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Ochoa CO, Navarro JC, Ávila OS, Bellorín AF, Gonzalez SA, Aixelá AM, Aragón CJ, Badia GS. Prognosis factors in heart-lung transplantation: 30 years experience in a reference center. Cir Esp 2024; 102:11-18. [PMID: 37984725 DOI: 10.1016/j.cireng.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/08/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Heart-lung transplantation has shown a progressive decrease in the number of procedures. There is a lack of information about this field in Spain. The main goal of this study is to analyze the experience of a national reference hospital. METHODS We performed a retrospective study of a historical cohort of heart-lung transplanted patients in a single center, during a 30 years period (from 1990 to 2021). The associations between variables were evaluated using the χ2 test or Fisher's exact test. Survival was analyzed using the Kaplan-Meier method. Differences were evaluated using the log-rank test and multivariate analysis with the Cox method. RESULTS A decrease in the number of procedures performed in the last decade was observed [2000-2009: 19 procedures (44.2%); 2010-2021: 15 procedures (34.8%)]. Early postoperative mortality was 23.3%, falling to 13.3% from 2010. In-hospital mortality was 41%, falling to 33% from 2010. Main factors related to higher mortality: previous thoracic surgery, corticosteroid therapy, extracorporeal circulation (ECLS) greater than 200 min, ischemia time greater than 300 min, and tracheal dehiscence (p < 0.005). Overall survival at one, five, and ten years was 58%, 44.7%, and 36.1%, respectively. Factors associated with lower survival rates: previous thoracic surgery, male donor, extracorporeal circulation greater than 200 min, ischemia time greater than 300 min, tracheal dehiscence and weight difference (p < 0.005). CONCLUSIONS There has been a progressive decrease in the number of heart-lung transplantations, being more evident in the last decade, but showing an improvement in both mortality and survival.
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Affiliation(s)
- Carlos Ordoñez Ochoa
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Jose Cerón Navarro
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain.
| | - Olga Salamea Ávila
- Servicio de Neumología, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Alilis Fontana Bellorín
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Stephania Aguilar Gonzalez
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Alfonso Morcillo Aixelá
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Carlos Jorda Aragón
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
| | - Gabriel Sales Badia
- Servicio de Cirugía Torácica, Hospital Universitario la Fe de Valencia, Valencia, Spain; Unidad de Trasplante Pulmonar y Cardiopulmonar, Hospital Universitario la Fe de Valencia, Valencia, Spain
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2
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Yan HJ, Zheng XY, Huang H, Xu L, Tang HT, Wang JJ, Li CH, Zhang SX, Fu SY, Wen HY, Tian D. Double-lung versus heart-lung transplantation for end-stage cardiopulmonary disease: a systematic review and meta-analysis. Surg Today 2023; 53:1001-1012. [PMID: 36068414 DOI: 10.1007/s00595-022-02579-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
We compared posttransplant outcomes following double-lung transplantation (DLTx) and heart-lung transplantation (HLTx), based on a search of PubMed, Cochrane Library, and Embase, from inception to March 8, 2022, for studies that report outcomes of these procedures. We then performed a meta-analysis of baseline characteristics and posttransplant outcomes. Subgroup analyses were implemented according to indication, publication year, and center. This study was registered on PROSPERO (number CRD42020223493). Ten studies were included in this meta-analysis, involving 1230 DLTx patients and 1022 HLTx patients. The DLTx group was characterized by older donors (P = 0.04) and a longer allograft ischemia time (P < 0.001) than the HLTx group. The two groups had comparable 1-year, 3-year, 5-year, 10-year survival rates (all P > 0.05), with similar results identified in subgroup analyses. We found no significant differences in 1-year, 5-year, and 10-year chronic lung allograft dysfunction (CLAD)-free survival, length of intensive care unit stay and hospital stay, length of postoperative ventilation, in-hospital mortality, or surgical complications between the groups (all P > 0.05). Thus, DLTx provides similar posttransplant survival to HLTx for end-stage cardiopulmonary disease. These two procedures have a comparable risk of CLAD and other posttransplant outcomes.
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Affiliation(s)
- Hao-Ji Yan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Xiang-Yun Zheng
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Heng Huang
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Lin Xu
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Hong-Tao Tang
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Jun-Jie Wang
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Cai-Han Li
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Sheng-Xuan Zhang
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Si-Yi Fu
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Hong-Ying Wen
- Department of Cardiothoracic Intensive Care Unit, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
| | - Dong Tian
- Department of Thoracic Surgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China.
- Heart and Lung Transplant Research Laboratory, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China.
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3
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Hascoët S, Pontailler M, Le Pavec J, Savale L, Mercier O, Fabre D, Mussot S, Simonneau G, Jais X, Feuillet S, Stephan F, Cohen S, Bonnet D, Humbert M, Dartevelle P, Fadel E. Transplantation for pulmonary arterial hypertension with congenital heart disease: Impact on outcomes of the current therapeutic approach including a high-priority allocation program. Am J Transplant 2021; 21:3388-3400. [PMID: 33844424 DOI: 10.1111/ajt.16600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 01/25/2023]
Abstract
Patients with end-stage pulmonary arterial hypertension due to congenital heart disease have limited access to heart-lung transplantation or double-lung transplantation. We aimed to assess the effects of a high-priority allocation program established in France in 2007. We conducted a retrospective study to compare waitlist and posttransplantation outcomes before versus after implementation of the high-priority allocation program. We included 67 consecutive patients (mean age at listing, 33.2 ± 10.5 years) with pulmonary arterial hypertension due to congenital heart disease listed for heart-lung transplantation or double-lung transplantation from 1997 to 2016. At one month, the incidences of transplantation and death before transplantation were 3.5% and 24.6% in 1997-2006, 4.8% and 4.9% for patients on the regular list in 2007-2016, and 41.2% and 7.4% for patients listed under the high-priority allocation program (p < .001 and p = .0001, respectively). Overall survival was higher in patients listed in 2007-2016 (84.2% and 61.2% at 1 and 10 years vs. 36.8% and 22.1%, p = .0001). Increased incidence of transplantation, decreased waiting list mortality, and improved early and long-term outcomes were observed in patients with pulmonary arterial hypertension due to congenital heart disease listed for transplantation in the recent era, characterized by implementation of a high-priority allocation program.
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Affiliation(s)
- Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France.,UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France
| | - Margaux Pontailler
- Department of Congenital Heart Diseases, Centre de référence Malformations Cardiaques Congénitales Complexes M3C, Centre de Compétence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Universitaire Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Jérôme Le Pavec
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Laurent Savale
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olaf Mercier
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Dominique Fabre
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Sacha Mussot
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Gérald Simonneau
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Xavier Jais
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Séverine Feuillet
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Francois Stephan
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Sarah Cohen
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, Paris, France
| | - Damien Bonnet
- Department of Congenital Heart Diseases, Centre de référence Malformations Cardiaques Congénitales Complexes M3C, Centre de Compétence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Universitaire Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Université de Paris, Paris, France
| | - Marc Humbert
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Pulmonology, Centre de Référence de l'Hypertension Pulmonaire Sévère, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Philippe Dartevelle
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
| | - Elie Fadel
- UMR-S 999, Inserm, Hôpital Marie Lannelongue, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Plessis-Robinson, France.,Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Plessis-Robinson, France
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4
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El-Sayed Ahmed MM, Thomas M, Makey IA, Martin AK, Erasmus DB, Sareyyupoglu B, Landolfo KP, Pham SM. Heart-lung transplant in congenitally corrected transposition of the great arteries and dextrocardia patient. SAGE Open Med Case Rep 2021; 9:2050313X20987449. [PMID: 33633862 PMCID: PMC7887666 DOI: 10.1177/2050313x20987449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/18/2020] [Indexed: 11/23/2022] Open
Abstract
A 53-year-old male patient was presented to our institution with the clinical picture of biventricular failure. The echocardiogram revealed congenitally corrected transposition of the great arteries, dextrocardia with situs solitus, atrioventricular discordance and ventriculoatrial discordance, severe systemic and mitral valves regurgitation, and severe pulmonary hypertension (mean pulmonary artery pressure: 51 mm Hg). He underwent heart–lung transplant. He was discharged on postoperative day 25 with left ventricular ejection fraction of 60%–65%, and with oxygen independency.
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Affiliation(s)
- Magdy M El-Sayed Ahmed
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Ian A Makey
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Archer K Martin
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - David B Erasmus
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Kevin P Landolfo
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
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5
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Albinni S, Marx M, Lang IM. Focused Update on Pulmonary Hypertension in Children-Selected Topics of Interest for the Adult Cardiologist. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E420. [PMID: 32825190 PMCID: PMC7559541 DOI: 10.3390/medicina56090420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 11/16/2022]
Abstract
Pulmonary hypertensive vascular disease (PHVD), and pulmonary hypertension (PH), which is a broader term, are severe conditions associated with high morbidity and mortality at all ages. Treatment guidelines in childhood are widely adopted from adult data and experience, though big differences may exist regarding aetiology, concomitant conditions and presentation. Over the past few years, paediatric aspects have been incorporated into the common guidelines, which currently address both children and adults with pulmonary hypertension (PH). There are multiple facets of PH in the context of cardiac conditions in childhood. Apart from Eisenmenger syndrome (ES), the broad spectrum of congenital heart disease (CHD) comprises PH in failing Fontan physiology, as well as segmental PH. In this review we provide current data and novel aspects on the pathophysiological background and individual management concepts of these conditions. Moreover, we focus on paediatric left heart failure with PH and its challenging issues, including end stage treatment options, such as mechanical support and paediatric transplantation. PH in the context of rare congenital disorders, such as Scimitar Syndrome and sickle cell disease is discussed. Based on current data, we provide an overview on multiple underlying mechanisms of PH involved in these conditions, and different management strategies in children and adulthood. In addition, we summarize the paediatric aspects and the pros and cons of the recently updated definitions of PH. This review provides deeper insights into some challenging conditions of paediatric PH in order to improve current knowledge and care for children and young adults.
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Affiliation(s)
- Sulaima Albinni
- Paediatric Heart Centre Vienna, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Wien, Austria;
| | - Manfred Marx
- Paediatric Heart Centre Vienna, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Wien, Austria;
| | - Irene M. Lang
- AKH-Vienna, Department of Cardiology, Medical University of Vienna, 1090 Wien, Austria;
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6
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Not All Septal Defects Are Equal: Outcomes of Bilateral Lung Transplant With Cardiac Defect Repair vs Combined Heart-Lung Transplant in Patients With Eisenmenger Syndrome in the United States. Chest 2020; 158:2097-2106. [PMID: 32565271 DOI: 10.1016/j.chest.2020.05.597] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/07/2020] [Accepted: 05/17/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Thoracic transplantation is considered for patients with Eisenmenger syndrome (ES) who have refractory right ventricular failure despite optimal therapy for pulmonary arterial hypertension. This study compared the outcomes of bilateral lung transplantation (BLT) with cardiac defect repair vs combined heart-lung transplantation (HLT). RESEARCH QUESTION This study presents an updated analysis using a US national registry to evaluate the outcomes of patients diagnosed with ES who underwent HLT or BLT with repair of cardiac defects. STUDY DESIGN AND METHODS This study identified patients with ES who underwent thoracic transplantation from 1987 to 2018 from the United Network for Organ Sharing database. Survival curves were estimated by using the Kaplan-Meier method and were compared by using the log-rank test. RESULTS During the study period, 442 adults with ES underwent thoracic transplantation (316 HLTs and 126 BLTs). Following BLT, overall survival 1, 5, and 10 years' posttransplant was 63.1%, 38.5%, and 30.2%, respectively. Following HLT, overall survival 1, 5, and 10 years' posttransplant was 68.0%, 47.3%, and 30.5% (P = .6). When survival analysis was stratified according to type of defect, patients with an atrial septal defect had better survival following BLT than following HLT (88.3% vs 63.2% 1 year posttransplant, P < .01; 71.1% vs 49.8% 3 years' posttransplant, P < .01; and 37.4% vs 29.9% 10 years' posttransplant, P = .08). Patients with a ventricular septal defect (VSD) exhibited better survival following HLT than following BLT (78.2% vs 49.6% 1 year posttransplant, P < .01; 55.6% vs 34.3% 5 years' posttransplant, P < .01; and 35.7% vs 26.5% 10 years' posttransplant, P = .03). The most common cause of mortality in patients with VSD undergoing BLT was cardiac ventricular failure. INTERPRETATION This study suggests that the best transplant option for patients with VSD remains HLT, which prevents subsequent development of ventricular failure. BLT with cardiac defect repair should be considered as the first-line treatment option in patients with ES due to an uncorrected atrial septal defect. These patients can be considered to have isolated and reversible right ventricular failure akin to patients with advanced pulmonary arterial hypertension.
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7
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Huston JH, Brittain EL, Robbins IM. Pulmonary Hypertension and Right Ventricular Failure: Lung Transplant Versus Heart-Lung Transplant. Cardiol Clin 2020; 38:269-281. [PMID: 32284103 DOI: 10.1016/j.ccl.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Pulmonary arterial hypertension is a highly morbid disease with limited treatment options that improve survival and currently the only curative treatment is transplantation. There is a small body of literature comparing the efficacy of lung and heart-lung transplantation in this population. The bulk of evidence suggests that most patients with severe right ventricular failure undergoing transplant will have recovery of right ventricular function after lung transplantation. Existing data suggest that, in the absence of complex congenital heart disease or significant left ventricular dysfunction, double-lung transplant is the surgical procedure of choice.
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Affiliation(s)
- Jessica H Huston
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, 1215 21st Avenue South, Suite 5037, Nashville, TN 37232, USA.
| | - Evan L Brittain
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 300A, Nashville, TN 37203, USA
| | - Ivan M Robbins
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T1218 MCN, Nashville, TN, USA
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8
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Taimeh Z. Assessment and treatment of the failing right heart: considerations for transplantation referral. J Thorac Dis 2019; 11:S1817-S1820. [PMID: 31632759 DOI: 10.21037/jtd.2019.08.60] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Long considered an insignificant chamber, the right ventricle has been recently under spotlight, especially with emerging data supporting its critical role in disease progression. The right ventricle is a triangular heart chamber with complex physiology and pathophysiology. In this review, we discuss the normal physiology of the right ventricle, right ventricular failure, and recent advances in treatment with emphasis on optimal timing for transplantation referral.
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Affiliation(s)
- Ziad Taimeh
- Texas Heart Institute, Baylor College of Medicine, Houston, TX, USA
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9
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Le Pavec J, Hascoët S, Fadel E. Heart-lung transplantation: current indications, prognosis and specific considerations. J Thorac Dis 2018; 10:5946-5952. [PMID: 30505505 DOI: 10.21037/jtd.2018.09.115] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Heart-lung transplantation (HLTx) is currently the best treatment for patients who have end-stage heart and lung failure. Idiopathic pulmonary arterial hypertension (IPAH) was the main indication for HLTx in the 1980s. However, when studies showed resolution of right ventricular dysfunction after double-lung transplantation (DLTx), this last procedure became the preferred option for end-stage IPAH. Currently, the main indication of HLTx is congenital heart disease (CHD), followed by acquired heart disease combined with pulmonary hypertension and/or intrinsic lung disease. Although early posttransplant survival remains lower after HLTx than after lung transplantation, careful patient selection combined with surgical advances are producing improvements. Here, we review the practice patterns, trends, and outcomes of HLTx worldwide.
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Affiliation(s)
- Jérôme Le Pavec
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.,Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,UMR_S 999, Université Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Sébastien Hascoët
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,UMR_S 999, Université Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis-Robinson, France.,Service de Cardiopédiatrie, Centre de Référence des Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Elie Fadel
- Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardio-pulmonaire, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France.,Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France.,UMR_S 999, Université Paris-Sud, INSERM, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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10
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Gadre S, Turowski J, Budev M. Overview of Lung Transplantation, Heart-Lung Transplantation, Liver-Lung Transplantation, and Combined Hematopoietic Stem Cell Transplantation and Lung Transplantation. Clin Chest Med 2017; 38:623-640. [PMID: 29128014 DOI: 10.1016/j.ccm.2017.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lung transplantation (LTx) has evolved to represent the therapy of choice for many patients with end-stage lung diseases. Appropriate candidate selection for LTx is an important determinant of a positive outcome from transplantation. Posttransplantation survival has steadily improved, but long-term survival continues to be a challenge with a median survival of 5.8 years. Similarly, combined heart-lung transplantation and simultaneous liver-lung transplantation has been performed successfully in select patients who are not expected to survive either organ transplant alone. Moreover, LTx has been performed in patients who develop end-stage pulmonary complications following hematopoietic stem cell transplantation.
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Affiliation(s)
- Shruti Gadre
- Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, A-90, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Jason Turowski
- Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, A-90, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Marie Budev
- Lung Transplant and Heart Lung Transplant Program, Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, A-90, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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11
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Idrees JJ, Pettersson GB. State of the Art of Combined Heart-Lung Transplantation for Advanced Cardiac and Pulmonary Dysfunction. Curr Cardiol Rep 2016; 18:36. [PMID: 26922590 DOI: 10.1007/s11886-016-0713-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Over the last several decades, significant advances and improvements in care of transplant patients have resulted in markedly improved outcomes. A number of options are available for patients with advanced cardiopulmonary dysfunction requiring transplantation. There is a debate about when isolated heart or isolated lung transplantation is no longer possible or advisable and combined heart-lung transplantation is justified. Organ availability and allocation severely limit the latter option to very few well-selected patients. We review practice patterns, trends, and outcomes after triple-organ heart-lung transplant (HLTx) worldwide, as well as our own experience with heart-lung transplant in the modern era.
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Affiliation(s)
- Jay J Idrees
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/Mail Stop J4-1, Cleveland, OH, 44195, USA.,Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue/Mail Stop J4-1, Cleveland, OH, 44195, USA. .,Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH, USA.
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12
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Kortchinsky T, Mussot S, Rezaiguia S, Artiguenave M, Fadel E, Stephan F. Extracorporeal life support in lung and heart-lung transplantation for pulmonary hypertension in adults. Clin Transplant 2016; 30:1152-8. [DOI: 10.1111/ctr.12805] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Talna Kortchinsky
- Cardiothoracic Intensive Care Unit; Centre Chirurgical Marie Lannelongue; Le Plessis Robinson France
| | - Sacha Mussot
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation; Centre Chirurgical Marie Lannelongue; Le Plessis Robinson France
| | - Saïda Rezaiguia
- Cardiothoracic Intensive Care Unit; Centre Chirurgical Marie Lannelongue; Le Plessis Robinson France
| | - Margaux Artiguenave
- Cardiothoracic Intensive Care Unit; Centre Chirurgical Marie Lannelongue; Le Plessis Robinson France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation; Centre Chirurgical Marie Lannelongue; Le Plessis Robinson France
| | - François Stephan
- Cardiothoracic Intensive Care Unit; Centre Chirurgical Marie Lannelongue; Le Plessis Robinson France
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13
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Multidetector computed tomography shows reverse cardiac remodeling after double lung transplantation for pulmonary hypertension. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Mandich Crovetto D, Alonso Charterina S, Jiménez López-Guarch C, Pont Vilalta M, Pérez Núñez M, de Pablo Gafas A, Escribano Subías P. Multidetector computed tomography shows reverse cardiac remodeling after double lung transplantation for pulmonary hypertension. RADIOLOGIA 2016; 58:277-82. [PMID: 27198195 DOI: 10.1016/j.rx.2016.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To use multidetector computed tomography (MDCT) to evaluate the structural changes in the right heart and pulmonary arteries that occur in patients with severe pulmonary hypertension treated by double lung transplantation. MATERIAL AND METHODS This was a retrospective study of 21 consecutive patients diagnosed with severe pulmonary hypertension who underwent double lung transplantation at our center between 2010 and 2014. We analyzed the last MDCT study done before lung transplantation and the first MDCT study done after lung transplantation. We recorded the following variables: diameter of the pulmonary artery trunk, ratio of the diameter of the pulmonary artery trunk to the diameter of the ascending aorta, diameter of the right ventricle, ratio of the diameter of the left ventricle to the diameter of the right ventricle, and eccentricity index. Statistical analysis consisted of the comparison of the means of the variables recorded. RESULTS In all cases analyzed, the MDCT study done a mean of 24±14 days after double lung transplantation showed a significant reduction in the size of the right heart chambers, with improved indices of ventricular interdependency index, and reduction in the size of the pulmonary artery trunk (p<0.001 for all the variables analyzed). CONCLUSION Patients with pulmonary hypertension treated by double lung transplantation present early reverse remodeling of the changes in the structures of the right heart and pulmonary arterial tree. MDCT is useful for detecting these changes.
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Affiliation(s)
- D Mandich Crovetto
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España.
| | - S Alonso Charterina
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | | | - M Pont Vilalta
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Pérez Núñez
- Servicio de Radiodiagnóstico, Hospital Universitario 12 de Octubre, Madrid, España
| | - A de Pablo Gafas
- Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, España
| | - P Escribano Subías
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España
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15
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Girgis RE, Khaghani A. A global perspective of lung transplantation: Part 1 - Recipient selection and choice of procedure. Glob Cardiol Sci Pract 2016; 2016:e201605. [PMID: 29043255 PMCID: PMC5642749 DOI: 10.21542/gcsp.2016.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 04/08/2016] [Indexed: 11/17/2022] Open
Abstract
Lung transplantation has grown considerably in recent years and its availability has spread to an expanding number of countries worldwide. Importantly, survival has also steadily improved, making this an increasingly viable procedure for patients with end-stage lung disease and limited life expectancy. In this first of a series of articles, recipient selection and type of transplant operation are reviewed. Pulmonary fibrotic disorders are now the most indication in the U.S., followed by chronic obstructive pulmonary disease and cystic fibrosis. Transplant centers have liberalized criteria to include older and more critically ill candidates. A careful, systematic, multi-disciplinary selection process is critical in identifying potential barriers that may increase risk and optimize long-term outcomes.
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Affiliation(s)
- Reda E. Girgis
- Richard DeVos Heart and Lung Transplant Program, Spectrum Health,
| | - Asghar Khaghani
- Michigan State University, College of Human Medicine, Grand Rapids, MI, USA
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16
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Barry AE, Chaney MA, Cartwright BL, Birch ML, Wall MH. CASE 3--2016: Cardiopulmonary Instability Following Single-Lung Transplant. J Cardiothorac Vasc Anesth 2015; 30:539-47. [PMID: 26748977 DOI: 10.1053/j.jvca.2014.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Aaron E Barry
- Departments of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Mark A Chaney
- Departments of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
| | | | - Martin L Birch
- Anesthesiology, University of Minnesota, Minneapolis, MN
| | - Michael H Wall
- Anesthesiology, University of Minnesota, Minneapolis, MN
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17
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Kato TS, Armstrong HF, Schulze PC, Lippel M, Amano A, Farr M, Bacchetta M, Bartels MN, Di Tullio MR, Homma S, Mancini D. Left and Right Ventricular Functional Dynamics Determined by Echocardiograms Before and After Lung Transplantation. Am J Cardiol 2015; 116:652-9. [PMID: 26089014 DOI: 10.1016/j.amjcard.2015.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 01/19/2023]
Abstract
Impaired cardiac function is considered a contraindication for lung transplantation (LT). Because right ventricular (RV) function is expected to improve after LT, poor left ventricular (LV) function is often the determinant for LT eligibility. However, the changes in cardiac function before and after LT have not yet been elucidated. Therefore, we reviewed echocardiograms obtained from 67 recipients before and after LT. In a subset of 49 patients, both RV and LV longitudinal strains based on 2-dimensional speckle tracking echocardiography were analyzed. The cardiopulmonary exercise tests were also reviewed. All patients showed significant improvements in their exercise capacity after LT. RV echo parameters improved in all patients after LT (RV fractional area change: 36.7 ± 5.6% to 41.5 ± 2.7%, RV strain: -15.5 ± 2.9% to -18.0 ± 2.1%, RV E/E': 8.4 ± 1.8 to 7.7 ± 1.8; all p <0.05). Overall, the left ventricular ejection fraction (LVEF) did not change (58.7 ± 6.0% to 57.5 ± 9.7%, p = 0.385); however, 20 patients (30%) showed >10% decrease in LVEF after LT (61.5 ± 6.1% to 47.3 ± 4.2%, p <0.001) and an increase in LV E/E' (11.8 ± 1.8 to 12.9 ± 2.2, p = 0.049). Multivariate logistic regression analysis revealed that pre-LT LV E/E' was associated with decrease in LVEF after LT (odds ratio 1.381, 95% confidence interval 1.010 to 1.947, p = 0.043). Furthermore, patients with strain data showed that lower pre-LT LV strain was independently associated with LVEF decrease after LT (odds ratio 1.293, 95% confidence interval 1.088 to 1.614, p = 0.002). Although RV function improves after LT, LV systolic and diastolic functions deteriorate in a sizable proportion of patients. Impaired LV diastolic function before transplant appears to increase the risk of LVEF deterioration after LT.
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18
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Bhamra-Ariza P, Keogh AM, Muller DW. Percutaneous Interventional Therapies for the Treatment of Patients With Severe Pulmonary Hypertension. J Am Coll Cardiol 2014; 63:611-618. [DOI: 10.1016/j.jacc.2013.11.022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 11/05/2013] [Accepted: 11/11/2013] [Indexed: 02/01/2023]
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19
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Rampolla R. Lung transplantation: an overview of candidacy and outcomes. Ochsner J 2014; 14:641-648. [PMID: 25598729 PMCID: PMC4295741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Various factors must be taken into account when considering lung transplantation, including candidacy, contraindications, and outcomes. METHODS This article presents a review of the data and literature on lung transplantation, tracking the evolution of the treatment as it applies to different conditions, as well as an examination of patient survival rates in relation to pathology and treatment. RESULTS Timely referral and careful selection of candidates for lung transplantation maximize the outcomes of the procedure, resulting in a longer lifespan with improved physical health for patients. CONCLUSION Lung transplantation is a therapeutic option for patients with various lung diseases. Adapting treatment options and follow-up treatment to the individual patient's lifestyle and pathology optimizes patient survival rates after transplantation.
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Affiliation(s)
- Reinaldo Rampolla
- Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA
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