Perioperative Bleeding Risk in Lung Transplantation After Previous Cardiothoracic Surgery

Previous cardiothoracic surgery (CTS) is associated with a significant risk of perioperative bleeding in lung transplantation (LT). The types of prior surgery have not been well-defined. We aimed to quantify the risk of perioperative bleeding in LT based on a history of previous CTS.

We conducted a retrospective study of adult patients who underwent bilateral LT and stratified recipients into no prior CTS (No-CTS), minimally invasive CTS (Mi-CTS), or open/invasive CTS (I-CTS). The primary outcome was the occurrence of severe/massive bleeding or worse bleeding by the modified universal definition of perioperative bleeding (UDPB). Multivariable analysis was performed with p value <0.05 for statistical significance.

507 recipients were included. I-CTS had 3.93 higher odds of severe/massive bleeding (95% CI [1.98-7.98]; p < 0.001) and 4.37 higher odds of worse bleeding than No-CTS (95% CI [2.27-8.70]; p < 0.001). I-CTS had 2.38 higher odds of worse bleeding than Mi-CTS (95% CI [1.14-5.11]; p = 0.023). Mi-CTS had a higher risk of severe/massive bleeding and worse bleeding than No-CTS.

Patients with more invasive prior CTS had an increased risk of perioperative bleeding and worse outcomes. More invasive previous surgery predicts bleeding risk and requires more transfusion and hospital resources. Centers should examine opportunities for preoperative optimization, intraoperative management, and intraoperative extracorporeal life support (ECLS) strategies to mitigate this risk.