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International Collaboration Agreement: The Impact of a New Lung Allocation Policy on Post Transplant Outcomes in Argentina and Uruguay
Abstracts S159 complementary functions, can increase the number of transplants and improve the results. This is an effective approach to upgrade heart transplant care and should be used in other centers in the world that have not achieved their maximum effectiveness in heart transplant. 4( 15) International Collaboration Agreement: The Impact of a New Lung Allocation Policy on Post Transplant Outcomes in Argentina and Uruguay A.M. Bertolotti ,1 J.M. Osses,2 J.O. Cáneva,2 P. Curbelo,3 R. Ahumada,2 G.R. Wagner,2 A. Musetti,3 M. Candioti Lehmann,1 R.R. Favaloro.1 1Intrathoracic Transplantation and Heart Failure Division, University Hospital Favaloro Foundation, Buenos Aires, Argentina; 2Pneumology and Lung Transplantation, University Hospital Favaloro Foundation, Buenos Aires, Argentina; 3Pneumology and Lung Transplantation, Hospital Maciel, Montevideo, Uruguay. Purpose: The lung allocations policies develop by each country should be oriented to assure the accessibility and to improve post lung transplant (LT) outcomes. Since 2003, within an international collaboration agreement, all LT recipients from Uruguay were transplanted at a single centre in Argentina. In December 2010, a new lung allocation policy (LAP) was established to meet these goals in Argentina and Uruguay. The purpose was to compare early post LT outcomes according to the change in the LAP in Argentina and Uruguay. Methods: We retrospectively analyzed records of LT recipients from Argentina and Uruguay transplanted at a single centre, between January 1994 and June 2014. Patients were divided into two groups, according to the in force LAP at the moment of the LT procedure. Group 1 (G1) included all LT recipients between 1994 and 2010 and Group 2 (G2) between 2011 and 2014. Survival was analyzed by Kaplan Meier curves and compared by Log Rank Test between groups. Results: The study included 267 LT (143 SLT and 124 BLT) performed to 258 recipients. G1:185 LT (69%) and G2:82 LT (31%). The percentage of SLT/BLT (G1 vs G2) was 62%/38% vs 35%/65% (p< 0.001) respectively. Clinical status at LT was: Emergency 14% vs 54%; Urgency 16% vs 28% and Elective 70% vs 18%;(p< 0.001). The use of CPB during LT was 30% vs 50% (p= 0.003) and Ischemic Time was 300±86 min vs 340±66 min (p= 0.001). In-hospital mortality was 24% vs 11% (p= 0.01). Comparative survival at 1 and 2 years was 64% and 54% vs 87% and 87%; (p< 0.001)(Figure 1). Conclusion: A significant increase in the number of emergency LT, longer ischemic times and greater necessity of CPB for implantation was observed with the implementation of the new lung allocation policy. Nonetheless, the in-hospital mortality was significantly lower, and the 1 and 2 years survival showed a significant improvement. These results support in part the new strategy for lung allocation in Argentina and Uruguay.
4( 16) Pre-operative Use of Pulmonary Arterial Hypertension-Targeted Medication and the Effects on Post-Pulmonary Endarterectomy Morbidity and Mortality T.M. Fernandes ,1 D.S. Poch,1 D.G. Papamatheakis,1 N.H. Kim,1 K.M. Kerr,1 P.F. Fedullo,1 V.G. Pretorius,2 M.M. Madani,2
W.R. Auger.1 1Division of Pulmonary and Critical Care, University of California, San Diego, La Jolla, CA; 2Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, CA. Purpose: The definitive treatment for chronic thromboembolic pulmonary hypertension remains a pulmonary endarterectomy (PEA) at an experienced surgical center. Despite this recommendation, many patients with surgically accessible disease are pre-treated with pulmonary arterial hypertension-targeted medications. The effects of such a strategy on post-operative outcomes are not well defined. Methods: We examined all patients who underwent PEA at UCSD from January 2011 through December 2013. Differences in outcomes were compared between patients pre-treated and those who were not using t-tests for continuous variables and chi-square tests for dichotomous variables. Logistic regression was used to determine odds of reperfusion lung injury. Results: Of the 438 patients who underwent surgery during this time period, 43.6% were pre-treated with any PAH medications. There was no significant difference in preoperative PVR between the two groups (671.9 vs. 656.5, untreated vs. pre-treated; p= 0.656), but the mean PA pressure (42.8 vs. 45.7, untreated vs. treated; p= 0.01) and cardiac output (4.35 vs. 4.79, untreated vs. pre-treated; p= 0.001) were higher in the pre-treated group. There were no differences in post-operative mortality (1.6% vs. 1.0%, untreated vs. pre-treated; p= 0.62) or residual pulmonary hypertension (7.3% vs. 11.6%, untreated vs. pre-treated; p= 0.14) between the two groups, but those pre-treated had a higher incidence of reperfusion lung injury (15.7% vs. 27.4%, untreated vs. pre-treated; p= 0.003). Adjusting for age, sex, BMI, preoperative right atrial pressure, cardiac output, mean PA pressure and PVR, the odds a pre-treated patient developed reperfusion lung injury were 2.46 times higher (95% CI: 1.44-4.20) than the odds a untreated patient developed lung injury. Conclusion: There was no difference in post-operative mortality or residual pulmonary hypertension between treated and untreated patients. Pre-treated patients had a higher rate of reperfusion lung injury, a risk that remained after adjusting known risk factors for reperfusion lung injury. These findings need to be corroborated in a prospective, randomized controlled trial of medical therapy before PEA. 4( 17) Echocardiographic Evidence for Right Ventricular Functional Improvement After Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension K. Broch ,1 A. Ragnarsson,2 R. Andersen,2 E. Gude,1 A. Fiane,3 J. Andreassen,1 S. Aakhus,1 A.K. Andreassen.1 1Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; 2Department of Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; 3Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway. Purpose: Balloon pulmonary angioplasty (BPA) has been reported to improve hemodynamics and functional capacity in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Because right ventricular (RV) function has significant prognostic impact in CTEPH, we aimed to determine echocardiographically whether BPA ameliorated signs of RV dysfunction in these patients. Methods: In 21 patients with CTEPH (age 56 ± 13 years; 9 males), echocardiography, cardiopulmonary exercise testing, blood samples and rightsided cardiac catheterisation were performed before and after 4 ± 2 BPA procedures. Echocardiographic images were blinded and analysed off-line with particular focus on RV function according to current recommendations. Differences from baseline to follow-up were analysed by paired samples t-tests. Results: Results are presented in the Table. BPA significantly improved hemodynamics, peak oxygen consumption and levels of N-terminal proB-type natriuretic peptide (NT-proBNP). Echocardiography demonstrated significant improvements in all pre-specified measures of RV function: fractional area change; tricuspid annular plane systolic excursion (TAPSE); and RV free wall peak strain. RV end diastolic area and free wall thickness decreased. Furthermore, left ventricular (LV) diameter and stroke volume increased significantly. Conclusion: Subsequent to BPA, a significant improvement in RV functional parameters was observed. The echocardiographic demonstration of
4( 16) Pre-operative Use of Pulmonary Arterial Hypertension-Targeted Medication and the Effects on Post-Pulmonary Endarterectomy Morbidity and Mortality T.M. Fernandes ,1 D.S. Poch,1 D.G. Papamatheakis,1 N.H. Kim,1 K.M. Kerr,1 P.F. Fedullo,1 V.G. Pretorius,2 M.M. Madani,2
W.R. Auger.1 1Division of Pulmonary and Critical Care, University of California, San Diego, La Jolla, CA; 2Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, CA. Purpose: The definitive treatment for chronic thromboembolic pulmonary hypertension remains a pulmonary endarterectomy (PEA) at an experienced surgical center. Despite this recommendation, many patients with surgically accessible disease are pre-treated with pulmonary arterial hypertension-targeted medications. The effects of such a strategy on post-operative outcomes are not well defined. Methods: We examined all patients who underwent PEA at UCSD from January 2011 through December 2013. Differences in outcomes were compared between patients pre-treated and those who were not using t-tests for continuous variables and chi-square tests for dichotomous variables. Logistic regression was used to determine odds of reperfusion lung injury. Results: Of the 438 patients who underwent surgery during this time period, 43.6% were pre-treated with any PAH medications. There was no significant difference in preoperative PVR between the two groups (671.9 vs. 656.5, untreated vs. pre-treated; p= 0.656), but the mean PA pressure (42.8 vs. 45.7, untreated vs. treated; p= 0.01) and cardiac output (4.35 vs. 4.79, untreated vs. pre-treated; p= 0.001) were higher in the pre-treated group. There were no differences in post-operative mortality (1.6% vs. 1.0%, untreated vs. pre-treated; p= 0.62) or residual pulmonary hypertension (7.3% vs. 11.6%, untreated vs. pre-treated; p= 0.14) between the two groups, but those pre-treated had a higher incidence of reperfusion lung injury (15.7% vs. 27.4%, untreated vs. pre-treated; p= 0.003). Adjusting for age, sex, BMI, preoperative right atrial pressure, cardiac output, mean PA pressure and PVR, the odds a pre-treated patient developed reperfusion lung injury were 2.46 times higher (95% CI: 1.44-4.20) than the odds a untreated patient developed lung injury. Conclusion: There was no difference in post-operative mortality or residual pulmonary hypertension between treated and untreated patients. Pre-treated patients had a higher rate of reperfusion lung injury, a risk that remained after adjusting known risk factors for reperfusion lung injury. These findings need to be corroborated in a prospective, randomized controlled trial of medical therapy before PEA. 4( 17) Echocardiographic Evidence for Right Ventricular Functional Improvement After Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension K. Broch ,1 A. Ragnarsson,2 R. Andersen,2 E. Gude,1 A. Fiane,3 J. Andreassen,1 S. Aakhus,1 A.K. Andreassen.1 1Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway; 2Department of Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway; 3Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway. Purpose: Balloon pulmonary angioplasty (BPA) has been reported to improve hemodynamics and functional capacity in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Because right ventricular (RV) function has significant prognostic impact in CTEPH, we aimed to determine echocardiographically whether BPA ameliorated signs of RV dysfunction in these patients. Methods: In 21 patients with CTEPH (age 56 ± 13 years; 9 males), echocardiography, cardiopulmonary exercise testing, blood samples and rightsided cardiac catheterisation were performed before and after 4 ± 2 BPA procedures. Echocardiographic images were blinded and analysed off-line with particular focus on RV function according to current recommendations. Differences from baseline to follow-up were analysed by paired samples t-tests. Results: Results are presented in the Table. BPA significantly improved hemodynamics, peak oxygen consumption and levels of N-terminal proB-type natriuretic peptide (NT-proBNP). Echocardiography demonstrated significant improvements in all pre-specified measures of RV function: fractional area change; tricuspid annular plane systolic excursion (TAPSE); and RV free wall peak strain. RV end diastolic area and free wall thickness decreased. Furthermore, left ventricular (LV) diameter and stroke volume increased significantly. Conclusion: Subsequent to BPA, a significant improvement in RV functional parameters was observed. The echocardiographic demonstration of