Objectives: Mechanical lung assist (MLA; extracorporeal membrane oxygenation (ECMO) or extracorporeal lung assist (ECLA)) is increasingly used as a temporary bridge to lung transplantation (LTx). This study was designed to evaluate the impact of preoperative MLA on the operative outcome, including longer-term survival, in comparison to patients undergoing LTx without preoperative MLA.
Methods: A total of 143 patients underwent LTx at our institution from 2002 to 2011. Forty-three percent (n=62) of patients presented with idiopathic pulmonary fibrosis and 71% (n=102) presented with severely elevated pulmonary artery pressure.
Results: Thirteen patients (9.1%) required pre-LTx MLA support (age 44 ±13 years, double LTx 73.3%, female gender 53%) whereas 130 patients did not (age 52 ±11 years, double LTx 41.5%, female gender 36.9%). In one patient, MLA was successfully weaned and the patient underwent subsequent LTx. All patients in the MLA group were intraoperatively supported with continuous ECMO. One patient had to be supported with MLA after LTx for a period of 8 days. The short-term and mid-term postoperative survival of the MLA patient group was not significantly different from the non-MLA group (LogRank p=0.28). The 30-day, 90-day and 1-year survivals were 95%, 90% and 71%, respectively, in the patients without MLA compared to 85%, 77% and 68% in the MLA group.
Conclusions: MLA has no impact on long-term survival rate in LTx patients, but has an influence in postoperative survival. MLA support is a valuable tool to bridge unstable patients to LTx.
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http://dx.doi.org/10.1177/0267659114540975 | DOI Listing |
Acta Anaesthesiol Scand
March 2025
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Background: The expression of anti-programmed cell death ligand-1 (PD-L1) in tumors is widely used as a biomarker to predict the therapeutic efficacy of anti-programmed cell death-1(PD-1)/PD-L1 antibodies. However, the predictive accuracy of this method is limited. High-mobility group box 1 (HMGB1) is known to modulate cancer immunity.
View Article and Find Full Text PDFIntensive Care Med
January 2025
Medical Intensive Care Unit, AP-HP, Saint-Louis Hospital, Paris-Cité University, INSERM UMR1342 Institut de Recherche Saint-Louis, Paris, France.
Purpose: Invasive pulmonary aspergillosis (IPA) is a life-threatening opportunistic infection in immunocompromised patients. The diagnosis is often made late, with mortality reaching 90% when mechanical ventilation is needed. We sought to develop and validate a risk prediction model for the diagnosis of IPA.
View Article and Find Full Text PDFClin Pract
January 2025
Department of Cardiothoracic Surgery, General University Hospital of Patras, 26504 Patras, Greece.
Artificial intelligence (AI) has emerged as a transformative technology in healthcare, with its integration into cardiac surgery offering significant advancements in precision, efficiency, and patient outcomes. However, a comprehensive understanding of AI's applications, benefits, challenges, and future directions in cardiac surgery is needed to inform its safe and effective implementation. A systematic review was conducted following PRISMA guidelines.
View Article and Find Full Text PDFAnn Card Anaesth
January 2025
Department of Anaesthesiology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.
We report a case of a 74-year-old female with a retrosternal goiter undergoing video-assisted thoracic surgery (VATS) for a left lung lower lobectomy, necessitating one-lung ventilation (OLV). We encountered a highly unusual complication: contralateral tension pneumothorax. Forty-five minutes into the surgical procedure, a sudden cardiovascular collapse occurred.
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