title: Lung transplantation for severe pulmonary hypertension--awake extracorporeal membrane oxygenation for postoperative left ventricular remodelling.
abstract: BACKGROUND
  Bilateral lung transplantation (BLTx) is an established treatment for end-stage pulmonary hypertension (PH). Ventilator weaning failure and death are more common as in BLTx for other indications. We hypothesized that left ventricular (LV) dysfunction is the main cause of early postoperative morbidity or mortality and investigated a weaning strategy using awake venoarterial extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  In 23 BLTx for severe PH, ECMO used during BLTx was continued for a minimum of 5 days (BLTx-ECMO group). Echocardiography, left atrial (LA) and Swan-Ganz catheters were used for monitoring. Early extubation after transplantation was attempted under continued ECMO.
  
  
  RESULTS
  Preoperatively, all patients had severely reduced cardiac index (mean, 2.1 L/min/m2). On postoperative day 2, reduction of ECMO flow resulted in increasing LA and decreasing systemic blood pressures. On the day of ECMO explantation (median, postoperative day 8), LV diameter had increased; LA and blood pressures remained stable. Survival rates at 3 and 12 months were 100% and 96%, respectively. Data were compared to two historic control groups of BLTx without ECMO (BLTx ventilation) or combined heart-lung transplantation for severe PH.
  
  
  CONCLUSIONS
  Early after BLTx for severe PH, the LV may be unable to handle normalized LV preload. This can be effectively bridged with awake venoarterial ECMO.
authors.affiliation: 1 Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. 2 Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. 3 Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. 4 Department of Pediatric Respiratory Medicine and Neonatology, Hannover Medical School, Hannover, Germany. 5 German Centre for Lung Research, Hannover, Germany.
authors.forename: Igor
authors.initials: I
authors.lastname: Tudorache
authors.forename: Wiebke
authors.initials: W
authors.lastname: Sommer
authors.forename: Christian
authors.initials: C
authors.lastname: Kühn
authors.forename: Olaf
authors.initials: O
authors.lastname: Wiesner
authors.forename: Johannes
authors.initials: J
authors.lastname: Hadem
authors.forename: Thomas
authors.initials: T
authors.lastname: Fühner
authors.forename: Fabio
authors.initials: F
authors.lastname: Ius
authors.forename: Murat
authors.initials: M
authors.lastname: Avsar
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Schwerk
authors.forename: Dietmar
authors.initials: D
authors.lastname: Böthig
authors.forename: Jens
authors.initials: J
authors.lastname: Gottlieb
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Christoph
authors.initials: C
authors.lastname: Bara
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.forename: Gregor
authors.initials: G
authors.lastname: Warnecke
mesh_terms: D000293:Adolescent; D000328:Adult; D060666:Airway Extubation; D016022:Case-Control Studies; D002648:Child; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling; D014851:Wakefulness; D055815:Young Adult