Eur J Cardiothorac Surg. 2024 Nov 29:ezae420. doi: 10.1093/ejcts/ezae420. Online ahead of print.
ABSTRACT
OBJECTIVES: Severe pulmonary hypertension is the leading lung transplantation indication in younger patients. Despite validated risk scores, their influence on lung allocation has been negligible, with continued reliance on decompensation and ECMO bridging.This single-center, retrospective study assesses outcomes of ECMO-bridging in lung transplantation for pulmonary hypertension and evaluates short-term predictability of ECMO-bridging.
METHODS: Pulmonary hypertension patients listed for lung transplantation between 01.2010-03.2023 were included. Peri- and post-operative course were compared dependent upon ECMO-bridging status. Bridging risk analysis within 90 days of re-evaluation included patients not requiring ECMO at listing, with listing parameters evaluated using a univariate Cox’s proportional hazard regression.
RESULTS: In total 114/123 patients listed underwent lung transplantation. Twenty-eight required ECMO bridging. No differences in primary graft dysfunction grade 3 at 72 h (30 vs 20%; p = 0.28) or graft survival were evident (1-year: 82 vs 88%; 5-vear: 54 vs 59%; p = 0.84). ECMO-bridging resulted in longer intensive care unit stays post-lung transplant (p = 0.002), higher rates of both re-thoracotomy (p = 0.049) and vascular complications (p = 0.031). Factors increasing 90 day ECMO risk included NT-proBNP (p < 0.001), 6 min walk (p = 0.03) and O2 requirement at rest (p = 0.006).
CONCLUSIONS: Lung transplant survival outcomes are not affected by ECMO-bridging in patients with severe pulmonary hypertension. It does however expose patients to additional risk, and efforts such as easy-to-measure parameters to pre-emptively identify patients requiring bridging to assist with effective allocation should be encouraged.
PMID:39626308 | DOI:10.1093/ejcts/ezae420
