PMID- 20371187
OWN - NLM
STAT- MEDLINE
DCOM- 20110512
LR  - 20100823
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 38
IP  - 3
DP  - 2010 Sep
TI  - Long-term outcome of double-lung and heart-lung transplantation for pulmonary 
      hypertension: a comparative retrospective study of 219 patients.
PG  - 277-84
LID - 10.1016/j.ejcts.2010.02.039 [doi]
AB  - OBJECTIVE: Whether double-lung transplantation (DLT) or heart-lung 
      transplantation (HLT) is the best option in patients with pulmonary hypertension 
      (PH) remains unclear. At our institution, patients with severe right ventricular 
      dysfunction or congenital systemic-to-pulmonary shunt (CSPS) are preferentially 
      treated with HLT. We sought to determine whether the outcomes warrant continuing 
      this policy. METHODS: We retrospectively reviewed cases of DLT (n=67) or HLT 
      (n=152) performed for end-stage PH between 1986 and 2008 at our institution. 
      According to the new clinical classification of PH, 147 patients were group I 
      (pulmonary arterial hypertension group, of which 30 had CSPS), 24 were group III 
      (PH associated with lung disease and/or hypoxaemia), 20 were group IV (chronic 
      thrombo-embolic PH) and 20 were group V (sarcoidosis or histiocytosis X). 
      RESULTS: Compared with the HLT group, the DLT group had less severe disease as 
      reflected by a higher preoperative cardiac index (2.5 + or - 0.8 vs 2.0 + or - 
      0.4; P=0.0006), lower New York Heart Association (NYHA) functional class (3.4 + 
      or - 0.4 vs 3.8 + or - 0.5; P<0.0001), lower rates of kidney failure (31% vs 66%; 
      P<0.0001) and liver failure (13% vs 38%; P=0.0003) and less need for preoperative 
      inotropic support (10% vs 25%; P=0.014). Nevertheless, survival after 1, 5, 10 
      and 15 years was not significantly different between the two groups (HLT group: 
      70%, 50%, 39% and 26%; and DLT group: 79%, 52%, 43% and 30%; respectively; 
      P=0.932). Freedom from obliterative bronchiolitis-related death was significantly 
      greater in the HLT group (100% at 1 year, 84% at 5 years and 74% at 10 years; 
      compared with 98%, 70%, and 59%, respectively, in the DLT group; P=0.035). 
      CONCLUSIONS: In patients with end-stage PH, good long-term survival rates were 
      obtained using either DLT or HLT. However, these results were achieved with 
      preferential use of HLT in patients with right heart failure or CSPS. 
      Obliterative bronchiolitis-related death was less common with HLT than with DLT.
CI  - Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by 
      Elsevier B.V. All rights reserved.
FAU - Fadel, Elie
AU  - Fadel E
AD  - Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, 
      Hopital Marie-Lannelongue, Le Plessis Robinson, Paris-Sud University, Paris, 
      France. fadel@ccml.com
FAU - Mercier, Olaf
AU  - Mercier O
FAU - Mussot, Sacha
AU  - Mussot S
FAU - Leroy-Ladurie, Francois
AU  - Leroy-Ladurie F
FAU - Cerrina, Jacques
AU  - Cerrina J
FAU - Chapelier, Alain
AU  - Chapelier A
FAU - Simonneau, Gerald
AU  - Simonneau G
FAU - Dartevelle, Philippe
AU  - Dartevelle P
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20100403
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Bronchiolitis Obliterans/prevention & control
MH  - Child
MH  - Epidemiologic Methods
MH  - Female
MH  - Heart Defects, Congenital/complications
MH  - Heart Failure/complications
MH  - Heart-Lung Transplantation/*methods
MH  - Humans
MH  - Hypertension, Pulmonary/etiology/*surgery
MH  - Immunosuppressive Agents/therapeutic use
MH  - Lung Diseases/complications
MH  - Lung Transplantation/*methods
MH  - Male
MH  - Middle Aged
MH  - Postoperative Care/methods
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Right/complications
MH  - Young Adult
EDAT- 2010/04/08 06:00
MHDA- 2011/05/13 06:00
CRDT- 2010/04/08 06:00
PHST- 2009/10/12 00:00 [received]
PHST- 2010/01/27 00:00 [revised]
PHST- 2010/02/01 00:00 [accepted]
PHST- 2010/04/08 06:00 [entrez]
PHST- 2010/04/08 06:00 [pubmed]
PHST- 2011/05/13 06:00 [medline]
AID - S1010-7940(10)00217-4 [pii]
AID - 10.1016/j.ejcts.2010.02.039 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2010 Sep;38(3):277-84. doi: 10.1016/j.ejcts.2010.02.039. 
      Epub 2010 Apr 3.