- Email: [email protected]
Early post-operative vasoplegia in lung transplantation
S88
34TH EACTA ANNUAL CONGRESS ABSTRACTS / Journal of Cardiothoracic and Vascular Anesthesia 33 (2019) S85 S104
Exposure to volatile anaesthetic was quantified by determining the area under the end tidal expired anaesthetic agent vs time curve. This was adjusted for anaesthetic type using minimum alveolar concentration (MAC), to give MAC-hours which were plotted against vital status then assessed using logistic regression. Results: Final analysis included 746 patients, 342 received total intravenous anaesthetic and 404 were exposed to volatile agents, with mean time to follow up of 3.65 (1.2-6.1) years. Log rank testing did not demonstrate significant differences in survival between volatile and total intravenous anaesthetics in terms of cancer specific (p = 0.80) or overall survival (p = 0.74). Anaesthetic type was not found to be a significant predictor for cancer specific or overall survival in univariate or multivariate Cox analysis (p = 0.81 for cancer specific survival and p = 0.94 for overall survival). Logistic regression used to assess dose-response was not significant for cancer specific survival (p = 0.054). No significance was found in univariate or multivariate Cox analysis for cancer specific survival based on logistic regression results. Discussion: This study found no significant relationship between anaesthetic technique and long term non-small cell lung cancer survival. This contradicts a large body of retrospective work suggesting a survival benefit in patients receiving total intravenous anaesthetic for cancer surgery, but is in keeping with the findings of Oh et al (1) who also demonstrated no effect in 362 patients undergoing surgery resection for non-small cell lung cancer. Ultimately a randomised controlled trial is required in this area. REFERENCE: Oh T et al (2018) Long-Term Oncologic Outcomes for Patients Undergoing Volatile Versus Intravenous Anesthesia for Non-Small Cell Lung Cancer Surgery: A Retrospective Propensity Matching Analysis, Cancer Control, 25:1-7
Session: LVAD/TRANSPLANT
September 4, 2019
S06:03
represents a severe limitation leading to Primary Graft Dysfunction (PGD) and multi-organ failure with great impact on survival and clinical outcomes. We hypothesise that LTx is associated with a high incidence of vasoplegia and that this is associated with a profound inflammatory response and high mortality and organ dysfunction. To test our hypotheses, we have identified patients who developed vasoplegia in the first 48 hours after LTx, described the impact of the vasoplegia on the clinical impact and explored the role of neutrophil degranulation products, such as Myeloperoxidase (MPO) and Heparin Binding Protein (HBP). Methods: We recruited 40 patients who underwent LTx in 2013-15 at Harefield Hospital. Clinical data were recorded. Vasoplegia was defined according to Tsiouris et al (1). PGD was diagnosed and scored according to ISHLT criteria 2005, Acute Kidney Injury (AKI) to KDIGO criteria. Blood samples were collected before surgery and at different timepoints after the arrival in ITU and analysed for MPO and HBP levels (Axis-Shield Heparin Binding Protein EIA, Abcam MPO ELISA kit). Data were analysed and reported as appropriate. Results: 13 patients developed post-operative vasoplegia (32%). Within this group, 6 patients also developed PGD 3 (46%, p 0.284) and 9 AKI (69%, p 0.312), 7 requiring haemofiltration (54%, p 0.032). Vasoplegic patients showed lower P/ F ratios on day 1 (23.1 [17.3, 35.7] vs. 31.4 [24.4, 41.4], p 0.151), day 2 936.0 [29.0, 44.6] vs. 46.7 [41.4, 50.5], p 0.011), and day 3 939.6 [29.7, 46.9] vs. 48.3 [43.4, 53.2], p 0.004). They also had longer ventilation duration (159 [59, 971] hours vs. 29 [15, 114] hours, p 0.012) and longer ITU stay (22 [5, 43] days vs. 5 [3, 9] days, p 0.029). Overall survival was not significantly affected by vasoplegia (log rank 1.005 p 0.316). Vasoplegic patients exhibit a tendency for higher levels of MPO early after surgery (232 [140, 406] ng/ml vs. 170 [110, 336] ng/ml before surgery (p 0.247), 566 [84, 1246] ng/ml vs. 312 [121, 658] ng/ml at the arrival in ITU (p 0.504), 441 [231, 753] ng/ml vs. 300 [142, 518] ng/ml at 6 hours (p 0.353), 160 [52, 447] ng/ml vs. 139 [112, 744] ng/ml at 12 hours (p 0.200)), but similar levels of HBP.
Early post-operative vasoplegia in lung transplantation
Imperial College, London, United Kingdom Royal Brompton & Harefield NHS Foundation Trust, LondonHarefield, United Kingdom 3 University Medical Centre, Utrecht, The Netherlands
Discussion: These results identify high incidence of vasoplegia in the LTx population. One third of our patients developed vasoplegia in the early post-operative period with significant impact on the early post-operative function in terms of gas exchange and need for ventilatory support and level 3 care. Moreover, the data may suggest potential involvement of neutrophil-derived myeloperoxidase and, therefore oxidative stress, in the early postoperative period events.
Introduction: Lung transplantation (LTx) is the main treatment for end-stage respiratory failure. The post-operative development of pulmonary and systemic inflammation
REFERENCE: Tsiouris A et al. Risk assessment and outcomes of vasoplegia after cardiac surgery. Gen Thorac Cardiovasc Surg. 2017 Oct;65(10):557-565.
V. Manikavasagar1, R. Romano1,2, T.-C. Aw2, E. de Waal3, A. Simon1,2, N. Marczin1,2 1
2
34TH EACTA ANNUAL CONGRESS ABSTRACTS / Journal of Cardiothoracic and Vascular Anesthesia 33 (2019) S85 S104
Exposure to volatile anaesthetic was quantified by determining the area under the end tidal expired anaesthetic agent vs time curve. This was adjusted for anaesthetic type using minimum alveolar concentration (MAC), to give MAC-hours which were plotted against vital status then assessed using logistic regression. Results: Final analysis included 746 patients, 342 received total intravenous anaesthetic and 404 were exposed to volatile agents, with mean time to follow up of 3.65 (1.2-6.1) years. Log rank testing did not demonstrate significant differences in survival between volatile and total intravenous anaesthetics in terms of cancer specific (p = 0.80) or overall survival (p = 0.74). Anaesthetic type was not found to be a significant predictor for cancer specific or overall survival in univariate or multivariate Cox analysis (p = 0.81 for cancer specific survival and p = 0.94 for overall survival). Logistic regression used to assess dose-response was not significant for cancer specific survival (p = 0.054). No significance was found in univariate or multivariate Cox analysis for cancer specific survival based on logistic regression results. Discussion: This study found no significant relationship between anaesthetic technique and long term non-small cell lung cancer survival. This contradicts a large body of retrospective work suggesting a survival benefit in patients receiving total intravenous anaesthetic for cancer surgery, but is in keeping with the findings of Oh et al (1) who also demonstrated no effect in 362 patients undergoing surgery resection for non-small cell lung cancer. Ultimately a randomised controlled trial is required in this area. REFERENCE: Oh T et al (2018) Long-Term Oncologic Outcomes for Patients Undergoing Volatile Versus Intravenous Anesthesia for Non-Small Cell Lung Cancer Surgery: A Retrospective Propensity Matching Analysis, Cancer Control, 25:1-7
Session: LVAD/TRANSPLANT
September 4, 2019
S06:03
represents a severe limitation leading to Primary Graft Dysfunction (PGD) and multi-organ failure with great impact on survival and clinical outcomes. We hypothesise that LTx is associated with a high incidence of vasoplegia and that this is associated with a profound inflammatory response and high mortality and organ dysfunction. To test our hypotheses, we have identified patients who developed vasoplegia in the first 48 hours after LTx, described the impact of the vasoplegia on the clinical impact and explored the role of neutrophil degranulation products, such as Myeloperoxidase (MPO) and Heparin Binding Protein (HBP). Methods: We recruited 40 patients who underwent LTx in 2013-15 at Harefield Hospital. Clinical data were recorded. Vasoplegia was defined according to Tsiouris et al (1). PGD was diagnosed and scored according to ISHLT criteria 2005, Acute Kidney Injury (AKI) to KDIGO criteria. Blood samples were collected before surgery and at different timepoints after the arrival in ITU and analysed for MPO and HBP levels (Axis-Shield Heparin Binding Protein EIA, Abcam MPO ELISA kit). Data were analysed and reported as appropriate. Results: 13 patients developed post-operative vasoplegia (32%). Within this group, 6 patients also developed PGD 3 (46%, p 0.284) and 9 AKI (69%, p 0.312), 7 requiring haemofiltration (54%, p 0.032). Vasoplegic patients showed lower P/ F ratios on day 1 (23.1 [17.3, 35.7] vs. 31.4 [24.4, 41.4], p 0.151), day 2 936.0 [29.0, 44.6] vs. 46.7 [41.4, 50.5], p 0.011), and day 3 939.6 [29.7, 46.9] vs. 48.3 [43.4, 53.2], p 0.004). They also had longer ventilation duration (159 [59, 971] hours vs. 29 [15, 114] hours, p 0.012) and longer ITU stay (22 [5, 43] days vs. 5 [3, 9] days, p 0.029). Overall survival was not significantly affected by vasoplegia (log rank 1.005 p 0.316). Vasoplegic patients exhibit a tendency for higher levels of MPO early after surgery (232 [140, 406] ng/ml vs. 170 [110, 336] ng/ml before surgery (p 0.247), 566 [84, 1246] ng/ml vs. 312 [121, 658] ng/ml at the arrival in ITU (p 0.504), 441 [231, 753] ng/ml vs. 300 [142, 518] ng/ml at 6 hours (p 0.353), 160 [52, 447] ng/ml vs. 139 [112, 744] ng/ml at 12 hours (p 0.200)), but similar levels of HBP.
Early post-operative vasoplegia in lung transplantation
Imperial College, London, United Kingdom Royal Brompton & Harefield NHS Foundation Trust, LondonHarefield, United Kingdom 3 University Medical Centre, Utrecht, The Netherlands
Discussion: These results identify high incidence of vasoplegia in the LTx population. One third of our patients developed vasoplegia in the early post-operative period with significant impact on the early post-operative function in terms of gas exchange and need for ventilatory support and level 3 care. Moreover, the data may suggest potential involvement of neutrophil-derived myeloperoxidase and, therefore oxidative stress, in the early postoperative period events.
Introduction: Lung transplantation (LTx) is the main treatment for end-stage respiratory failure. The post-operative development of pulmonary and systemic inflammation
REFERENCE: Tsiouris A et al. Risk assessment and outcomes of vasoplegia after cardiac surgery. Gen Thorac Cardiovasc Surg. 2017 Oct;65(10):557-565.
V. Manikavasagar1, R. Romano1,2, T.-C. Aw2, E. de Waal3, A. Simon1,2, N. Marczin1,2 1
2