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Left Atrial Pressure Continuous Monitoring Improves Early Postoperative Outcomes After Double Lung Transplantation for Pulmonary Hypertension
Abstracts S407 Pain-O-Meter (POM), which provides information about pain intensity, quality, location and duration. For each pain location the patients were asked to indicate intensity on the POM-VAS. A total VAS-score for each patient was calculated. There is also a list of sensory and affective words, POM-WDS. Each word has an assigned intensity value (range 1-5) where 5 indicates the worst intensity. The sensory and affective scores are added together to form a total pain intensity score. In addition the personal models of explanation of pain were explored as well as any pain medication treatment and consequences in everyday life. Results: The prevalence of pain was 58% after one year, 69 % after two years, 77 % after three years, 76 % after four years and 45 % after five years. The pain intensity scored ranged from 0 to 112 where 112 indicates a torturing and unbearable pain. Many of the lung recipients lacked pain treatment and they were uncertain about the reasons behind the pain and suffering. A comprehensive analysis of the bodily pain will be presented along with consequences in everyday life and co-morbidity. Conclusion: This comprehensive evaluation of bodily pain up to five years after lung transplantation reveal that pain is a common and serious symptom. It is a chronic condition with various locations and intensity that affects everyday life. 1( 248) Left Atrial Pressure Continuous Monitoring Improves Early Postoperative Outcomes After Double Lung Transplantation for Pulmonary Hypertension O. Mercier , J. Lepavec, N. Langer, L. Lamrani, S. Mussot, D. Fabre, E. Lebret, F. Laverdure, G. Tachon, A. Patrascu, P. Viard, F. Stephan, P.G. Dartevelle, E. Fadel. Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France. Purpose: Over the past decades, double lung transplantation (DLTx) became the gold standard treatment for end-stage pulmonary hypertension (PH) patients. However, in this setting, DLTx remains a challenging procedure with higher rate of severe primary graft dysfunction (PGD) compared to other diseases. It has been demonstrated that PH induced heart remodeling included diastolic left heart dysfunction, which could increased the risk of lung edema after DLTx. We hypothesized that continuous monitoring of the left atrial pressure (LAP) during the postoperative course could improve early outcomes. Methods: We retrospectively reviewed the chart of patients who underwent DLTx for PH in 2015, before and after the systematic use of postoperative LAP continuous monitoring. Results: Between January and June 2015, 9 patients underwent DLTx for PH with a preferential use of systematic postoperative ECMO to prevent severe PGD. From June to December 2015, the postoperative fluid management and the use of postoperative ECMO were dictated by the LAP value in 8 PH patients. Both groups were comparable regarding age (41±14 vs. 45±11), time between the diagnosis and transplantation (5.8±3.8 vs. 5.5±3.5), preoperative specific PH therapies, and hemodynamic severity. The LAP group experienced a significantly lower need for postoperative ECMO (1 vs. 7, p< 0.05), mechanical ventilation in ICU (7±7 vs. 32±28 days, p< 0.05) and lower rates of ICU length of stay (15.4±12.4 vs. 42.8±32 days, p< 0.05), bleeding and dialysis. Postoperative fluid balance remained neutral in the LAP group as opposed to a highly positive rate (> 5L) in the other group. Conclusion: Postoperative management of DLTx for PH based on continuous monitoring of the left atrial pressure significantly improved early outcome and may dramatically decrease clinical risk of primary graft dysfunction. 1( 249) WITHDRAWN 1( 250) HFpEF Associated with Reduced Survival Following Lung Transplantation J.P. Scott ,1 B.A. Boilson,2 R.C. Daly,3 M.E. Wylam,4 S.G. Peters,4 C.C. Kennedy.4 1Mayo Clinic, Rochester, MN; 2Cardiology, Mayo Clinic, Rochester, MN; 3Cardiac Surgery, Mayo Clinic, Rochester, MN; 4Pulmonary and Critical Care, Mayo Clinic, Rochester, MN.
Purpose: Following lung transplantation, heart failure with preserved ejection fraction (HFpEF) is an indicator of poorer prognosis. When measured by E/e’ (1) HFpEF can be shown to correlate with outcomes in non-transplant populations (2). Potential candidates for lung transplantation with elevated E/e’ (and elevated or reduced E/A ratios) are at risk of progression to symptomatic HFpEF following lung transplantation. While many patients with mild reduction in renal function can tolerate fluid retention, patients with HFpEF prior to lung transplant may develop significant and often incapacitating, dependent edema. Methods: For 57 lung recipients, 36 males and 21 females, mean age 54.1 (SD 10.6), transplanted at least 1 year ago, mean 2.7 years (SD 6.6) stratification of E/e’ ratio before as well as after lung transplantation indicate reduced survival for E/e’ values above 15 and worse for those above 20. Results: Survival is reduced in patients with high E/e’ : at 2 months median survival was 613 days (range, 146-2060 d) for patients with E/e’values 15-19.9, and 128 days (range 59 - 196 d) for E/e’ values 20 or higher (Logrank and Wilcoxon tests with df3 both p< 0.0001). Higher pre-transplant E/e’ values also indicate poorer outcomes (Log-rank and Wilcoxon both with df3 p< 0.0001). As might be anticipated, pre-transplant E/e’ directly correlates with pre-transplant mean wedge pressure (p< 0.02, Spearman). Conclusion: The apparent progression of HFpEF with lung transplantation is likely the result of several factors including the use of a calcineurin inhibitor with predictable pre load and after load effects. The association with higher mortality may be in part a consequence rather than the cause of poor outcomes. Early identification of HFpEF progression may allow early intervention and might improve outcomes. References: [1]Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997 Aug;30(2):474-80. [2] Elevated E/e' predicts prognosis in congestive heart failure patients with preserved systolic function. Circ J 2009 Jan;73(1):86-91 1( 251) Bronchial Complications After Living-Donor Lobar Lung Transplantation: Bronchial Stenoses in the Lobar to Segmental Bronchi Necessitating Earlier Intervention S. Sugimoto ,1 T. Kurosaki,2 K. Miyoshi,1 S. Otani,2 M. Yamane,1 S. Miyoshi,1 T. Oto.2 1General Thoracic Surgery, Okayama University Hospital, Okayama, Japan; 2Organ Transplant Center, Okayama University Hospital, Okayama, Japan. Purpose: Airway complications (AC) after lung transplantation (LT) could be life-threatening, necessitating careful treatment with bronchoscopic intervention. In living-donor lobar lung transplantation (LDLLT), because the right and left lower lobes from two healthy donors are implanted in the recipient in place of the whole lungs, AC after LDLLT could have different features from AC after conventional cadaveric LT (CLT). However, the difference of AC between LDLLT and CLT remains unknown. The purpose of this study was to compare the characteristics and outcomes of AC after LDLLT with those of AC after CLT. Methods: We retrospectively investigated 147 recipients of LT, including 78 recipients of LDLLT and 69 recipients of CLT, at our institution between October 1998 and December 2015. Results: AC requiring interventions developed in 8 of 144 anastomoses (8 recipients) after LDLLT and 13 of 116 anastomoses (11 recipients) after CLT (5.6% vs 11.2%, p= 0.11). AC occurred in the lobar to segmental bronchi after LDLLT and in the main stem to lobar bronchi after CLT. At the time of diagnosis, AC after LDLLT were exclusively stenosis in 8 recipients, while AC after CLT were 8 necrosis and 3 stenosis. Bronchoscopic intervention allowed AC to resolve without stent placement in 3 patients after LDLLT and 2 patients after CLT. Stent placement was performed in 5 patients after LDLLT and in 8 patients after CLT. Two patients after CLT required operative repair. Mean time to the first intervention after LDLLT was significantly earlier than that after CLT (34±36 vs 115±92 days, p= 0.02). There was no significant difference in 5-year survival rate between the two groups (70.0% vs 51.9%, p= 0.73). In the two groups, overall survival rates were similar in comparison with patients who did not have AC. Conclusion: Our study suggests that AC after LDLLT could be characterized by bronchial stenosis in the lobar to segmental bronchi, necessitating earlier treatments within a few months.
Purpose: Following lung transplantation, heart failure with preserved ejection fraction (HFpEF) is an indicator of poorer prognosis. When measured by E/e’ (1) HFpEF can be shown to correlate with outcomes in non-transplant populations (2). Potential candidates for lung transplantation with elevated E/e’ (and elevated or reduced E/A ratios) are at risk of progression to symptomatic HFpEF following lung transplantation. While many patients with mild reduction in renal function can tolerate fluid retention, patients with HFpEF prior to lung transplant may develop significant and often incapacitating, dependent edema. Methods: For 57 lung recipients, 36 males and 21 females, mean age 54.1 (SD 10.6), transplanted at least 1 year ago, mean 2.7 years (SD 6.6) stratification of E/e’ ratio before as well as after lung transplantation indicate reduced survival for E/e’ values above 15 and worse for those above 20. Results: Survival is reduced in patients with high E/e’ : at 2 months median survival was 613 days (range, 146-2060 d) for patients with E/e’values 15-19.9, and 128 days (range 59 - 196 d) for E/e’ values 20 or higher (Logrank and Wilcoxon tests with df3 both p< 0.0001). Higher pre-transplant E/e’ values also indicate poorer outcomes (Log-rank and Wilcoxon both with df3 p< 0.0001). As might be anticipated, pre-transplant E/e’ directly correlates with pre-transplant mean wedge pressure (p< 0.02, Spearman). Conclusion: The apparent progression of HFpEF with lung transplantation is likely the result of several factors including the use of a calcineurin inhibitor with predictable pre load and after load effects. The association with higher mortality may be in part a consequence rather than the cause of poor outcomes. Early identification of HFpEF progression may allow early intervention and might improve outcomes. References: [1]Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol. 1997 Aug;30(2):474-80. [2] Elevated E/e' predicts prognosis in congestive heart failure patients with preserved systolic function. Circ J 2009 Jan;73(1):86-91 1( 251) Bronchial Complications After Living-Donor Lobar Lung Transplantation: Bronchial Stenoses in the Lobar to Segmental Bronchi Necessitating Earlier Intervention S. Sugimoto ,1 T. Kurosaki,2 K. Miyoshi,1 S. Otani,2 M. Yamane,1 S. Miyoshi,1 T. Oto.2 1General Thoracic Surgery, Okayama University Hospital, Okayama, Japan; 2Organ Transplant Center, Okayama University Hospital, Okayama, Japan. Purpose: Airway complications (AC) after lung transplantation (LT) could be life-threatening, necessitating careful treatment with bronchoscopic intervention. In living-donor lobar lung transplantation (LDLLT), because the right and left lower lobes from two healthy donors are implanted in the recipient in place of the whole lungs, AC after LDLLT could have different features from AC after conventional cadaveric LT (CLT). However, the difference of AC between LDLLT and CLT remains unknown. The purpose of this study was to compare the characteristics and outcomes of AC after LDLLT with those of AC after CLT. Methods: We retrospectively investigated 147 recipients of LT, including 78 recipients of LDLLT and 69 recipients of CLT, at our institution between October 1998 and December 2015. Results: AC requiring interventions developed in 8 of 144 anastomoses (8 recipients) after LDLLT and 13 of 116 anastomoses (11 recipients) after CLT (5.6% vs 11.2%, p= 0.11). AC occurred in the lobar to segmental bronchi after LDLLT and in the main stem to lobar bronchi after CLT. At the time of diagnosis, AC after LDLLT were exclusively stenosis in 8 recipients, while AC after CLT were 8 necrosis and 3 stenosis. Bronchoscopic intervention allowed AC to resolve without stent placement in 3 patients after LDLLT and 2 patients after CLT. Stent placement was performed in 5 patients after LDLLT and in 8 patients after CLT. Two patients after CLT required operative repair. Mean time to the first intervention after LDLLT was significantly earlier than that after CLT (34±36 vs 115±92 days, p= 0.02). There was no significant difference in 5-year survival rate between the two groups (70.0% vs 51.9%, p= 0.73). In the two groups, overall survival rates were similar in comparison with patients who did not have AC. Conclusion: Our study suggests that AC after LDLLT could be characterized by bronchial stenosis in the lobar to segmental bronchi, necessitating earlier treatments within a few months.