title: Fate of patients with extracorporeal lung assist as a bridge to lung transplantation versus patients without--a single-center experience.
abstract: OBJECTIVE
  Mechanical lung assist (MLA; extracorporeal membrane oxygenation (ECMO) or extracorporeal lung assist (ECLA)) is increasingly used as a temporary bridge to lung transplantation (LTx). This study was designed to evaluate the impact of preoperative MLA on the operative outcome, including longer-term survival, in comparison to patients undergoing LTx without preoperative MLA.
  
  
  METHODS
  A total of 143 patients underwent LTx at our institution from 2002 to 2011. Forty-three percent (n=62) of patients presented with idiopathic pulmonary fibrosis and 71% (n=102) presented with severely elevated pulmonary artery pressure.
  
  
  RESULTS
  Thirteen patients (9.1%) required pre-LTx MLA support (age 44 ±13 years, double LTx 73.3%, female gender 53%) whereas 130 patients did not (age 52 ±11 years, double LTx 41.5%, female gender 36.9%). In one patient, MLA was successfully weaned and the patient underwent subsequent LTx. All patients in the MLA group were intraoperatively supported with continuous ECMO. One patient had to be supported with MLA after LTx for a period of 8 days. The short-term and mid-term postoperative survival of the MLA patient group was not significantly different from the non-MLA group (LogRank p=0.28). The 30-day, 90-day and 1-year survivals were 95%, 90% and 71%, respectively, in the patients without MLA compared to 85%, 77% and 68% in the MLA group.
  
  
  CONCLUSIONS
  MLA has no impact on long-term survival rate in LTx patients, but has an influence in postoperative survival. MLA support is a valuable tool to bridge unstable patients to LTx.
authors.affiliation: Division of Cardiovascular Surgery, Heart Center Leipzig of the University of Leipzig, Leipzig, Germany sven.lehmann@med.uni-leipzig.de.
authors.forename: S
authors.initials: S
authors.lastname: Lehmann
authors.affiliation: Division of Cardiology, Heart Center Leipzig of the University of Leipzig, Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Uhlemann
authors.affiliation: Division of Cardiovascular Surgery, Heart Center Leipzig of the University of Leipzig, Leipzig, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Leontyev
authors.affiliation: Division of Cardiovascular Surgery, Heart Center Leipzig of the University of Leipzig, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Meyer
authors.affiliation: Division of Cardiovascular Surgery, Heart Center Leipzig of the University of Leipzig, Leipzig, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Garbade
authors.affiliation: Division of Cardiovascular Surgery, Heart Center Leipzig of the University of Leipzig, Leipzig, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Seeburger
authors.affiliation: Division of Cardiovascular Surgery, Heart Center Leipzig of the University of Leipzig, Leipzig, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Laflamme
authors.affiliation: Division of Cardiovascular Surgery, Heart Center Leipzig of the University of Leipzig, Leipzig, Germany.
authors.forename: H B
authors.initials: HB
authors.lastname: Bittner
authors.affiliation: Division of Cardiovascular Surgery, Heart Center Leipzig of the University of Leipzig, Leipzig, Germany.
authors.forename: F W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000401:mortality / Q000601:surgery; D054990:Idiopathic Pulmonary Fibrosis / Q000401:mortality / Q000601:surgery; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012121:Respiration, Artificial; D015996:Survival Rate
keywords: Cox regression; ECMO; lung transplantation; risk factor analysis; survival; univariate and stepwise multivariate logistic regression analysis