Mid-term results of bilateral lung transplant with postoperatively extended intraoperative extracorporeal membrane oxygenation for severe pulmonary hypertension.
OBJECTIVE
In severe pulmonary hypertension, diastolic dysfunction of the left ventricle causes significant morbidity and mortality after lung transplantation, which may be successfully reversed using a protocol based on perioperative veno-arterial extracorporeal membrane oxygenation (ECMO) and early extubation. Here, we present echocardiographic data and mid-term outcomes.


METHODS
The records of lung transplanted patients at our institution between May 2010 and January 2016 were retrospectively reviewed. Echocardiography data were collected preoperatively, at discharge, 3 and 12 months after transplantation.


RESULTS
During the study period, 717 patients underwent lung transplantation at our institution, 38 (5%) patients being transplanted for severe pulmonary hypertension. All patients underwent bilateral lung transplantation on veno-arterial ECMO cannulated in the groin, through a sternum sparing thoracotomy in 36 (95%) patients. Extubation was performed early, after a median of 2 days, and awake ECMO was extended for at least 5 days after transplantation. The survival at 3 months, 1 year and 5 years was not different in comparison to patients transplanted for other underlying diseases ( P  = 0.45). At 1 year, tricuspid valve regurgitation had disappeared in all patients. The median of the left ventricular end-diastolic dimension improved from 40 (32-44) mm preoperatively to 45 (44-47) mm at 12 months after lung transplantation ( P  < 0.05). The median of the proximal right ventricular outflow diameter decreased to 25 (23-27) mm after 12 months, compared to 48 (43-51) mm preoperatively ( P  < 0.05).


CONCLUSIONS
The routine application of a prophylactic postoperative veno-arterial ECMO protocol in patients with severe pulmonary hypertension undergoing lung transplantation decreases postoperative mortality and favours achievement of normal cardiac function after 1 year.
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Jawad
J
Salman
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Fabio
F
Ius
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Wiebke
W
Sommer
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Thierry
T
Siemeni
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Christian
C
Kuehn
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Murat
M
Avsar
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Dietmar
D
Boethig
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Ulrich
U
Molitoris
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Christoph
C
Bara
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.|German Centre for Lung Research (DZL/BREATH), Hannover, Germany.
Jens
J
Gottlieb
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.|German Centre for Lung Research (DZL/BREATH), Hannover, Germany.
Tobias
T
Welte
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Axel
A
Haverich
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.|German Centre for Lung Research (DZL/BREATH), Hannover, Germany.
Marius M
MM
Hoeper
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.|German Centre for Lung Research (DZL/BREATH), Hannover, Germany.
Gregor
G
Warnecke
Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.|German Centre for Lung Research (DZL/BREATH), Hannover, Germany.
Igor
I
Tudorache
D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
Awake ECMO; Lung transplantation; Pulmonary arterial hypertension