Xia Yu, Ragalie William, Yang Eric H, Lluri Gentian, Biniwale Reshma, Benharash Peyman, Gudzenko Vadim, Saggar Rajan, Sayah David, Ardehali Abbas
Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California.
Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, California.
Ann Thorac Surg. 2022 Dec;114(6):2080-2086. doi: 10.1016/j.athoracsur.2021.11.016. Epub 2021 Dec 11.
Venovenous (VV) extracorporeal membrane oxygenation (ECMO) has been used as a bridge to lung transplantation with acceptable outcomes. We hypothesized that venoarterial (VA) ECMO, as part of a multidisciplinary ECMO program, yields similar outcomes as VV ECMO as a bridge in lung transplantation.
Records of all patients who had undergone ECMO with the intention to bridge to lung transplantation at University of California, Los Angeles, from January 1, 2012, to March 31, 2020, were reviewed. Baseline characteristics, in-hospital outcomes, long-term survival, and freedom from bronchiolitis obliterans syndrome were assessed.
During this interval, 58 patients were placed on ECMO with the intention to bridge to lung transplantation: 27 on VV ECMO, and 31 on VA ECMO, with a median duration of 7 and 17 days of support, respectively (P = .01). Successful bridge to lung transplantation occurred in 21 VV patients (78%) and in 26 VA patients (84%). Incidence of primary graft dysfunction III at 72 hours in the VV and the VA cohorts was 0% and 4%, respectively (P = .99). In-hospital and 90-day survival of the VV and VA groups was 100% and 96%, respectively (P = .99). Survival of the 2 groups at 3 years was not significantly different from a contemporary cohort of lung transplant recipients not bridged with ECMO.
VA and VV ECMO can both be used as a bridge to lung transplantation with high success, with short and medium-term survival similar to non-bridged lung transplant recipients. Both modes should be considered effective at bridging select candidates to lung transplantation.
静脉-静脉（VV）体外膜肺氧合（ECMO）已被用作肺移植的桥梁，效果尚可。我们推测，作为多学科ECMO项目的一部分，静脉-动脉（VA）ECMO作为肺移植桥梁的效果与VV ECMO相似。
回顾了2012年1月1日至2020年3月31日在加利福尼亚大学洛杉矶分校接受ECMO以作为肺移植桥梁的所有患者的记录。评估了基线特征、住院结局、长期生存率以及闭塞性细支气管炎综合征的无病生存率。
在此期间，58例患者接受了ECMO以作为肺移植桥梁：27例接受VV ECMO，31例接受VA ECMO，支持的中位持续时间分别为7天和17天（P = 0.01）。21例VV患者（78%）和26例VA患者（84%）成功过渡到肺移植。VV组和VA组在72小时时原发性移植物功能障碍III级的发生率分别为0%和4%（P = 0.99）。VV组和VA组的住院生存率和90天生存率分别为100%和96%（P = 0.99）。两组在3年时的生存率与未接受ECMO桥接的同期肺移植受者队列相比无显著差异。
VA和VV ECMO均可作为肺移植的桥梁，成功率高，短期和中期生存率与未接受桥接的肺移植受者相似。两种模式在将特定候选者过渡到肺移植方面均应被视为有效。
