The role of cardiopulmonary bypass in lung transplantation

Abstract

Despite segregation of unplanned CPB conversion cases from elective on-pump cases, patients with comparable preoperative demographic/risk profiles demonstrated better early postoperative outcomes and, possibly, an improved early survival with an off-pump strategy. A considerable proportion of high-risk patients require intraoperative conversion from off-pump to CPB, and this seems associated with suboptimal outcomes; however, there is no significant benefit to employing an elective on-pump strategy over emergent conversion in the high-risk group.

Bilateral central retinal/ophthalmic artery occlusion and near-complete ophthalmoplegia after bilateral lung transplant

“…Some authors report that any use of CPB may be detrimental to patient outcome 31 and that CPB for SLT/BLT should be reserved for decompensated cases whereas others feel that outcomes are comparable regardless of whether or not CPB is utilized 32 . A notable limitation of published reports comparing on-pump CPB and off-pump lung transplants is having grouped “off-pump cases, which required emergent conversion to CPB” with the “on-pump” CPB group 27 , 28 , 32 . Mohite et al showed that despite segregation of unplanned CPB conversion cases from elective on-pump cases, patients with comparable preoperative demographic and risk profiles demonstrated better early postoperative outcomes and a possible better early survival with an off-pump strategy 32 .…”

“…A notable limitation of published reports comparing on-pump CPB and off-pump lung transplants is having grouped “off-pump cases, which required emergent conversion to CPB” with the “on-pump” CPB group 27 , 28 , 32 . Mohite et al showed that despite segregation of unplanned CPB conversion cases from elective on-pump cases, patients with comparable preoperative demographic and risk profiles demonstrated better early postoperative outcomes and a possible better early survival with an off-pump strategy 32 . In contrast, off-pump BLT/SLT has other risks.…”

El trasplante pulmonar en la fibrosis quística y la influencia de la circulación extracorpórea

“…Se describe en la literatura que los pacientes trasplantados pulmonares (incluidos entre otros diagnósticos, pacientes con FQ) sin CEC tienen mejor ratio PaO 2 /FiO 2 postoperatoria, menos días de ventilación mecánica, tiempo en UCI y tiempo de hospitalización en comparación con los pacientes trasplantados bajo CEC. 293 Nuestra serie también encuentra mayores tiempos de VM en los receptores trasplantados bajo CEC (p = 0,012).…”

Noteworthy Literature Published in 2016 for Thoracic Organ Transplantation Anesthesiologists

“…44 In high-risk patients, several surgeons prefer elective on-pump procedures, although others are willing to trial off-pump procedures, with conversion to on pump as needed. Mohite et al 45 mainly utilized CPB for mechanical support in their center and compared elective CPB (n = 162) conversion with CPB after trial of off-pump (n = 54) and off-pump methods (n = 86) in their LTX cohort of 302 patients. Off-pump patients demonstrated better oxygenation and shorter ICU and hospital stay when compared with the propensity-matched elective CPB group.…”