues to rise. In this chapter, we attempt to elucidate the recent advances and outcomes in heart and lung transplantation. We also highlight how an ongoing COVID-19 pandemic affects the logistics of transplant programs.

show abstract

Textbook outcome in lung transplantation: Planned venoarterial extracorporeal membrane oxygenation versus off-pump support for patients without pulmonary hypertension

Cited by 10 publications

References 39 publications

Textbook Outcome for Superior Cavopulmonary Connection: A Metric for Single Ventricle Heart Surgery

Textbook Outcome for Superior Cavopulmonary Connection: A Metric for Single Ventricle Heart Surgery

Initial experience and outcomes with a hybrid extracorporeal membrane oxygenation and cardiopulmonary bypass circuit for lung transplantation

Recent Advances and Outcomes in Heart and Lung Transplantation

Contact Info

Product

Resources

About