Martin Archer Kilbourne, Fritz Ashley Virginia, Pham Si M, Landolfo Kevin P, Sareyyupoglu Basar, Brown Thomas E, Logvinov Ilana, Li Zhuo, Narula Tathagat, Makey Ian A, Thomas Mathew
Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, Fla.
Department of Cardiothoracic Surgery, Mayo Clinic Florida, Jacksonville, Fla.
JTCVS Open. 2023 Oct 1;16:1029-1037. doi: 10.1016/j.xjon.2023.09.033. eCollection 2023 Dec.
The utilization of extracorporeal life support (ECLS) for intraoperative support during lung transplantation has increased over the past decade. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has recently emerged as the preferred modality over cardiopulmonary bypass (CPB), many centers continue to use both forms of ECLS during lung transplantation. Our novel hybrid VA-ECMO/CPB circuit allows for seamless transition from VA-ECMO to CPB at a significant cost savings compared to a standalone VA-ECMO circuit. This study describes our initial experience and outcomes in the first 100 bilateral lung transplantations using this novel hybrid VA-ECMO/CPB circuit.
Medical records from September 2017 to May 2021 of the first 100 consecutive patients undergoing bilateral lung transplantation with intraoperative hybrid VA-ECMO support were examined retrospectively. We excluded patients with single lung transplants, retransplantations, preoperative ECLS bridging, and veno-venous (VV) ECMO and those supported with CPB only. Perioperative recipient, anesthetic, perfusion variables, and outcomes were assessed.
Of the 100 patients supported with VA-ECMO, 19 were converted intraoperatively to CPB. Right ventricular dysfunction was seen in 37% of patients, and the median mean pulmonary artery pressure was 28 mm Hg. No oxygenator clotting was observed with a median heparin dose of 13,000 units in the VA-ECMO group. Primary graft dysfunction grade 3 at 72 hours was observed in 10.1% of all patients and observed 1-year mortality was 4%.
The use of a hybrid VA-ECMO/CPB circuit in our institution allows for rapid conversion to CPB with acceptable outcomes across a diverse recipient group at a significantly reduced cost compared to standalone VA-ECMO circuits.
在过去十年中，体外生命支持（ECLS）在肺移植术中的应用有所增加。尽管静脉-动脉体外膜肺氧合（VA-ECMO）最近已成为比体外循环（CPB）更受青睐的方式，但许多中心在肺移植过程中仍同时使用这两种ECLS形式。我们新型的混合VA-ECMO/CPB回路能够实现从VA-ECMO到CPB的无缝转换，与单独的VA-ECMO回路相比，可显著节省成本。本研究描述了我们使用这种新型混合VA-ECMO/CPB回路进行的前100例双侧肺移植的初步经验和结果。
回顾性检查了2017年9月至2021年5月期间连续100例接受术中混合VA-ECMO支持的双侧肺移植患者的病历。我们排除了单肺移植、再次移植、术前ECLS桥接、静脉-静脉（VV）ECMO以及仅接受CPB支持的患者。评估了围手术期受者、麻醉、灌注变量和结果。
在100例接受VA-ECMO支持的患者中，19例术中转为CPB。37%的患者出现右心室功能障碍，平均肺动脉压中位数为28 mmHg。VA-ECMO组中，肝素剂量中位数为13,000单位时未观察到氧合器凝血。所有患者中，10.1%在72小时时出现3级原发性移植物功能障碍，1年观察死亡率为4%。
在我们机构中使用混合VA-ECMO/CPB回路能够快速转为CPB，在不同的受者群体中取得了可接受的结果，与单独的VA-ECMO回路相比，成本显著降低。
