PMID- 35780817
OWN - NLM
STAT- MEDLINE
DCOM- 20230224
LR  - 20230228
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 115
IP  - 3
DP  - 2023 Mar
TI  - Intraoperative Support for Primary Bilateral Lung Transplantation: A 
      Propensity-Matched Analysis.
PG  - 743-749
LID - S0003-4975(22)00858-X [pii]
LID - 10.1016/j.athoracsur.2022.06.014 [doi]
AB  - BACKGROUND: Single-center studies support benefits of venoarterial extracorporeal 
      membrane oxygenation (VA-ECMO) as a method of intraoperative support. 
      Propensity-matched data from a large cohort, however, are currently lacking. 
      Therefore, our goal was to compare outcomes of intraoperative VA-ECMO and 
      cardiopulmonary bypass (CPB) during bilateral lung transplantation (LTx) with a 
      propensity analysis. METHODS: We performed a retrospective analysis of 795 
      consecutive primary adult LTx patients (June 1, 2011-December 26, 2020) using no 
      intraoperative support (n = 210), VA-ECMO (n = 150), or CPB (n = 197). Exclusion 
      criteria included LTx on venovenous-ECMO, single/redo LTx, ex vivo lung 
      perfusion, and concomitant solid-organ transplantation or cardiac procedure. 
      Propensity analysis was performed comparing patients who underwent intraoperative 
      CPB or VA-ECMO. RESULTS: The propensity CPB group required more blood products at 
      72 hours (P = .02) and longer intensive care unit length of stay (P < .001) and 
      ventilator dependence days (P < .001). There were no differences in 
      cerebrovascular accident (P = 1), reintubation (P = .4), dialysis (P = .068), 
      in-hospital mortality (P = .33), and 1-year (P = .67) and 3-year (P = .32) 
      survival. The CPB group had a higher incidence of grade 3 primary graft 
      dysfunction at 72 hours (P < .001). Neither support strategy was a predictor of 
      1- and 3-year mortality in our multivariable model (VA-ECMO, P = .72 and P = .57; 
      CPB, P = .45 and P = .91, respectively). CONCLUSIONS: Intraoperative VA-ECMO 
      during lung transplantation was associated with fewer postoperative blood 
      transfusions, shorter length of mechanical ventilation, and lower incidence of a 
      grade 3 primary graft dysfunction at 72 hours. Although there were some 
      differences in the postoperative course between the VA-ECMO and CPB groups, 
      support type was not associated with differences in survival.
CI  - Copyright (c) 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Chan, Ernest G
AU  - Chan EG
AD  - Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania.
FAU - Hyzny, Eric J
AU  - Hyzny EJ
AD  - Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania.
FAU - Furukawa, Masashi
AU  - Furukawa M
AD  - Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania.
FAU - Ryan, John P
AU  - Ryan JP
AD  - Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania.
FAU - Subramaniam, Kathirvel
AU  - Subramaniam K
AD  - Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh 
      School of Medicine, Pittsburgh, Pennsylvania.
FAU - Morrell, Matthew R
AU  - Morrell MR
AD  - Division of Pulmonary and Critical Care, Department of Surgery, University of 
      Utah, Salt Lake City, Utah.
FAU - Pilewski, Joseph
AU  - Pilewski J
AD  - Department of Medicine, Pulmonary, Allergy, and Critical Care Medicine Division, 
      University of Pittsburgh, Pittsburgh, Pennsylvania.
FAU - Luketich, James D
AU  - Luketich JD
AD  - Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania.
FAU - Sanchez, Pablo G
AU  - Sanchez PG
AD  - Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, 
      Pittsburgh, Pennsylvania. Electronic address: sanchezpg@upmc.edu.
LA  - eng
PT  - Journal Article
DEP - 20220630
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
CIN - Ann Thorac Surg. 2023 Mar;115(3):750. PMID: 35863400
MH  - Adult
MH  - Humans
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - *Primary Graft Dysfunction
MH  - *Lung Transplantation/methods
MH  - Cardiopulmonary Bypass/methods
EDAT- 2022/07/06 06:00
MHDA- 2023/02/25 06:00
CRDT- 2022/07/05 08:43
PHST- 2021/12/19 00:00 [received]
PHST- 2022/04/19 00:00 [revised]
PHST- 2022/06/06 00:00 [accepted]
PHST- 2022/07/06 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2022/07/05 08:43 [entrez]
AID - S0003-4975(22)00858-X [pii]
AID - 10.1016/j.athoracsur.2022.06.014 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2023 Mar;115(3):743-749. doi: 10.1016/j.athoracsur.2022.06.014. 
      Epub 2022 Jun 30.