Left atrial pressure continuous monitoring improves early postoperative outcomes after double-lung transplantation for pulmonary hypertension.

Objectives: Double-lung transplantation (DLTx) has become the treatment of choice for patients with end-stage pulmonary hypertension (PH). However, DLTx remains a demanding procedure, associated with a greater incidence of severe primary graft dysfunction (PGD) compared with other indications. PH-induced cardiac remodeling includes diastolic left heart dysfunction, which may increase the risk of PGD. We hypothesized that continuous monitoring of left atrial pressure (LAP) could improve early outcomes. Methods: We retrospectively reviewed the chart of patients who underwent DLTx for PH between 2015 and 2022. The use of postoperative LAP monitoring was left to the discretion of the attending transplant surgeon. Results: A total of 135 patients underwent DLTx for PH. Among them, 72 were managed either with prophylactic postoperative extracorporeal membrane oxygenation (ECMO) or with ECMO weaning guided by transesophageal echocardiography and Swan-Ganz catheter, whereas 63 underwent systematic ECMO weaning after the placement of a LAP catheter maintained for 3 to 5 days. Both groups were comparable regarding age, PH diagnoses, and disease severity. The LAP group showed significantly less postoperative ECMO use (25% vs 83%, Conclusions: Continuous postoperative monitoring of LAP after DLTx for PH was associated with improved early outcomes. This strategy may help reduce the incidence of severe postoperative complications in this high-risk population.