Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung.
BACKGROUND
Worsening of lung failure in patients awaiting a lung transplantation might lead to ventilation-refractory hypercapnia and respiratory acidosis. Most transplant centers consider pretransplantation extracorporeal membrane oxygenation as a contraindication for lung transplantation because of the poor outcome. We have, for the first time, applied the novel pumpless interventional lung assist NovaLung for bridge to lung transplantation in patients with severe ventilation-refractory hypercapnia. We report on our initial experience.


METHODS
Between March 2003 and March 2005, 176 lung transplantations were performed, of which 60% were high-urgency lung transplantations. Twelve of the high-urgency recipients had severe ventilation-refractory hypercapnia and respiratory acidosis. These patients were connected to the novel pumpless interventional lung assist NovaLung for bridge to lung transplantation.


RESULTS
The length of interventional lung assist NovaLung support was 15 +/- 8 days (4-32 days). PaO2, pH, and PaCO2 levels in arterial blood prior to interventional lung assist NovaLung implantation were 71 +/- 27 mm Hg, 7.121 +/- 0.1, and 128 +/- 42 mm Hg, respectively. Six hours after interventional lung assist NovaLung implantation, PaO2, pH, and PaCO2 levels had changed to 83 +/- 17 mm Hg (ns), 7.344 +/- 0.1 (P < .05), and 52 +/- 5 mm Hg (P < .05), respectively. Four patients died of multiorgan failure, 2 patients before and 2 after lung transplantation. Thus, 10 out of 12 patients were successfully bridged to lung transplantation, and 8 are still alive (1-year survival, 80%).


CONCLUSIONS
This report suggests that interventional lung assist NovaLung implantation is an effective bridge to lung transplantation strategy in patients with ventilation-refractory hypercapnia.
Fischer
Stefan
S
Hannover Thoracic Transplant Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
Simon
Andre R
AR
Welte
Tobias
T
Hoeper
Marius M
MM
Meyer
Anna
A
Tessmann
Rene
R
Gohrbandt
Bernhard
B
Gottlieb
Jens
J
Haverich
Axel
A
Strueber
Martin
M
D000142:Acidosis, Respiratory / Q000628:therapy*; D004867:Equipment Design; D006801:Humans; D006935:Hypercapnia / Q000628:therapy*; D016040:Lung Transplantation; D011300:Preoperative Care; D012720:Severity of Illness Index; D012122:Ventilators, Mechanical