Fessler J, Davignon M, Sage E, Roux A, Cerf C, Feliot E, Gayat E, Parquin F, Fischler M, Guen ML. Intraoperative Implications of the Recipients' Disease for Double-Lung Transplantation.
J Cardiothorac Vasc Anesth 2020;
35:530-538. [PMID:
32741611 DOI:
10.1053/j.jvca.2020.07.039]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES
To compare intraoperative patterns among patients based on their primary pulmonary disease (cystic fibrosis [CF], chronic obstructive pulmonary disease [COPD]/emphysema [CE], and pulmonary fibrosis [PF]) during double- lung transplantation. The following 3 major outcomes were reported: blood transfusion, extracorporeal membrane oxygenation (ECMO) management, and the possibility of immediate extubation at the end of surgery.
DESIGN
Retrospective analysis of a prospectively maintained database, including donor and recipient characteristics and intraoperative variables.
SETTING
Foch Hospital, Suresnes, France (academic center performing 60-80 lung transplantations per year).
PARTICIPANTS
Patients who underwent double- lung transplantation from 2012-2019. Patients with retransplantation, multiorgan transplantation, or surgery performed with cardiopulmonary bypass were excluded.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Two hundred forty-six patients had CF, 117 had CE, and 66 had PF. No patient had primary pulmonary arterial hypertension. Blood transfusion was higher in the CF group than in the other 2 groups (red blood cells [p < 0.001], fresh frozen plasma [p = 0.004]). The CF and CE groups were characterized by a lower intraoperative requirement of ECMO (p = 0.002), and the PF group more frequently required postoperative ECMO (p < 0.001). CF and CE patients were more frequently extubated in the operating room than were PF patients (37.4%, 50.4%, and 13.6%, respectively; p < 0.001).
CONCLUSIONS
Intraoperative outcomes differed depending on the initial pathology. Such differences should be taken into account in specific clinical studies and in intraoperative management protocols.
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