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Intraoperative support during lung transplantation.

Pedro Reck Dos Santos1, Jonathan D'Cunha1

  • 1Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.

Journal of Thoracic Disease
|January 7, 2022
PubMed
Summary

Intraoperative mechanical support, like veno-arterial extracorporeal membrane oxygenation (VA ECMO), is crucial for hemodynamic and ventilatory stability during lung transplantation (LTx). This support helps minimize complications and protect newly implanted lungs.

Keywords:
Lung transplantation (LTx)acute lung injury (ALI)cardiopulmonary bypass (CPB)end-stage lung diseasesintraoperative supportprimary graft dysfunction (PGD)veno-arterial extracorporeal membrane oxygenation (VA ECMO)veno-venous extracorporeal membrane oxygenation (VV ECMO)

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Area of Science:

  • Cardiovascular Surgery
  • Pulmonology
  • Transplantation Medicine

Background:

  • Lung transplantation (LTx) increasingly involves patients with comorbidities, necessitating aggressive surgical approaches.
  • Intraoperative mechanical support is vital for managing hemodynamic and ventilatory stability during LTx.
  • Minimizing intraoperative injury is paramount for improving LTx outcomes.

Purpose of the Study:

  • To highlight the essential role of intraoperative mechanical support in lung transplantation.
  • To discuss the benefits of veno-arterial extracorporeal membrane oxygenation (VA ECMO) in providing a protective environment for lung grafts.
  • To emphasize the importance of understanding patient physiology for safe and effective use of mechanical support.

Main Methods:

  • Review of intraoperative mechanical support strategies in lung transplantation.
  • Focus on the increasing use and benefits of veno-arterial extracorporeal membrane oxygenation (VA ECMO).
  • Discussion of the exclusive use of VA ECMO at the institution over the past decade.

Main Results:

  • Veno-arterial extracorporeal membrane oxygenation (VA ECMO) is gaining popularity and has been exclusively used for LTx at the institution for 10 years.
  • New technologies facilitate more liberal intraoperative VA ECMO use, creating a protective environment for grafts.
  • Mechanical support ensures hemodynamic and ventilatory stability, crucial for complex LTx cases.

Conclusions:

  • Intraoperative mechanical support, particularly VA ECMO, is essential for safe and effective lung transplantation.
  • VA ECMO provides a physiologic environment, potentially offering prophylactic lung protection during the critical perioperative period.
  • Precise indication and safe use of mechanical support require understanding patient anatomy and cardiopulmonary physiology.