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Extracorporeal life support in lung and heart–lung transplantation for pulmonary hypertension in adults
Author(s) -
Kortchinsky Talna,
Mussot Sacha,
Rezaiguia Saïda,
Artiguenave Margaux,
Fadel Elie,
Stephan François
Publication year - 2016
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12805
Subject(s) - medicine , extracorporeal membrane oxygenation , pulmonary hypertension , lung , extracorporeal , lung transplantation , hemodynamics , transplantation , surgery , retrospective cohort study , cardiology , heart transplantation
After bilateral lung and heart–lung transplantation in adults with pulmonary hypertension, hemodynamic and oxygenation deficiencies are life‐threatening complications that are increasingly managed with extracorporeal life support (ECLS). The primary aim of this retrospective study was to assess 30‐day and 1‐year survival rates in patients managed with vs without post‐operative venoarterial ECLS in 2008–2013. The secondary endpoints were the occurrence rates of nosocomial infection, bleeding, and acute renal failure. Of the 93 patients with pulmonary hypertension who received heart‐lung (n=29) or bilateral lung (n=64) transplants, 28 (30%) required ECLS a median of 0 [0–6] hours after surgery completion and for a median of 3.0 [2.0–8.5] days. Compared to ECLS patients, controls had higher survival at 30 days (95.0% vs 78.5%; P =.02) and 1 year (83% vs 64%; P =.005), fewer nosocomial infections (48% vs 79%; P =.0006), and fewer bleeding events (17% vs 43%; P =.008). The need for renal replacement therapy was not different between groups (11% vs 17%; P =.54). Venoarterial ECLS is effective in treating pulmonary graft dysfunction with hemodynamic failure after heart‐lung or bilateral lung. However, ECLS use was associated with higher rates of infection and bleeding.