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Michel SG, Hagl C, Kauke T, Kneidinger N, Schneider C. [Lung transplantation: current situation and developments]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:108-114. [PMID: 38191810 DOI: 10.1007/s00104-023-02023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/10/2024]
Abstract
Lung transplantation is currently the gold standard treatment for end-stage lung diseases. Advances in the preservation of donor lungs, the surgical technique and immunosuppressive therapy have led to lung transplantation now being a routine procedure. Nevertheless, the shortage of donor organs, the acute and particularly chronic lung allograft dysfunction (CLAD) still represent major challenges even in experienced centers. Research in this area is still necessary to improve the long-term survival of lung recipients.
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Affiliation(s)
- S G Michel
- Herzchirurgische Klinik, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland.
- Comprehensive Pneumology Center Munich, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland.
- Munich Heart Alliance, Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), München, Deutschland.
| | - C Hagl
- Herzchirurgische Klinik, LMU Klinikum, Marchioninistraße 15, 81377, München, Deutschland
- Comprehensive Pneumology Center Munich, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
- Munich Heart Alliance, Deutsches Zentrum für Herz-Kreislaufforschung (DZHK), München, Deutschland
| | - T Kauke
- Comprehensive Pneumology Center Munich, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
- Abteilung für Thoraxchirurgie, LMU Klinikum, München, Deutschland
| | - N Kneidinger
- Comprehensive Pneumology Center Munich, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
- Medizinische Klinik und Poliklinik V, Pneumologie, LMU Klinikum, München, Deutschland
| | - C Schneider
- Comprehensive Pneumology Center Munich, Deutsches Zentrum für Lungenforschung (DZL), München, Deutschland
- Abteilung für Thoraxchirurgie, LMU Klinikum, München, Deutschland
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Costello JP, Carvajal HG, Abarbanell AM, Eghtesady P, Nath DS. Surgical considerations in infant lung transplantation: Challenges and opportunities. Am J Transplant 2021; 21:15-20. [PMID: 32852866 DOI: 10.1111/ajt.16282] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/03/2020] [Accepted: 08/16/2020] [Indexed: 01/25/2023]
Abstract
Lung transplantation is a crucial component in the treatment of end-stage lung disease in infants. Traditionally, most lung transplants have been performed in older children and adults, resulting in a scarcity of data for infant patients. To address the challenges unique to this age group, novel strategies to provide the best preoperative, intraoperative, and postoperative care for these youngest patients are paramount. We review recent advances in bridge-to-transplantation therapy, including the use of a paracorporeal lung assist device, and differences in surgical technique, including bronchial artery revascularization, for incorporation into the overarching treatment strategy for infants undergoing lung transplantation.
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Affiliation(s)
- John P Costello
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Horacio G Carvajal
- Section of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Aaron M Abarbanell
- Section of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Pirooz Eghtesady
- Section of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Dilip S Nath
- Section of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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Abstract
Children with end-stage lung failure awaiting lung transplant would benefit from improvements in artificial lung technology allowing for wearable pulmonary support as a bridge-to-transplant therapy. In this work, we designed, fabricated, and tested the Pediatric MLung-a dual-inlet hollow fiber artificial lung based on concentric gating, which has a rated flow of 1 L/min, and a pressure drop of 25 mm Hg at rated flow. This device and future iterations of the current design are designed to relieve pulmonary arterial hypertension, provide pulmonary support, reduce ventilator-associated injury, and allow for more effective therapy of patients with end-stage lung disease, including bridge-to-transplant treatment.
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Kozłowska Z, Owsiańska Z, Wroblewska JP, Kałużna A, Marszałek A, Singh Y, Mroziński B, Liu Q, Karolak JA, Stankiewicz P, Deutsch G, Szymankiewicz-Bręborowicz M, Szczapa T. Genotype-phenotype correlation in two Polish neonates with alveolar capillary dysplasia. BMC Pediatr 2020; 20:320. [PMID: 32600276 PMCID: PMC7322906 DOI: 10.1186/s12887-020-02200-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Alveolar capillary dysplasia (ACD) is a rare cause of severe pulmonary hypertension and respiratory failure in neonates. The onset of ACD is usually preceded by a short asymptomatic period. The condition is refractory to all available therapies as it irreversibly affects development of the capillary bed in the lungs. The diagnosis of ACD is based on histopathological evaluation of lung biopsy or autopsy tissue or genetic testing of FOXF1 on chromosome 16q24.1. Here, we describe the first two Polish patients with ACD confirmed by histopathological and genetic examination. CASE PRESENTATION The patients were term neonates with high Apgar scores in the first minutes of life. They both were diagnosed prenatally with heart defects. Additionally, the first patient presented with omphalocele. The neonate slightly deteriorated around 12th hour of life, but underwent surgical repair of omphalocele followed by mechanical ventilation. Due to further deterioration, therapy included inhaled nitric oxide (iNO), inotropes and surfactant administration. The second patient was treated with prostaglandin E1 since birth due to suspicion of aortic coarctation (CoA). After ruling out CoA in the 3rd day of life, infusion of prostaglandin E1 was discountinued and immediately patient's condition worsened. Subsequent treatment included re-administration of prostaglandin E1, iNO and mechanical ventilation. Both patients presented with transient improvement after application of iNO, but died despite maximized therapy. They were histopathologically diagnosed post-mortem with ACD. Array comparative genomic hybridization in patient one and patient two revealed copy-number variant (CNV) deletions, respectively, ~ 1.45 Mb in size involving FOXF1 and an ~ 0.7 Mb in size involving FOXF1 enhancer and leaving FOXF1 intact. CONCLUSIONS Both patients presented with a distinct course of ACD, extra-pulmonary manifestations and response to medications. Surgery and ceasing of prostaglandin E1 infusion should be considered as potential causes of this variability. We further highlight the necessity of thorough genetic testing and histopathological examination and propose immunostaining for CD31 and CD34 to facilitate the diagnostic process for better management of infants with ACD.
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Affiliation(s)
- Zuzanna Kozłowska
- Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland.
| | - Zuzanna Owsiańska
- Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna P Wroblewska
- Department of Pathology, Poznan University of Medical Sciences and Greater Poland Cancer Center, Poznan, Poland
| | - Apolonia Kałużna
- Department of Pathology, Poznan University of Medical Sciences and Greater Poland Cancer Center, Poznan, Poland
| | - Andrzej Marszałek
- Department of Pathology, Poznan University of Medical Sciences and Greater Poland Cancer Center, Poznan, Poland
| | - Yogen Singh
- Department of Neonatology and Paediatric Cardiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Bartłomiej Mroziński
- Department of Pediatric Cardiology and Nephrology, Poznan University of Medical Sciences, Poznan, Poland
| | - Qian Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Justyna A Karolak
- Chair and Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Stankiewicz
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Gail Deutsch
- Department of Pathology, Seattle Children's Hospital, Seattle, USA
| | - Marta Szymankiewicz-Bręborowicz
- Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Szczapa
- Department of Neonatology, Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Poznan University of Medical Sciences, Poznan, Poland
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Partridge EA, Davey MG, Hornick M, Dysart KC, Olive A, Caskey R, Connelly JT, Hedrick HL, Peranteau WH, Flake AW. Pumpless arteriovenous extracorporeal membrane oxygenation: A novel mode of respiratory support in a lamb model of congenital diaphragmatic hernia. J Pediatr Surg 2018; 53:1453-1460. [PMID: 29605270 DOI: 10.1016/j.jpedsurg.2018.02.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) is commonly required in neonates with congenital diaphragmatic hernia (CDH) complicated by pulmonary hypertension (PH). ECMO carries significant risk, and is contraindicated in the setting of extreme prematurity or intracranial hemorrhage. Pumpless arteriovenous ECMO (P-ECMO) may represent an alternative for respiratory support. The present study summarizes our initial experience with P-ECMO in a lamb model of CDH. STUDY DESIGN Surgical creation of CDH was performed at 65-75days' gestation. At term (135-145days), lambs were delivered into the P-ECMO circuit. Three animals were maintained on a low-heparin infusion protocol (target ACT 160-180) and three animals were maintained with no systemic heparinization. RESULTS Animals were supported by the circuit for 380.7 +/- 145.6h (range, 102-504h). Circuit flow rates ranged from 97 to 208ml/kg/min, with adequacy of organ perfusion demonstrated by stable serum lactate levels (3.0 +/- 1.7) and pH (7.4 +/- 0.3). Necropsy demonstrated no evidence of thrombogenic complications. CONCLUSION Pumpless extracorporeal membrane oxygenation achieved support of CDH model lambs for up to three weeks. This therapy has the potential to bridge neonates with decompensated respiratory failure to CDH repair with no requirement for systemic anticoagulation, and may be applicable to patients currently precluded from conventional ECMO support.
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Affiliation(s)
- Emily A Partridge
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Marcus G Davey
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Matthew Hornick
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Kevin C Dysart
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Aliza Olive
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Robert Caskey
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - James T Connelly
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Holly L Hedrick
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - William H Peranteau
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
| | - Alan W Flake
- Center for Fetal Research, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104.
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Karimov JH, Horvath DJ, Byram N, Sunagawa G, Kuban BD, Gao S, Dessoffy R, Fukamachi K. Early in vivo experience with the pediatric continuous-flow total artificial heart. J Heart Lung Transplant 2018; 37:1029-1034. [PMID: 29703578 DOI: 10.1016/j.healun.2018.03.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Heart transplantation in infants and children is an accepted therapy for end-stage heart failure, but donor organ availability is low and always uncertain. Mechanical circulatory support is another standard option, but there is a lack of intracorporeal devices due to size and functional range. The purpose of this study was to evaluate the in vivo performance of our initial prototype of a pediatric continuous-flow total artificial heart (P-CFTAH), comprising a dual pump with one motor and one rotating assembly, supported by a hydrodynamic bearing. METHODS In acute studies, the P-CFTAH was implanted in 4 lambs (average weight: 28.7 ± 2.3 kg) via a median sternotomy under cardiopulmonary bypass. Pulmonary and systemic pump performance parameters were recorded. RESULTS The experiments showed good anatomical fit and easy implantation, with an average aortic cross-clamp time of 98 ± 18 minutes. Baseline hemodynamics were stable in all 4 animals (pump speed: 3.4 ± 0.2 krpm; pump flow: 2.1 ± 0.9 liters/min; power: 3.0 ± 0.8 W; arterial pressure: 68 ± 10 mm Hg; left and right atrial pressures: 6 ± 1 mm Hg, for both). Any differences between left and right atrial pressures were maintained within the intended limit of ±5 mm Hg over a wide range of ratios of systemic-to-pulmonary vascular resistance (0.7 to 12), with and without pump-speed modulation. Pump-speed modulation was successfully performed to create arterial pulsation. CONCLUSION This initial P-CFTAH prototype met the proposed requirements for self-regulation, performance, and pulse modulation.
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Affiliation(s)
- Jamshid H Karimov
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Nicole Byram
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gengo Sunagawa
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Barry D Kuban
- Medical Device Solutions, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shengqiang Gao
- Medical Device Solutions, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raymond Dessoffy
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kiyotaka Fukamachi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Maul TM, Nelson JS, Wearden PD. Paracorporeal Lung Devices: Thinking Outside the Box. Front Pediatr 2018; 6:243. [PMID: 30234079 PMCID: PMC6134049 DOI: 10.3389/fped.2018.00243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 08/13/2018] [Indexed: 11/18/2022] Open
Abstract
Extracorporeal Membrane Oxygenation (ECMO) is a resource intensive, life-preserving support system that has seen ever-expanding clinical indications as technology and collective experience has matured. Clinicians caring for patients who develop pulmonary failure secondary to cardiac failure can find themselves in unique situations where traditional ECMO may not be the ideal clinical solution. Existing paracorporeal ventricular assist device (VAD) technology or unique patient physiologies offer the opportunity for thinking "outside the box." Hybrid ECMO approaches include splicing oxygenators into paracorporeal VAD systems and alternative cannulation strategies to provide a staged approach to transition a patient from ECMO to a VAD. Alternative technologies include the adaptation of ECMO and extracorporeal CO2 removal systems for specific physiologies and pediatric aged patients. This chapter will focus on: (1) hybrid and alternative approaches to extracorporeal support for pulmonary failure, (2) patient selection and, (3) technical considerations of these therapies. By examining the successes and challenges of the relatively select patients treated with these approaches, we hope to spur appropriate research and development to expand the clinical armamentarium of extracorporeal technology.
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Affiliation(s)
- Timothy M Maul
- Department of Cardiac Surgery, Nemours Children's Hospital, Orlando, FL, United States.,Department of Biomedical Engineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer S Nelson
- Department of Cardiac Surgery, Nemours Children's Hospital, Orlando, FL, United States
| | - Peter D Wearden
- Department of Cardiac Surgery, Nemours Children's Hospital, Orlando, FL, United States.,Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States
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Pediatric Artificial Lung: A Low-Resistance Pumpless Artificial Lung Alleviates an Acute Lamb Model of Increased Right Ventricle Afterload. ASAIO J 2016; 63:223-228. [PMID: 27861431 DOI: 10.1097/mat.0000000000000481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Lung disease in children often results in pulmonary hypertension and right heart failure. The availability of a pediatric artificial lung (PAL) would open new approaches to the management of these conditions by bridging to recovery in acute disease or transplantation in chronic disease. This study investigates the efficacy of a novel PAL in alleviating an animal model of pulmonary hypertension and increased right ventricle afterload. Five juvenile lambs (20-30 kg) underwent PAL implantation in a pulmonary artery to left atrium configuration. Induction of disease involved temporary, reversible occlusion of the right main pulmonary artery. Hemodynamics, pulmonary vascular input impedance, and right ventricle efficiency were measured under 1) baseline, 2) disease, and 3) disease + PAL conditions. The disease model altered hemodynamics variables in a manner consistent with pulmonary hypertension. Subsequent PAL attachment improved pulmonary artery pressure (p = 0.018), cardiac output (p = 0.050), pulmonary vascular input impedance (Z.0 p = 0.028; Z.1 p = 0.058), and right ventricle efficiency (p = 0.001). The PAL averaged resistance of 2.3 ± 0.8 mm Hg/L/min and blood flow of 1.3 ± 0.6 L/min. This novel low-resistance PAL can alleviate pulmonary hypertension in an acute animal model and demonstrates potential for use as a bridge to lung recovery or transplantation in pediatric patients with significant pulmonary hypertension refractory to medical therapies.
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Gazit AZ, Sweet SC, Grady RM, Boston US, Huddleston CB, Hoganson DM, Shepard M, Raithel S, Mehegan M, Doctor A, Spinella PC, Eghtesady P. Recommendations for utilization of the paracorporeal lung assist device in neonates and young children with pulmonary hypertension. Pediatr Transplant 2016; 20:256-70. [PMID: 26899454 DOI: 10.1111/petr.12673] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 11/28/2022]
Abstract
The management of decompensating critically ill children with severe PH is extremely challenging and requires a multidisciplinary approach. Unfortunately, even with optimal care, these children might continue to deteriorate and develop inadequate systemic perfusion and at times cardiac arrest secondary to a pulmonary hypertensive crisis. Tools to support these children are limited, and at times, the team should proceed with offering extracorporeal support, especially in newly diagnosed patients who have not benefitted from medical therapy prior to their acute deterioration, in patients with severe pulmonary venous disease and in patients with alveolar capillary dysplasia. Currently, the only approved mode for extracorporeal support in pediatric patients with PH eligible for lung transplantation is ECMO. To decrease the risks associated with ECMO, and offer potential for increased duration of support, extubation, and rehabilitation, we transitioned four small children with refractory PH from ECMO to a device comprising an oxygenator interposed between the PA and LA. This work describes in great detail our experience with this mode of support with emphasis on exclusion criteria, the implantation procedure, and the post-implantation management.
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Affiliation(s)
- Avihu Z Gazit
- Division of Pediatric Critical care, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Stuart C Sweet
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - R Mark Grady
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Umar S Boston
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - David M Hoganson
- Pediatric Cardiac Surgery, Harvard Medical School, Boston, MA, USA
| | - Mark Shepard
- Saint Louis Children's Hospital, St. Louis, MO, USA
| | | | - Mary Mehegan
- Saint Louis Children's Hospital, St. Louis, MO, USA
| | - Allan Doctor
- Division of Pediatric Critical care, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Philip C Spinella
- Division of Pediatric Critical care, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Pirooz Eghtesady
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Abstract
PURPOSE OF REVIEW Lung transplantation for infants and children is an accepted but rarely exercised option for the treatment of end-stage lung disease, with outcomes equivalent to those for adults. However, widespread misconceptions regarding pediatric outcomes often confound timely and appropriate referral to specialty centers. We present the updated information for primary pediatricians to utilize when counseling families with children confronted by progressive end-stage pulmonary or cardiovascular disease. RECENT FINDINGS We provide general guidelines to consider for referral, and discuss allocation of organs in children, information regarding standard treatment protocols, and survival outcomes. SUMMARY Lung transplantation is a worthwhile treatment option to consider in children with end-stage lung disease. The treatment is complex, but lung transplant provides substantial survival benefit and markedly improved quality of life for children and their families. This timely review provides comprehensive information for pediatricians who are considering options for treatment of children with end-stage lung disease.
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Affiliation(s)
- Carol Conrad
- aDivision of Pediatric Pulmonary Medicine bDivision of Critical Care, Department of Pediatrics, Center for Excellence in Pulmonary Biology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California, USA
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Puehler T, Ensminger S, Schulz U, Fuchs U, Tigges-Limmer K, Börgermann J, Morshuis M, Hakim K, Oldenburg O, Niedermeyer J, Renner A, Gummert J. [Heart and combined heart-lung transplantation. Indications, chances and risks]. Herz 2014; 39:66-73. [PMID: 24452762 DOI: 10.1007/s00059-013-4042-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Orthotopic heart transplantation (HTX) is nowadays the worldwide accepted gold standard for the treatment of terminal heart failure. The main indications for HTX are non-ischemic dilatative (54%) and ischemic (37%) heart failure. In the acute phase after HTX the survival rate is approximately 90%. Good short and long-term results with survival rates ranging from 81% after 1 year to more than 50% after 11 years demonstrate that there is currently no real treatment alternative to HTX for treatment of end-stage heart failure. In the case of irreversible pulmonary hypertension in combination with end-stage heart failure or complex congenital heart syndromes, a combined heart and lung transplantation (HLTX) is necessary. Compared with HTX the short-term survival of HLTX is reduced, mostly for technical reasons. Improved long-term results after HTX and HLTX are a result of highly specialized transplantation units and effective immunosuppression. However, a major problem is the shortage of organ donors in Germany and the resulting long waiting times for patients with frequently occurring blood groups of up to 10 months for transplantation. The consequence of the latter is the ever increasing number of implanted cardiac assist devices in patients not only as a bridge to transplant but also as destination therapy.
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Affiliation(s)
- T Puehler
- Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinikum der Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland,
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Hoganson DM, Gazit AZ, Boston US, Sweet SC, Grady RM, Huddleston CB, Eghtesady P. Paracorporeal lung assist devices as a bridge to recovery or lung transplantation in neonates and young children. J Thorac Cardiovasc Surg 2013; 147:420-6. [PMID: 24199759 DOI: 10.1016/j.jtcvs.2013.08.078] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 08/16/2013] [Accepted: 08/27/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate paracorporeal lung assist devices to treat neonates and children with decompensated respiratory failure as a bridge to recovery or lung transplantation. METHODS One neonate (23 days old) and 3 young children (aged 2, 9, and 23 months) presented with primary lung disease with pulmonary hypertension, including alveolar capillary dysplasia in 2 and right pulmonary hypoplasia and primary pulmonary hypertension in 1. The patients were listed for lung transplantation but decompensated and required extracorporeal membrane oxygenation (ECMO). The patients were transitioned from ECMO to a pumpless paracorporeal lung assist device (Maquet Quadrox-iD oxygenator in 3, Novalung in 1) with inflow from the pulmonary artery and return to the left atrium. RESULTS The patients were weaned from ECMO and supported by the device for 44 ± 29 days (range, 5-74). Three patients were extubated while supported by the device (after 9, 15, and 72 days). One patient was bridged to lung transplant (9 months old, with alveolar capillary dysplasia, supported 5 days). One patient was bridged to recovery with maximal medical therapy (23 months old, with primary pulmonary hypertension, supported 23 days). Two patients died while awaiting a suitable lung donor after a support time of 54 and 72 days. CONCLUSIONS Pediatric patients bridged from ECMO to lung transplantation have poor results. An alternative method for longer term respiratory support was necessary as a bridge for these patients. The use of a paracorporeal lung assist device successfully supported 4 patients to recovery, lung transplantation, or past the average wait time for pediatric donor lungs (27 days). This therapy has the potential to bridge children with decompensated respiratory failure to lung transplantation.
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Affiliation(s)
- David M Hoganson
- Division of Cardiothoracic Surgery, Department of Surgery, St Louis Children's Hospital and Washington University, St Louis, Mo
| | - Avihu Z Gazit
- Division of Critical Care, St Louis Children's Hospital and Washington University, St Louis, Mo; Division of Cardiology, St Louis Children's Hospital and Washington University, St Louis, Mo
| | - Umar S Boston
- Division of Cardiothoracic Surgery, Department of Surgery, St Louis Children's Hospital and Washington University, St Louis, Mo
| | - Stuart C Sweet
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St Louis Children's Hospital and Washington University, St Louis, Mo
| | - R Mark Grady
- Division of Cardiology, St Louis Children's Hospital and Washington University, St Louis, Mo
| | - Charles B Huddleston
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, St Louis University, St Louis, Mo
| | - Pirooz Eghtesady
- Division of Cardiothoracic Surgery, Department of Surgery, St Louis Children's Hospital and Washington University, St Louis, Mo.
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