title: Extracorporeal Support During Bilateral Sequential Lung Transplantation in Patients With Pulmonary Hypertension: Risk Factors and Outcomes.
abstract: OBJECTIVE
  To identify preoperative predictors of extracorporeal support in patients with pulmonary hypertension (PH) undergoing bilateral sequential lung transplantation (LTx), and to examine outcomes associated with the use of extracorporeal support.
  
  
  METHODS
  Retrospective, observational study.
  
  
  METHODS
  Single organ transplantation and tertiary care university medical center.
  
  
  METHODS
  Adults with PH (preoperative mean pulmonary artery pressure (mPAP)≥25 mmHg) who underwent primary bilateral sequential LTx during 2007 to 2013.
  
  
  RESULTS
  Of 262 patients with PH undergoing LTx, extracorporeal support was initiated intraoperatively in 149 (57%). Preoperative severe right ventricle (RV) dysfunction and moderate or severe tricuspid regurgitation (TR) were associated with extracorporeal support. In the remaining 208 patients without those factors, increasing preoperative oxygen requirement (odds ratio [OR] 1.30 per 1 L/min, 95% confidence intervals [CI] 1.11-1.52, p = 0.001), presence of RV dilation (OR 2.77, 95% CI 1.28-6.02, p = 0.010), and mPAP (OR 1.33 per 5-mmHg increase in mPAP, 95% CI 1.04-1.70, p = 0.021) were associated independently with extracorporeal support in the multivariable model. Analysis of 49 propensity-matched pairs showed longer intensive care unit (5 v 14 days, p = 0.006) and hospital stays (27 v 39 days, p = 0.016) and increased need for tracheostomy (16% v 41%, p = 0.017) in patients exposed to extracorporeal support but no differences in 30-day mortality, stroke, myocardial infarction, or dialysis.
  
  
  CONCLUSIONS
  Severity of RV dysfunction, TR, RV dilatation, increasing oxygen requirement, and increasing mPAP showed significant associations with the need for extracorporeal support during LTX in patients with PH. Extracorporeal support was associated with increased length of stay and tracheostomy but not with mortality or other complications. © 2016 Elsevier Inc. All rights reserved.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Pranav R
authors.initials: PR
authors.lastname: Shah
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Boisen
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Winger
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Jose
authors.initials: J
authors.lastname: Marquez
authors.affiliation: Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bermudez
authors.affiliation: Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Jay K
authors.initials: JK
authors.lastname: Bhama
authors.affiliation: Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Shigemura
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: D'Cunha
authors.affiliation: Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: subramaniamk@upmc.edu.
authors.forename: Kathirvel
authors.initials: K
authors.lastname: Subramaniam
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D007902:Length of Stay / Q000639:trends*; D016040:Lung Transplantation / Q000009:adverse effects / Q000639:trends*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery
keywords: CPB; cardiopulmonary bypass; circulatory hemodynamics; lung; transplantation