TEE for Lung Transplantation: A Case Series and Discussion of Vascular Complications

Abrams, Benjamin; Melnyk, Vladyslav; Allen, Wesley L.; Subramaniam, Kathirvel; Scott, Christopher D.; Mitchell, John D.; Seres, Tamás; Martin, Archer Kilbourne

doi:10.1053/j.jvca.2019.09.005

Cited by 25 publications

(75 citation statements)

References 16 publications

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“…A thorough preintervention TEE evaluation should be performed to include assessment of pulmonary veins (PV) and pulmonary arteries (PA). Evaluation of the left PA may be obstructed by ipsilateral mainstem bronchus (50). A prompt and accurate diagnosis for ventricular dysfunction, valvular dysfunction, hypovolemia, presence of patent foramen ovale, and right ventricular outflow obstruction can be gained with efficient TEE use (44,50).…”

Section: Invasive Monitoringmentioning

confidence: 99%

Anesthetic considerations in lung transplantation: past, present and future

Murray¹,

Boisen²,

Fritz³

et al. 2021

J Thorac Dis

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Lung transplantation is a very complex surgical procedure with many implications for the anesthetic care of these patients. Comprehensive preoperative evaluation is an important component of the transplant evaluation as it informs many of the decisions made perioperatively to manage these complex patients effectively and appropriately. These decisions may involve pre-emptive actions like pre-habilitation and nutrition optimization of these patients before they arrive for their transplant procedure. Appropriate airway and ventilation management of these patients needs to be performed in a manner that provides an optimal operating conditions and protection from ventilatory injury of these fragile post-transplant lungs.Pain management can be challenging and should be managed in a multi-modal fashion with or without the use of an epidural catheter while recognizing the risk of neuraxial technique in patients who will possibly be systemically anticoagulated. Complex monitoring is required for these patients involving both invasive and non-invasive including the use of transesophageal echocardiography (TEE) and continuous cardiac output monitoring. Management of the patient's hemodynamics can be challenging and involves managing the systemic and pulmonary vascular systems. Some patients may require extra-corporeal lung support as a planned part of the procedure or as a rescue technique and centers need to be proficient in instituting and managing this sophisticated method of hemodynamic support.

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Section: Invasive Monitoringmentioning

confidence: 99%

Anesthetic considerations in lung transplantation: past, present and future

Murray¹,

Boisen²,

Fritz³

et al. 2021

J Thorac Dis

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“…After induction of anesthesia and endotracheal intubation with a dual lumen endotracheal tube, we place a femoral arterial line, central venous catheter, pulmonary arterial catheter, end‐tidal carbon dioxide (ETCO 2 ) monitor, and transesophageal echocardiogram (TEE) probe. A TEE probe is placed in every lung transplant to guide ECMO cannula placement, monitor biventricular function, and assess the patency of pulmonary vasculature both before and following surgical anastomoses 4 . After initiation of veno‐arterial ECMO (VA‐ECMO), we obtain whole blood lactate, arterial blood gas (ABG), and activated clotting time (ACT) every 30 min.…”

Section: Techniquementioning

confidence: 99%

Intraoperative management of a hybrid extracorporeal membrane oxygenation circuit for lung transplantation

et al. 2020

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Background The use of extracorporeal circulation (ECC) for intraoperative cardiopulmonary support during lung transplantation has been increasing in the recent years. Our group previously described a novel hybrid extracorporeal membrane oxygenation (ECMO) circuit for use in lung transplantation. Technique Our approach for intraoperative management of our novel hybrid ECMO circuit for lung transplantation is driven by two main goals: The first is to deliver management that ensures an appropriate balance between the native and ECMO cardiac outputs in order to provide a stable environment that promotes attenuation of ischemic‐reperfusion injury during implantation. The second is to provide a stable hemodynamic environment that results in an appropriate global perfusion guided by multiple monitors and an organ systems‐based approach during implantation. Comments Our novel technique for intraoperative management of this circuit during lung transplantation is described.

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“…A TEE probe is placed in every lung transplant in order to guide ECMO cannula placement, monitor biventricular function, and assess the patency of pulmonary vasculature both prior to and following surgical anastomoses. 4 After initiation of veno-arterial ECMO (VA-ECMO), we obtain a whole blood lactate, arterial blood gas (ABG), and activated clotting time (ACT) every 30 minutes. Additionally, we check a fibrinogen and prothrombin time/international normalized ratio (PT/INR) every 2 hours.…”

Section: Monitoring Considerationsmentioning

confidence: 99%