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Serrao G, Vinayak M, Nicolas J, Subramaniam V, Lai AC, Laskey D, Kini A, Seethamraju H, Scheinin S. The Evaluation and Management of Coronary Artery Disease in the Lung Transplant Patient. J Clin Med 2023; 12:7644. [PMID: 38137713 PMCID: PMC10743826 DOI: 10.3390/jcm12247644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
Lung transplantation can greatly improve quality of life and extend survival in those with end-stage lung disease. In order to derive the maximal benefit from such a procedure, patients must be carefully selected and be otherwise healthy enough to survive a high-risk surgery and sometimes prolonged immunosuppressive therapy following surgery. Patients therefore must be critically assessed prior to being listed for transplantation with close attention paid towards assessment of cardiovascular health and operative risk. One of the biggest dictators of this is coronary artery disease. In this review article, we discuss the assessment and management of coronary artery disease in the potential lung transplant candidate.
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Affiliation(s)
- Gregory Serrao
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (M.V.); (J.N.); (V.S.); (A.C.L.); (D.L.); (A.K.); (H.S.); (S.S.)
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2
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Yeom R, Gorgone M, Malinovic M, Panzica P, Maslow A, Augoustides JG, Marchant BE, Fernando RJ, Nampi RG, Pospishil L, Neuburger PJ. Surgical Aortic Valve Replacement in a Patient with Very Severe Chronic Obstructive Pulmonary Disease. J Cardiothorac Vasc Anesth 2023; 37:2335-2349. [PMID: 37657996 DOI: 10.1053/j.jvca.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Richard Yeom
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Michelle Gorgone
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - Matea Malinovic
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Peter Panzica
- Department of Anesthesiology, Westchester Medical Center, Valhalla, NY
| | - Andrew Maslow
- Department of Anesthesiology, Rhode Island Hospital, Providence, RI
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Bryan E Marchant
- Department of Anesthesiology, Cardiothoracic and Critical Care Sections, Wake Forest University School of Medicine, Winston Salem, NC
| | - Rohesh J Fernando
- Department of Anesthesiology, Cardiothoracic Section, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC.
| | - Robert G Nampi
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Liliya Pospishil
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY
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3
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Larson EL, Lee AY, Lawton JS, Aziz H. Reoperative CABG in a patient with prior concomitant lung transplantation and two-vessel CABG. Glob Cardiol Sci Pract 2023; 2023:e202325. [PMID: 38404627 PMCID: PMC10886854 DOI: 10.21542/gcsp.2023.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/12/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Lung transplants (LTx) are being offered to increasingly older patients, and as a result, more concomitant coronary artery disease is being encountered in LTx candidates. While concurrent coronary artery bypass grafting (CABG) and LTx have become more common, the long-term considerations of reoperative CABG in patients following CABG with concomitant LTx are not fully understood. CASE PRESENTATION A 75-year-old man with a history of bilateral LTx and concomitant CABG X 2 15 years prior presented to the emergency room with tachycardia and chest discomfort radiating to the left upper extremity. Emergent coronary angiography revealed severe three-vessel coronary artery disease with two occluded saphenous vein grafts, severe distal obtuse marginal (OM) and left circumflex disease, a collateralized chronic total occlusion of the mid LAD, and tortuosity of the proximal right innominate artery. The patient underwent a complex redo sternotomy and CABG X 2 due to dense adhesions in the mediastinum and pleura bilaterally. The postoperative course was complicated by left leg SVG harvest site cellulitis treated with IV antibiotics and hypervolemia treated with diuresis. The patient was discharged postoperatively on day 13. DISCUSSION To our knowledge, this is the first reported successful reoperative CABG in a patient with a history of concomitant LTx and CABG. This case demonstrates feasibility, though additional caution is required due to the technical complexity and risk of immunosuppression in such complex patients.
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Affiliation(s)
- Emily L. Larson
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Anson Y. Lee
- Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI, USA
| | - Jennifer S. Lawton
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Hamza Aziz
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21287, USA
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4
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Meng E, Jiang SM, Servito T, Payne D, El-Diasty M. Lung transplantation and concomitant cardiac surgical procedures: A systematic review and meta-analysis. J Card Surg 2022; 37:3342-3352. [PMID: 35811496 DOI: 10.1111/jocs.16740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lung transplantation is an effective treatment option for end-stage lung diseases. In some cases, these patients may also have underlying cardiac disease which may require surgical intervention before or during transplantation. Concomitant cardiac surgery may often be preferred, as reduced lung function precludes these patients from pre-transplant surgery. Our meta-analysis sought to examine the impact of lung transplantation paired with concomitant cardiac surgery on long-term mortality. METHODS We conducted a systematic review of the MEDLINE, Embase, and Cochrane databases. Our primary outcome was overall mortality. Secondary outcomes included length of stay (LOS) in hospital and serious postoperative complication rates. We used a meta-analytic model to determine the differences in the above outcomes between patients who underwent lung transplantation with or without concomitant cardiac surgery. RESULTS Out of the 1876 articles screened, 7 met our pre-determined inclusion criteria. Lung transplantation with concomitant cardiac surgery was not associated with increased mortality compared to lung transplantation alone (hazard ratio = 1.02; 95% confidence interval [CI] = 0.80-1.31; I2 = 0%; p = .99). LOS in hospital was not significantly different between groups (standardized mean difference = 0.32; 95% CI = -0.91 to 1.55). Postoperative complication rates were also reported but not analyzed due to missing data. CONCLUSIONS There was no significant difference in mortality rates in patients undergoing lung transplantation with or without concomitant cardiac surgery at 1, 3, and 5 years. However, postoperative complication rates were higher in the concomitant group. The decision to perform concomitant procedures should be tailored to each patient's clinical condition.
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Affiliation(s)
- Eric Meng
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Stephanie M Jiang
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Therese Servito
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | - Mohammad El-Diasty
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
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5
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Elgharably H, Javorski MJ, McCurry KR. Bilateral sequential lung transplantation: technical aspects. J Thorac Dis 2022; 13:6564-6575. [PMID: 34992835 PMCID: PMC8662466 DOI: 10.21037/jtd-2021-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/02/2021] [Indexed: 12/02/2022]
Abstract
The surgical technique for lung transplantation has evolved dramatically over the last three decades. Significant improvements in short term outcomes in the early years of lung transplantation were due, in large part, to techniques developed to reduce airway anastomotic complications in single lung transplantation. Following development of the technique of en bloc double lung transplantation, evolution to the bilateral sequential technique further reduced airway complications for double lung transplantation. More recently, some programs have utilized the en bloc double lung transplant technique with bronchial artery revascularization to aid airway healing and potentially improve short- and long-term outcomes. The experience with bronchial artery revascularization remains limited to a few series, with the technique having not been widely adopted by most lung transplant programs. With the implementation of priority allocations schemes in many countries, patients with higher risk profiles are being prioritized for transplantation which results in more complex procedures in fragile recipients with multiple comorbidities. This includes the increased need for concomitant cardiac procedures as well as performing lung transplantation after prior cardiothoracic surgery. Different surgical approaches have been described for bilateral sequential lung transplantation with or without intra-operative mechanical circulatory support (MCS), such as sternotomy, clamshell (bilateral anterior thoracotomies with transverse sternotomy), and bilateral thoracotomy incisions. Herein, we aim, not only to describe the various surgical approaches for double lung transplantation, but to provide a comprehensive review of other aspects related to the recipient pathology and different anatomical variants as well as handling technical challenges that might be encountered during the procedure.
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Affiliation(s)
- Haytham Elgharably
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Michael J Javorski
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Kenneth R McCurry
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
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6
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Wallen TJ, Arnaoutakis GJ, Beaver T, Pelaez A, Chandrashekaran S, Shahmohammadi A, Emtiazjoo AM, Spiess B, Pipkin M, Machuca TN. Successful bridge to lung transplantation with transcatheter aortic valve replacement. Am J Transplant 2020; 20:3658-3661. [PMID: 32506577 DOI: 10.1111/ajt.16103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/06/2020] [Accepted: 05/19/2020] [Indexed: 01/25/2023]
Abstract
End-stage lung disease and advanced cardiac conditions are frequently seen together and represent a clinical dilemma. Even though both issues may be amenable to surgical management, combining lung transplant with surgical valve repair is rarely done and theoretically associated with increased morbidity and mortality risks, especially in elderly patients. Here, we describe 2 patients presenting with end-stage lung disease and significant aortic stenosis who were successfully bridged to lung transplant via transcatheter aortic valve replacement. Patient 1 was a 66-year-old man who underwent a double lung transplant 56 days after transcatheter aortic valve replacement. Patient 2 was a 70-year-old man who underwent a single right lung transplant 103 days after transcatheter aortic valve replacement. Both patients had uneventful postoperative courses and are alive at the 1-year time point with excellent performance status. This report suggests that transcatheter aortic valve replacement may favorably impact lung transplant candidacy for patients with end-stage lung disease in the setting of severe aortic stenosis, likely representing a better alternative to concomitant aortic valve replacement and lung transplant in elderly patients.
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Affiliation(s)
- Tyler J Wallen
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, The University of Florida, Gainesville, Florida, USA
| | - George J Arnaoutakis
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, The University of Florida, Gainesville, Florida, USA
| | - Thomas Beaver
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, The University of Florida, Gainesville, Florida, USA
| | - Andres Pelaez
- Department of Medicine, Division of Pulmonary Critical Care Medicine, The University of Florida, Gainesville, Florida, USA
| | - Satish Chandrashekaran
- Department of Medicine, Division of Pulmonary Critical Care Medicine, The University of Florida, Gainesville, Florida, USA
| | - Abbas Shahmohammadi
- Department of Medicine, Division of Pulmonary Critical Care Medicine, The University of Florida, Gainesville, Florida, USA
| | - Amir M Emtiazjoo
- Department of Medicine, Division of Pulmonary Critical Care Medicine, The University of Florida, Gainesville, Florida, USA
| | - Bruce Spiess
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, The University of Florida, Gainesville, Florida, USA
| | - Mauricio Pipkin
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, The University of Florida, Gainesville, Florida, USA
| | - Tiago N Machuca
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, The University of Florida, Gainesville, Florida, USA
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7
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Sinha N, Balayla G, Braghiroli J. Coronary artery disease in lung transplant patients. Clin Transplant 2020; 34:e14078. [PMID: 32940380 DOI: 10.1111/ctr.14078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 08/28/2020] [Indexed: 01/11/2023]
Abstract
Coronary artery disease (CAD) is a pathology often found in patients with end-stage lung disease. Although in the past CAD might have been considered an absolute contraindication, modern revascularization techniques have helped increase the number of transplants performed in this population. However, discrepancies in the guidelines for perioperative evaluation and risk mitigation strategies for the ischemic cardiac burden are present in the current literature. This is a review of the available data regarding perioperative evaluation, revascularization tactics, postoperative management, and survival rate that patients with different grades of coronary artery disease present after lung transplantation.
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Affiliation(s)
- Neeraj Sinha
- Division of Pulmonary and Critical Care Medicine, Transplant Pulmonology, University of Miami, Miami, FL, USA
| | - Galit Balayla
- Department of General Medicine, Central University of Venezuela, Caracas, Venezuela
| | - Joao Braghiroli
- Division of Interventional Cardiology, Jackson Health System, Miami, FL, USA
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Kanaparthi J, Kashem MA, Suryapalam M, Zhao H, Brann S, Leotta E, Minakata K, Keshavamurthy S, Shigemura N, Toyoda Y. Prior and Perioperative Revascularization Does Not Affect Survival in Lung Transplant Patients. Ann Thorac Surg 2020; 109:1677-1683. [DOI: 10.1016/j.athoracsur.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 10/24/2022]
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9
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Chan PG, Sanchez PG, Morrell MR, Kilic A, Sultan I. Concomitant surgical aortic valve replacement with bilateral orthotopic lung transplantation. J Card Surg 2019; 35:470-472. [DOI: 10.1111/jocs.14363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Patrick G. Chan
- Department of Cardiothoracic SurgeryUniversity of PittsburghPittsburgh Pennsylvania
| | - Pablo G. Sanchez
- Department of Cardiothoracic SurgeryUniversity of PittsburghPittsburgh Pennsylvania
| | | | - Arman Kilic
- Department of Cardiothoracic SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Department of MedicineUniversity of PittsburghPittsburgh Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic SurgeryUniversity of PittsburghPittsburgh Pennsylvania
- Heart and Vascular InstituteUniversity of Pittsburgh Medical CenterPittsburgh Pennsylvania
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10
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Biniwale R, Ross D, Iyengar A, Kwon OJ, Hunter C, Aboulhosn J, Gjertson D, Ardehali A. Lung transplantation and concomitant cardiac surgery: Is it justified? J Thorac Cardiovasc Surg 2016; 151:560-6. [DOI: 10.1016/j.jtcvs.2015.10.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/05/2015] [Accepted: 10/01/2015] [Indexed: 01/24/2023]
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11
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Castleberry AW, Martin JT, Osho AA, Hartwig MG, Hashmi ZA, Zanotti G, Shaw LK, Williams JB, Lin SS, Davis RD. Coronary revascularization in lung transplant recipients with concomitant coronary artery disease. Am J Transplant 2013; 13:2978-88. [PMID: 24102830 PMCID: PMC4332513 DOI: 10.1111/ajt.12435] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 07/16/2013] [Accepted: 07/20/2013] [Indexed: 01/25/2023]
Abstract
Coronary artery disease (CAD) is not uncommon among lung transplant candidates. Several small, single-center series have suggested that short-term outcomes are acceptable in selected patients who undergo coronary revascularization prior to, or concomitant with, lung transplantation. Our objective was to evaluate perioperative and intermediate-term outcomes in this patient population at our institution. We performed a retrospective, observational cohort analysis of 898 lung transplant recipients between 1997 and 2010. Pediatric, multivisceral, lobar or repeat transplantations were excluded, resulting in 791 patients for comparative analysis, of which 49 (median age 62, 79.6% bilateral transplant) underwent concurrent coronary artery bypass and 38 (median age 64, 63.2% bilateral transplant) received preoperative percutaneous coronary intervention (PCI). Perioperative mortality, overall unadjusted survival and adjusted hazard ratio for cumulative risk of death were similar among both revascularization groups as well as controls. The rate of postoperative major adverse cardiac events was also similar among groups; however, concurrent coronary artery bypass was associated with longer postoperative length of stay, more time in the intensive care unit and more postoperative days requiring ventilator support. These results suggest that patients with CAD need not be excluded from lung transplantation. Preferential consideration should be given to preoperative PCI when feasible.
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Affiliation(s)
- A. W. Castleberry
- Department of Surgery, Duke University Medical Center, Durham, NC,Corresponding author: Anthony W. Castleberry,
| | - J. T. Martin
- Division of Cardiothoracic Surgery, University of Kentucky, Lexington, KY
| | - A. A. Osho
- Duke University School of Medicine, Durham, NC
| | - M. G. Hartwig
- Department of Surgery, Duke University Medical Center, Durham, NC,Division of Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Z. A. Hashmi
- Division of Cardiothoracic Surgery, Indiana University Health, Indianapolis, IN
| | - G. Zanotti
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - L. K. Shaw
- Duke Clinical Research Institute, Durham, NC
| | - J. B. Williams
- Department of Surgery, Duke University Medical Center, Durham, NC,Division of Thoracic Surgery, Duke University Medical Center, Durham, NC,Duke Clinical Research Institute, Durham, NC
| | - S. S. Lin
- Department of Surgery, Duke University Medical Center, Durham, NC,Division of Thoracic Surgery, Duke University Medical Center, Durham, NC,Department of Immunology and Department of Pathology, Duke University Medical Center, Durham, NC
| | - R. D. Davis
- Department of Surgery, Duke University Medical Center, Durham, NC,Division of Thoracic Surgery, Duke University Medical Center, Durham, NC
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12
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Esper SA. Role of Transesophageal Echocardiography in Perioperative Patient Management of Lung Transplantation Surgery. ACTA ACUST UNITED AC 2013. [DOI: 10.5005/jp-journals-10034-1008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Lung transplantation is the only option for patients with end-stage lung disease. Chronic obstructive lung disease, idiopathic pulmonary fibrosis, cystic fibrosis and primary pulmonary hypertension are few common indications for lung transplantation. Patients with end-stage lung disease may have pre-existing cardiovascular compromise related to pulmonary hypertension and other cardiovascular lesions, such as coronary artery disease or valvular heart disease. Preoperative evaluation and optimization of hemodynamics is expected to improve outcomes from lung transplantation. Intraoperative hemodynamic instability is common during lung transplantation and requires highest level of cardiovascular monitoring. After transplantation, vascular anastomosis should be evaluated for flow patterns to rule out obstruction from stenosis or thrombosis. Postoperative complications are common and include bleeding, cardiac failure and hypoxemia from right to left shunt. Primary graft dysfunction may necessitate mechanical cardiorespiratory support. Transesophageal echocardiography plays a central role in preoperative evaluation, intraoperative hemodynamic management, evaluation of pulmonary vascular anastomosis, diagnosis of postoperative complications and also in the critical care management of mechanical cardiorespiratory support.
How to cite this article
Subramaniam K, Esper SA. Role of Transesophageal Echocardiography in Perioperative Patient Management of Lung Transplantation Surgery. J Perioper Echocardiogr 2013;1(2):48-56.
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13
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Shigemura N, Sareyyupoglu B, Bhama J, Bonde P, Thacker J, Bermudez C, Gries C, Crespo M, Johnson B, Pilewski J, Toyoda Y. Combining tricuspid valve repair with double lung transplantation in patients with severe pulmonary hypertension, tricuspid regurgitation, and right ventricular dysfunction. Chest 2011; 140:1033-1039. [PMID: 21700686 DOI: 10.1378/chest.10-2929] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Concomitant tricuspid valve repair (TVR) and double lung transplantation (DLTx) has been a surgical option at our institution since 2004 in an attempt to improve the outcome of DLTx for end-stage pulmonary hypertension, severe tricuspid regurgitation, and right ventricle (RV) dysfunction. This study is a review of that single institutional experience. METHODS Consecutive cases of concomitant TVR and DLTx performed between 2004 and 2009 (TVR group, n = 20) were retrospectively compared with cases of DLTx alone for severe pulmonary hypertension without TVR (non-TVR group, n = 58). RESULTS There was one in-hospital death in the TVR group. The 90-day and 1- and 3-year survival rates for the TVR group were 90%, 75%, and 65%, respectively, which were not significantly different from those for the non-TVR group. The TVR group required less inotropic support and less prolonged mechanical ventilation in the ICU. Follow-up echocardiography demonstrated immediate elimination of both volume and pressure overload in the RV and tricuspid regurgitation in the TVR group. Notably, there was a significantly lower incidence of primary graft dysfunction following transplantation in the TVR group (P < .05). Pulmonary functional improvement shown by an FEV(1) increase after 6 months was also significantly better in the TVR group (40% vs 20%, P < .05). CONCLUSIONS Combined TVR and DLTx procedures were successfully performed without an increase in morbidity or mortality and contributed to decreased primary graft dysfunction. In our experience, this combined operative approach achieves clinical outcomes equal or superior to the outcomes seen in DLTx patients without RV dysfunction and severe tricuspid regurgitation.
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Affiliation(s)
- Norihisa Shigemura
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Basar Sareyyupoglu
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jay Bhama
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Pramod Bonde
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jnanesh Thacker
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Christian Bermudez
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Cynthia Gries
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Maria Crespo
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Bruce Johnson
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joseph Pilewski
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Yoshiya Toyoda
- Division of Cardiothoracic Transplantation, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Rama-Maceiras P, Díaz-Allegue M, Pato-López O, Ramos-López L, Rey-Rilo T, Bonome-González C. [Perioperative treatment of a man receiving a left-lung transplant combined with coronary revascularization without use of extracorporeal circulation: with a brief review of pathophysiology and the literature]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:425-430. [PMID: 20857638 DOI: 10.1016/s0034-9356(10)70269-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Patients with significant coronary artery disease were once traditionally rejected as candidates for lung transplants because of higher risk of morbidity and mortality. We report the case of a man who received a left lung transplant and coronary revascularization without extracorporeal circulation in a combined surgical procedure after being diagnosed with significant coronary disease during the preoperative study for acceptance as a candidate for lung transplantation. We review the history of such combination procedures, which are changing clinicians' attitudes as to appropriate therapeutic approaches to take for complex patients. We also discuss the possible advantages of performing surgery without extracorporeal circulation. To our knowledge, this is the first report of a combined procedure that took place in a Spanish hospital.
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Affiliation(s)
- P Rama-Maceiras
- Servicio de Anestesiología y Reanimación. Complejo Hospitalario Universitario. A Coruña.
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15
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Yuan SM, Shinfeld A, Raanani E. Cardiopulmonary bypass as an adjunct for the noncardiac surgeon. J Cardiovasc Med (Hagerstown) 2008; 9:338-55. [PMID: 18334888 DOI: 10.2459/jcm.0b013e3282eee889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of cardiopulmonary bypass (CPB) in noncardiac surgical settings has been increasingly developed and has greatly benefited noncardiac surgeon. A few years after the advent of CPB as well as profound hypothermic circulatory arrest in the early years, it was employed by neurosurgeons in cerebrovascular surgery and by general thoracic surgeons in carinal tumor resection. Indications for CPB were extended and modified year after year. It has facilitated not only the surgical management by surgeons of lesions that cannot be managed safely and effectively by conventional techniques, or conventional techniques carry significant risks to the patient, but also the preservation of the viability of multiple organ procurement, the practice of isolated limb perfusion for the treatment of malignancies of the extremities, and emergent cardiopulmonary resuscitation. Owing to the complications arising from CPB and profound hypothermic circulatory arrest, such as postoperative bleeding, coagulopathy, and neurologic deficits, efforts have been made to avoid these common hazards. Thus, innovative techniques including extracorporeal membrane oxygenation, percutaneous cardiopulmonary support, venovenous bypass, normothermic CPB, and minimally invasive approaches have emerged and played an important role as alternatives of standard CPB in decreasing morbidity and mortality and improving survival.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiac and Thoracic Surgery, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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16
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Lasocki S, Castier Y, Geffroy A, Mal H, Brugière O, Lesèche G, Montravers P. Early cardiac tamponade due to tension pneumopericardium after bilateral lung transplantation. J Heart Lung Transplant 2007; 26:1069-71. [PMID: 17919630 DOI: 10.1016/j.healun.2007.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 06/28/2007] [Accepted: 07/11/2007] [Indexed: 10/22/2022] Open
Abstract
We report the case of a 42-year-old woman who developed severe hemodynamic instability with marked arterial pulsed pressure variation in the early course of bilateral lung transplantation. The diagnosis of tension pneumopericardium was made on Day 2 post-operatively based on chest X-ray and echocardiography. Transoesophageal echocardiography revealed both a cardiac tamponade and a right-to-left shunt via a patent foramen ovale. The treatment and mechanisms of these two rare complications are discussed.
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Affiliation(s)
- Sigismond Lasocki
- Réanimation Chirurgicale, CHU Bichat-Claude Bernard, Université Paris VII, Paris, France.
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Abstract
PURPOSE OF REVIEW To describe recent advances in lung transplantation relevant to anesthesiologists. RECENT FINDINGS There is recent literature describing medical, surgical, anesthetic and critical care of lung transplant recipients. SUMMARY There have been substantial changes in preoperative selection and preparation of lung transplant recipients; these include donation after cardiac death, and improved lung-preservation solutions. Newer immunosuppression regimens have been successfully evaluated in clinical trials. Particular advances in anesthesia include endorsement of fluid restriction in thoracic surgery, greater use of transesophageal echocardiography, and postoperative extracorporeal membrane oxygenation.
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Affiliation(s)
- Paul S Myles
- Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Australia.
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Johnson SB, Allred AM, Cline AM, Angel LF, Sako EY, Baisden CE, Calhoon JH. Cardiac procedures in lung transplant recipients do not increase mortality in selected patients. Ann Thorac Surg 2006; 82:460-3; discussion 463-4. [PMID: 16863744 DOI: 10.1016/j.athoracsur.2006.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2005] [Revised: 02/26/2006] [Accepted: 03/03/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Associated comorbidities in potential lung transplant recipients may significantly impact operative morbidity and mortality. We undertook this review to specifically study whether patients who underwent associated cardiac procedures either before (as a prerequisite) or during their lung transplantation had different outcomes when compared with the overall cohort of lung transplant recipients. METHODS A retrospective chart review was performed of all patients who underwent lung transplantation at the University of Texas Health Science Center at San Antonio from January 1994 to June 2004. The records of these patients were analyzed for patient-days on the ventilator, hospital length of stay, operative morbidity and mortality, and long-term survival. The patients were then divided into two groups and compared: patients who had a cardiac intervention either prerequisite to or concurrent with their transplant (group C, n = 13) and patients who did not (group NC [no cardiac intervention], n = 120). RESULTS Although the median length of stay was longer in group C when compared with group NC, the number of patient-days on the ventilator and the operative morbidity and mortality were similar for both groups. Likewise, overall long-term survival was not significantly different (Kaplan-Meier method, p = 0.70). CONCLUSIONS Patients who are otherwise deemed to be good candidates for lung transplantation but are found to have an associated cardiac condition that could adversely affect their candidacy may still be considered for transplantation in selected cases if the cardiac abnormality can be addressed either before or during transplantation.
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Affiliation(s)
- Scott B Johnson
- University of Texas Health Science Center, San Antonio, Texas, USA.
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Orens JB, Estenne M, Arcasoy S, Conte JV, Corris P, Egan JJ, Egan T, Keshavjee S, Knoop C, Kotloff R, Martinez FJ, Nathan S, Palmer S, Patterson A, Singer L, Snell G, Studer S, Vachiery JL, Glanville AR. International guidelines for the selection of lung transplant candidates: 2006 update--a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006; 25:745-55. [PMID: 16818116 DOI: 10.1016/j.healun.2006.03.011] [Citation(s) in RCA: 699] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 01/12/2006] [Accepted: 03/13/2006] [Indexed: 10/24/2022] Open
Affiliation(s)
- Jonathan B Orens
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland 21287, USA
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