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Cited by 242Transplantation: Methods and OutcomesMechanical Circulatory Support DevicesOrgan Transplantation Techniques and Outcomes

The DOI matches its Crossref record; 38 of the 38 references it cites were found in a registry or an index.

Intraoperative extracorporeal membrane oxygenation and the possibility of postoperative prolongation improve survival in bilateral lung transplantation

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Hoetzenecker, Konrad, Schwarz, Stefan, Muckenhuber, Moritz, Benazzo, Alberto, Frommlet, Florian, Schweiger, Thomas, Bata, Orsolya, Jaksch, Peter, Ahmadi, Negar, Muraközy, Gabriella, Prosch, Helmut, Hager, Helmut, Roth, Georg, Lang, György, Taghavi, Shahrokh, Klepetko, Walter·2018·The Journal of Thoracic and Cardiovascular Surgery
DOI 10.1016/j.jtcvs.2017.10.144
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Abstract

Objectives The value of intraoperative extracorporeal membrane oxygenation (ECMO) in lung transplantation remains controversial. In our department, ECMO has been used routinely for intraoperatively unstable patients for more than 15 years. Recently, we have extended its indication to a preemptive application in almost all cases. In addition, we prolong ECMO into the early postoperative period whenever graft function does not meet certain quality criteria or in patients with primary pulmonary hypertension. The objective of this study was to review the results of this strategy.Methods All standard bilateral lung transplantations performed between January 2010 and June 2016 were included in this single-center, retrospective analysis. Patients were divided into 3 groups: group I-no ECMO (n = 116), group II-intraoperative ECMO (n = 343), and group III-intraoperative and prolonged postoperative ECMO (n = 123). The impact of different ECMO strategies on primary graft function, short-term outcomes, and patient survival were analyzed.Results The use of intraoperative ECMO was associated with improved 1-, 3-, and 5-year survival compared with non-ECMO patients (91% vs 82%, 85% vs 76%, and 80% vs 74%; log-rank P = .041). This effect was still evident after propensity score matching of both cohorts. Despite the high number of complex patients in group III, outcome was excellent with higher survival rates than in the non-ECMO group at all time points.Conclusions Intraoperative ECMO results in superior survival when compared with transplantation without any extracorporeal support. The concept of prophylactic postoperative ECMO prolongation is associated with excellent outcomes in recipients with pulmonary hypertension and in patients with questionable graft function at the end of implantation.

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  • Several reports have demonstrated higher rates of grade 3 primary graft dysfunction among patients who underwent BOLT with versus without ECMO support.

    “While VA ECMO offers hemodynamic stability and adequate gas exchange, and facilitates controlled allograft reperfusion,3,8,18,28 several reports have demonstrated higher rates of grade 3 PGD among patients who underwent BOLT with versus without ECMO support.9,10,13”

    From Textbook outcome in lung transplantation: Planned venoarterial extracorporeal membrane oxygenation versus off-pump support for patients without pulmonary hypertension (2022) · cites this paper as [9]

    The PGD results (p. 2198) report grade 3 PGD at 72 hours in 0% of both the intraoperative-ECMO and no-ECMO groups after propensity-score matching—not a higher rate with ECMO. The paper also reports a trend toward less grade 2 or 3 PGD with intraoperative ECMO. (LLM, conf=0.90)

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  • Previously reported associations between planned VA ECMO and increased grade 3 primary graft dysfunction are likely confounded by differences in underlying physiology and illness severity between planned support groups.

    “In this context, our findings suggest that previously reported associations between planned VA ECMO and increased grade 3 PGD are likely confounded by differences in underlying physiology and illness severity between planned support strata.”

    From Textbook outcome in lung transplantation: Planned venoarterial extracorporeal membrane oxygenation versus off-pump support for patients without pulmonary hypertension (2022) · cites this paper as [9]

    The Discussion says an earlier ECMO comparison included more complex patients in its ECMO groups and did not adjust for baseline differences. The Propensity Score Matching section likewise identifies substantial differences between this paper’s support groups. But the paper does not report the claimed prior association between planned VA ECMO and increased grade 3 PGD; its own matched comparison found grade 3 PGD at 0% in both groups (p. 2198). (LLM, conf=0.82)

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Metadata

Authors
Hoetzenecker, K., Schwarz, S., Muckenhuber, M., Benazzo, A., Frommlet, F., Schweiger, T., Bata, O., Jaksch, P., Ahmadi, N., Muraközy, G., Prosch, H., Hager, H., Roth, G., Lang, G., Taghavi, S., & Klepetko, W.
Affiliations
  • Medical University of Vienna (AT)
  • National Institute of Oncology (HU)
  • University of Ottawa (CA)
Corresponding author
Klepetko, Walter
ORCID
Venue
The Journal of Thoracic and Cardiovascular Surgery
Publisher
Elsevier BV
Published
2018-05
Volume
155
Issue
5
Pages
2193-2206.e3
ISSN
0022-5223 (ISSN-L)
DOI
10.1016/j.jtcvs.2017.10.144
OpenAlex
W2772602769
Cited by
242
References
38
Citations by year
2026: 13 · 2025: 18 · 2024: 36 · 2023: 26 · 2022: 40 · 2021: 38 · 2020: 39 · 2019: 23 · 2018: 9
FWCI
19.87
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
  • Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
Keywords
extracorporeal membrane oxygenation, intraoperative ECMO, bilateral lung transplantation, primary graft function, patient survival, idiopathic pulmonary arterial hypertension, graft function
MeSH terms
Adult, Female, Graft Survival, Humans, Hypertension, Pulmonary, Intraoperative Care, Lung Diseases, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors, Extracorporeal Membrane Oxygenation, Lung Transplantation, Treatment Outcome, Risk Assessment, Primary Graft Dysfunction

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