ArticleEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2025
Extended Use of Central Veno-Arterial Extracorporeal Membrane Oxygenation in Lung Transplantation for Patients with Pulmonary Arterial Hypertension.
Article in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Safety of Invasive Procedures During Adult Extracorporeal Membrane Oxygenation: A Systematic Review.Journal of clinical medicine · 2026Review
- Main pulmonary artery reconstruction during lung transplantation for idiopathic pulmonary artery hypertension with giant pulmonary artery aneurysm.JTCVS techniques · 2026Article
- Paradigm shift: from pulmonary vasodilation to cardiopulmonary dual-track therapy-a comprehensive review of pathophysiology and advances in pulmonary hypertension-associated right heart failure.Respiratory research · 2026Review
- Management of exogenous lipoid pneumonia after fuel aspiration: a single-center experience.Journal of Zhejiang University. Science. B · 2025Article
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15 authors.
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Abstract
objectivesLung transplantation (LTx) for patients with pulmonary arterial hypertension (PAH) is associated with high postoperative morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) supports patients' haemodynamics during and after LTx. However, the optimal ECMO strategy, especially for patients with PAH, is debated. Here, we report our unique strategy for patients with PAH, using postoperative central veno-arterial (VA)-ECMO combined with delayed chest closure.
methodsThis was a retrospective single-centre study of consecutive bilateral lung transplantations for adult patients with PAH performed between 2021 and 2024. Patients' characteristics, perioperative ECMO strategy, and postoperative outcomes were reviewed.
resultsDuring the study period, 20 PAH patients (idiopathic or hereditary PAH [n = 17], PAH secondary to collagen disease [n = 1], pulmonary veno-occlusive disease [n = 1], and Eisenmenger syndrome [n = 1]) underwent cadaveric LTx. Intraoperative support comprised either central VA-ECMO (n = 17) or cardiopulmonary bypass (n = 3). In 17 patients, central VA-ECMO was maintained postoperatively with temporary skin closure. The reason for postoperative central VA-ECMO was anticipated post-LTx heart failure due to PAH and suboptimal cardiac function. The median duration of ECMO support was 4 days (interquartile range: 2-4). There were 9 (45.0%) haemothorax evacuations while patients were on postoperative central VA-ECMO. No patients experienced haemodynamic collapse after LTx. All patients survived during the observation period, resulting in a 100% survival rate at both 90 days and 1 year (95% confidence interval: 83.2%-100%).
conclusionsExtended postoperative central VA-ECMO and delayed chest closure were feasible for patients with PAH who underwent LTx. Meticulous haemostasis is mandatory, given the high chance of haemothorax evacuation.
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