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.
AbstractPurposeBilateral 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 methodsWe 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.
Results50 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.
ConclusionsThis 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.
KeywordsPulmonary arterial hypertension
Lung transplantation
Extracorporeal membrane oxygenation
Left ventricular dysfunction
AbbreviationCPBcardiopulmonary bypass
DCDDdonation after circulatory determination of death
ECMOextracorporeal membrane oxygenation
IPAHidiopathic pulmonary arterial hypertension
ISHLTInternational Society for Heart and Lung Transplantation
LVDleft ventricular dysfunction
LVEFleft ventricular ejection fraction
mPAPmean pulmonary arterial pressure
PAHpulmonary arterial hypertension
PCWPpulmonary capillary wedge pressure
PGDprimary graft dysfunction
RHCright heart catheterization
VA-ECMOvenoarterial extracorporeal membrane oxygenation
VV-ECMOvenovenous extracorporeal membrane oxygenation
WHOWorld Health Organization
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