Survival and left ventricular dysfunction post lung transplantation for pulmonary arterial hypertension

ElsevierVolume 72, December 2022, 154120Journal of Critical CareAuthor links open overlay panelMadeleineOttoMDaDavidMcGiffinMBBS, FRACScHelenWhitfordMBBS, FRACPdChristinaKurePhDcGregorySnellMBBS, FRACP, MD, OAMdArneDiehlMD, FACEM, FCICMabJuditOroszMD, FCICMaAidan J.C.BurrellMBBS, FCICM, PhDabHighlights•

High survival rates can occur following lung transplant for pulmonary hypertension.

Postoperative left ventricular dysfunction is common in these patients.

Postoperative left ventricular dysfunction is reversible with no impact on survival.

Prophylactic extracorporeal membrane oxygenation may be used in patients at risk.

AbstractPurpose

Bilateral lung transplantation for end-stage pulmonary arterial hypertension (PAH) is traditionally associated with higher early post-transplant mortality when compared with other indications. Changes in perioperative management, including the growing use of perioperative extracorporeal membrane oxygenation (ECMO) and an increased awareness of postoperative left ventricular dysfunction (LVD), have resulted in outcomes that are uncertain.

Materials and methods

We conducted a single-center, retrospective observational study at a lung transplantation center in Melbourne, Australia, from 2006 to 2019. ECMO use was categorized as preoperative, prophylactic, or rescue. Postoperative LVD was defined as a reduction in left ventricular function on echocardiography or using strict clinical criteria.

Results

50 patients underwent lung transplantation for PAH. 12-month survival was 48/50 (96%). ECMO was used in 26 (52%) patients, and the use of prophylactic VA-ECMO increased over the study period. Postoperative LVD was diagnosed in 21 (42%) patients. 12-month survival and left ventricular function was no different between LVD and non-LVD groups.

Conclusions

This study showed that high survival rates can be achieved following lung transplantation for PAH. We found that ECMO utilization was common, and indications have changed over time. LVD was common but did not impact 12-month survival.

Keywords

Pulmonary arterial hypertension

Lung transplantation

Extracorporeal membrane oxygenation

Left ventricular dysfunction

AbbreviationCPB

cardiopulmonary bypass

DCDD

donation after circulatory determination of death

ECMO

extracorporeal membrane oxygenation

IPAH

idiopathic pulmonary arterial hypertension

ISHLT

International Society for Heart and Lung Transplantation

LVD

left ventricular dysfunction

LVEF

left ventricular ejection fraction

mPAP

mean pulmonary arterial pressure

PAH

pulmonary arterial hypertension

PCWP

pulmonary capillary wedge pressure

PGD

primary graft dysfunction

RHC

right heart catheterization

VA-ECMO

venoarterial extracorporeal membrane oxygenation

VV-ECMO

venovenous extracorporeal membrane oxygenation

WHO

World Health Organization

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© 2022 Published by Elsevier Inc.

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