Lung Transplantation in Pulmonary Hypertension: A Multidisciplinary Unit's Management Experience

Quezada-Loaiza, Carlos A.; Gafas, Alicia de Pablo; Pérez, Virginia; Alonso, Raquel Cano; Juarros, Lourdes; Real, M. Isabel; López, E.; Cortes, Marcelino; Meneses, José Carlos; González, Ignacio Hernández; Gude, V. Díaz-Hellín; Subías, Pilar Escribano; Gámez, Pablo

doi:10.1016/j.transproceed.2018.02.073

Cited by 13 publications

(8 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nevertheless, ECMO during the postoperative period of PEA as a BTR has usually good results [2]. The use of ECMO as a bridge to lung transplantation in Spain demonstrates good results [11]. A complementary and interesting option for end-stage patients, or those waiting for lung transplantation, could be the creation of an interatrial septostomy [12].…”

Section: Resultsmentioning

confidence: 99%

ECMO in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension as a bridge to therapy

et al. 2023

View full text Add to dashboard Cite

Section: Resultsmentioning

confidence: 99%

ECMO in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension as a bridge to therapy

et al. 2023

View full text Add to dashboard Cite

“…Initiation of extracorporeal membrane oxygenation remains the last resort and has been used perioperatively for management of pulmonary hypertensive crisis and as interim measure while awaiting for definitive treatment with lung transplantation. [ 8 – 10 ]…”

Section: Discussionmentioning

confidence: 99%

Anesthesia for pulmonary veno-occlusive disease: the dilemma and what we should know as anesthesiologists

et al. 2020

View full text Add to dashboard Cite

Introduction: Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension. It is often underdiagnosed or misdiagnosed as idiopathic pulmonary arterial hypertension (PAH). Inappropriate treatment may cause worsening of symptoms which may lead to fatal outcomes. Anesthetic considerations and management for pulmonary hypertension are well described, but few anesthesiologists are aware of the entity of PVOD and its management. Patient concerns: We report a case of PVOD in a 73-year-old female who was on concurrent aspirin and anagrelide, requiring emergent open femoral hernia repair. Diagnosis: PVOD and incarcerated femoral hernia Intervention: Combined spinal-epidural (CSE) was performed to enable the surgery. Outcome: Surgery was completed successfully under central neuraxial anesthesia and the patient remained stable and comfortable throughout, avoiding the need for general anesthesia. Due to the concurrent aspirin and anagrelide therapy, significant bleeding from the CSE puncture site was observed immediately post-operatively. This was resolved with external manual compression and withholding the aspirin and anagrelide. Patient remained well without neurological deficit and was discharged postoperative day seven. Lessons: It is important to differentiate PVOD from PAH due to the controversial use of pulmonary vasodilators in PVOD. Pulmonary vasodilator is commonly used to treat acute pulmonary hypertension in PAH but its usage may lead to pulmonary edema in patients with PVOD. Hence, with no ideal treatment available, the avoidance of general anesthesia is crucial to prevent acute pulmonary hypertensive crisis in patient with PVOD. However, this needs to be weighed against the elevated risk of central neuraxial bleeding when performing a CSE in a patient on concurrent aspirin and anagrelide therapy. Calculated decision-making considering the risks and benefits of all alternatives should be carried out in such a scenario, and measures should be taken in anticipation of the potential consequences of the eventual decision. Conclusion: It is important to differentiate PVOD from PAH. PVOD has unique anesthetic considerations due to the controversial use of pulmonary vasodilators. This case also emphasizes the importance of active anticipation of potential issues and adequate follow up.

show abstract

“…Additionally, patients with phenotypes known to respond poorly to medical therapy, such as pulmonary venoocclusive disease (PVOD), should be referred promptly (9). Ideally, early referral allows time for patients to consider transplantation, and for the transplant teams to fully evaluate patient candidacy, while working to mitigate any potential risks (24).…”

Section: Pre-transplant Managementmentioning

confidence: 99%

Lung transplantation for pulmonary hypertension

Hwalek¹,

Rosenheck²,

Whitson³

2021

J Thorac Dis

View full text Add to dashboard Cite

From its identification as a distinct disease entity, understanding and management of pulmonary hypertension has continuously evolved. Diagnostic and therapeutic interventions have greatly improved the prognostic implications of this devastating disease, previously rapidly and uniformly fatal to one chronically managed by multi-disciplinary teams. Improved diagnostic algorithms and active research into biochemical signatures of pulmonary hypertension (PH) have led to earlier diagnosis of PH. Medical therapy has moved from upfront use of continuous intravenous prostaglandins to administration of combinations of oral medications targeting multiple pathways underlying this disease process. In addition to improved medical therapies, recently introduced interventions such as pulmonary endarterectomy and pulmonary artery balloon angioplasty for chronic thromboembolic pulmonary hypertension (CTEPH) give patients an increasing array of treatment options. Despite these many advances, lung transplantation remains the definitive treatment for patients with disease refractory to or progressing on best medical therapy. As our understanding of medical therapy has advanced, so to have best practices for lung transplantation. Recipient selection and approach to organ transplantation techniques have continuously evolved. Mechanical circulatory support has become increasingly employed to bridge patients through lung transplantation in the immediate post transplantation recovery. In this review, we give a history of lung transplantation for PH, an overview of PH, discuss current best practices and look to the future for insights into the care of these patients.

show abstract

Lung Transplantation in Pulmonary Hypertension: A Multidisciplinary Unit's Management Experience

Cited by 13 publications

References 26 publications

ECMO in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension as a bridge to therapy

ECMO in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension as a bridge to therapy

Anesthesia for pulmonary veno-occlusive disease: the dilemma and what we should know as anesthesiologists

Lung transplantation for pulmonary hypertension

Contact Info

Product

Resources

About