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Updated: May 11, 2025

Donor Posterior Atrial Flap Rotation for Left Atrial Cuff Reconstruction in Lung Transplantation

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Published on: October 11, 2024

Perioperative Bleeding Risk in Lung Transplantation After Previous Cardiothoracic Surgery.

Bryan Chow¹, Morgan A Rosser¹, Jacob A Klapper²

¹Department of Anesthesiology, Division of Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA.

Clinical Transplantation

|April 17, 2025

Summary

This summary is machine-generated.

Previous invasive cardiothoracic surgery (CTS) significantly increases bleeding risk during lung transplantation (LT). Minimally invasive CTS also poses a higher risk than no prior surgery, highlighting the need for tailored management strategies.

Keywords:

extracorporeal life support lung transplantation perioperative bleeding previous cardiothoracic surgery textbook outcome transplant outcomes

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Area of Science:

Cardiothoracic Surgery
Transplantation Medicine
Hemorrhagic Risk Assessment

Background:

Previous cardiothoracic surgery (CTS) is a known risk factor for bleeding during lung transplantation (LT).
The specific impact of different types of prior CTS on perioperative bleeding in LT is not well-defined.
Quantifying this risk is crucial for patient management and resource allocation.

Purpose of the Study:

To evaluate the association between prior cardiothoracic surgery (CTS) and perioperative bleeding risk in lung transplantation (LT).
To stratify bleeding risk based on the invasiveness of previous CTS (none, minimally invasive, or open/invasive).

Main Methods:

Retrospective study of 507 adult patients undergoing bilateral lung transplantation (LT).
Patients categorized into no prior CTS (No-CTS), minimally invasive CTS (Mi-CTS), or open/invasive CTS (I-CTS).
Primary outcome: severe/massive bleeding or worse, defined by the modified universal definition of perioperative bleeding (UDPB). Multivariable analysis used.

Main Results:

Open/invasive CTS (I-CTS) was associated with significantly higher odds of severe/massive bleeding (3.93x) and worse bleeding (4.37x) compared to no prior CTS (No-CTS).
I-CTS also showed higher odds of worse bleeding (2.38x) compared to minimally invasive CTS (Mi-CTS).
Minimally invasive CTS (Mi-CTS) presented a higher risk of severe/massive and worse bleeding than No-CTS.

Conclusions:

More invasive prior cardiothoracic surgery (CTS) independently predicts increased perioperative bleeding risk and worse outcomes in lung transplantation (LT).
This increased risk necessitates greater transfusion requirements and hospital resource utilization.
Centers should optimize preoperative, intraoperative, and extracorporeal life support (ECLS) strategies to mitigate bleeding risks in patients with prior CTS.