Intraoperative Support for Primary Bilateral Lung Transplantation: A Propensity-Matched Analysis

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Transplantation Medicine

Background:

• Single-center studies suggest benefits of intraoperative venoarterial extracorporeal membrane oxygenation (VA-ECMO) for support.
• Large-scale, propensity-matched data comparing VA-ECMO and cardiopulmonary bypass (CPB) during bilateral lung transplantation (LTx) are lacking.

Purpose of the Study:

• To compare outcomes of intraoperative VA-ECMO versus CPB during bilateral lung transplantation using propensity analysis.
• To evaluate the impact of different intraoperative support strategies on patient outcomes.

Main Methods:

• Retrospective analysis of 795 primary adult lung transplantation patients (June 2011–December 2020).
• Patients were categorized into no intraoperative support, VA-ECMO, or CPB groups.
• Propensity analysis compared outcomes between intraoperative CPB and VA-ECMO groups, excluding specific complex cases.

Main Results:

• The CPB group required more blood products, had longer ICU stays, and more ventilator dependence days compared to the VA-ECMO group.
• No significant differences were observed in cerebrovascular accident, reintubation, dialysis, or in-hospital mortality between groups.
• The CPB group exhibited a higher incidence of grade 3 primary graft dysfunction at 72 hours.

Conclusions:

• Intraoperative VA-ECMO during lung transplantation is associated with reduced postoperative blood transfusions, shorter mechanical ventilation duration, and lower primary graft dysfunction rates.
• Despite observed postoperative differences, neither VA-ECMO nor CPB support strategy predicted 1- or 3-year mortality.
• Support type did not influence long-term survival outcomes in this propensity-matched analysis.