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Hartwig M, van Berkel V, Bharat A, Cypel M, Date H, Erasmus M, Hoetzenecker K, Klepetko W, Kon Z, Kukreja J, Machuca T, McCurry K, Mercier O, Opitz I, Puri V, Van Raemdonck D. The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: The use of mechanical circulatory support in lung transplantation. J Thorac Cardiovasc Surg 2023; 165:301-326. [PMID: 36517135 DOI: 10.1016/j.jtcvs.2022.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation. METHODS The AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement. RESULTS The expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively. CONCLUSIONS Achieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.
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Affiliation(s)
- Matthew Hartwig
- Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
| | | | | | | | - Hiroshi Date
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Michiel Erasmus
- University Academic Center Groningen, Groningen, The Netherlands
| | | | | | | | - Jasleen Kukreja
- University of California San Francisco, San Francisco, Calif
| | - Tiago Machuca
- University of Florida College of Medicine, Gainesville, Fla
| | | | - Olaf Mercier
- Université Paris-Saclay and Marie Lannelongue Hospital, Le Plessis-Robinson, France
| | | | - Varun Puri
- Washington University School of Medicine, St Louis, Mo
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2
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Suh JW. Surgical Complications Affecting the Early and Late Survival Rates after Lung Transplantation. J Chest Surg 2022; 55:332-337. [PMID: 35924542 PMCID: PMC9358157 DOI: 10.5090/jcs.22.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jee Won Suh
- Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
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3
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Anesthetic Management During Lung Transplantation - What's New in 2021? Thorac Surg Clin 2022; 32:175-184. [PMID: 35512936 DOI: 10.1016/j.thorsurg.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
As outcomes of lung transplantation (LTx) are improving transplant centers are pushing boundaries. There has been a steady increase in the medical complexity of lung transplant candidates. Many transplant centers are listing older patients with comorbidities, and there has been a steady rise in the number of candidates supported with extracorporeal membrane oxygenation (ECMO) as a bridge to transplantation. There has been a growing appreciation of the importance intraoperative management of potentially modifiable risk factors has on postoperative outcomes. Evidence suggests that LTx even in high-risk patients requiring perioperative ECMO can offer excellent results. This article outlines the current state-of-the-art intraoperative management of LTx.
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Murray AW, Boisen ML, Fritz A, Renew JR, Martin AK. Anesthetic considerations in lung transplantation: past, present and future. J Thorac Dis 2022; 13:6550-6563. [PMID: 34992834 PMCID: PMC8662503 DOI: 10.21037/jtd-2021-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/10/2021] [Indexed: 01/01/2023]
Abstract
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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Affiliation(s)
- Andrew W Murray
- Department of Anesthesiology, Mayo Clinic Graduate School of Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashley Fritz
- Division of Cardiothoracic and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - J Ross Renew
- Department of Anesthesiology, Mayo Clinic Graduate School of Medicine, Mayo Clinic, Jacksonville, FL, USA
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[Intraoperative transesophageal echocardiography as monitoring procedure in noncardiac surgery patients]. Anaesthesist 2021; 70:1059-1072. [PMID: 34762164 DOI: 10.1007/s00101-021-01035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 11/27/2022]
Abstract
Transesophageal echocardiography (TEE) is firmly established in cardiac surgery for diagnostics, hemodynamic monitoring and as a guiding tool. Dynamic and (patho)physiological processes of the heart can be immediately depicted. Ideally, therapeutic changes can be derived. For this reason, TEE is increasingly used in high-risk non-cardiac surgery interventions and in the interventional setting. In the first part of this advanced training series, general aspects regarding TEE examinations as well as indications and contraindications are presented. Clinical fields of application, where TEE can play a role in hemodynamic monitoring are outlined. The second part focusses on an emergency examination pathway and differential diagnoses, which can be made in the event of intraoperative hemodynamic instability or unexplained hypoxemia using TEE. The article concludes with an outlook on the use of computer-aided evaluation of TEE images.
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Courtwright AM, Wilkey B, Devarajan J, Subramani S, Martin AK, Fritz AV, Cassara CM, Boisen ML, Bottiger BA, Pollak A, Maisonave Y, Gelzinis TA. The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2020 Part I - Lung Transplantation. J Cardiothorac Vasc Anesth 2021; 36:33-44. [PMID: 34670721 DOI: 10.1053/j.jvca.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/11/2022]
Abstract
This special article focuses on the highlights in cardiothoracic transplantation literature in the year 2020. Part I encompasses the recent literature on lung transplantation, including the advances in preoperative assessment and optimization, donor management, including the use of ex-vivo lung perfusion, recipient management, including those who have been infected with coronavirus disease 2019, updates on the perioperative management, including the use of extracorporeal membrane oxygenation, and long-term outcomes.
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Affiliation(s)
| | - Barbara Wilkey
- Department of Anesthesiology, University of Colorado, Boulder, CO
| | | | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, FL
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Florida, Jacksonville, FL
| | - Christopher M Cassara
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Angela Pollak
- Department of Anesthesiology, Duke University, Durham, NC
| | | | - Theresa A Gelzinis
- University of Pittsburgh, Corresponding Author, UPMC Presbyterian Hospital, Pittsburgh, PA.
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Kumar N, Hussain N, Kumar J, Essandoh MK, Bhatt AM, Awad H, Perez WJ, Whitson BA, Ganapathi AM, Mokadam NA, Gorelik L, Turner K, Iyer MH. Evaluating the Impact of Pulmonary Artery Obstruction After Lung Transplant Surgery: A Systematic Review and Meta-analysis. Transplantation 2021; 105:711-722. [PMID: 33760790 DOI: 10.1097/tp.0000000000003407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pulmonary artery obstruction is an uncommon but significant complication after lung transplantation. Although numerous reports have documented its occurrence, the hemodynamic parameters associated with its presentation and diagnostic considerations remain ill-defined. This systematic review summarizes evidence in the literature surrounding pulmonary artery obstruction after lung transplantation surgery. METHODS Databases were searched for all articles and abstracts reporting on pulmonary artery obstruction. Data collected included the number of patients studied, patient characteristics, incidences of pulmonary artery obstruction, and timing and imaging modality used for diagnosis. RESULTS Thirty-four full-text citations were included in this review. The point prevalence of pulmonary artery obstruction was 3.66%. The peak pulmonary artery velocity associated with obstruction was found to be 2.60 ± 0.58 m/s. The diameter of the obstructed pulmonary artery predictive of poor outcomes was noted to be 0.78 ± 0.40 cm. The majority of diagnoses were made in the late postoperative period using pulmonary angiogram and transesophageal echocardiography. Overall, 76% of patients (47 of 62) required emergent procedural reintervention, and 23% of patients (14 of 62) diagnosed with pulmonary artery obstruction died during their hospital stay. CONCLUSIONS This systematic review underscores the importance of identifying pulmonary artery obstruction immediately after lung transplant surgery. The clinical implications of these results warrant the development of identification and management strategies for early detection of irregularities in pulmonary artery anastomosis in lung transplant patients.
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Affiliation(s)
- Nicolas Kumar
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Nasir Hussain
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Julia Kumar
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Michael K Essandoh
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Amar M Bhatt
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Hamdy Awad
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - William J Perez
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Asvin M Ganapathi
- Division of Cardiac Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Nahush A Mokadam
- Division of Cardiac Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Leonid Gorelik
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Katja Turner
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Manoj H Iyer
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
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8
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Kim KK, Krause M, Brandes IF, Khanna AK, Bartels K. Transesophageal echocardiography for perioperative management in thoracic surgery. Curr Opin Anaesthesiol 2021; 34:7-12. [PMID: 33315644 DOI: 10.1097/aco.0000000000000947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Perioperative transesophageal echocardiography (TEE) is most often employed during cardiac surgery. This review will summarize some of the recent findings relevant to TEE utilization during thoracic surgical procedures. RECENT FINDINGS Hemodynamic monitoring is a key component of goal-directed fluid therapy, which is also becoming more common for management of thoracic surgical procedures. Although usually not required for the anesthetic management of common thoracic surgeries, TEE is frequently used during lung transplantation and pulmonary thromboendarterectomy. Few clinical studies support current practice patterns, and most recommendations are based on expert opinion. SUMMARY Currently, routine use of TEE in thoracic surgery is often limited to specific high-risk patients and/or procedures. As in other perioperative settings, TEE may be utilized to elucidate the reasons for acute hemodynamic instability without apparent cause. Contraindications to TEE apply and have to be taken into consideration before performing a TEE on a thoracic surgical patient.
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Affiliation(s)
- Kevin K Kim
- Department of Anesthesiology, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Martin Krause
- Department of Anesthesiology, University of Colorado, School of Medicine, Aurora, Colorado, USA
| | - Ivo F Brandes
- Universitätsmedizin Göttingen, Klinik für Anästhesiologie, Göttingen, Germany
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Karsten Bartels
- Department of Anesthesiology, University of Colorado, School of Medicine, Aurora, Colorado, USA
- Outcomes Research Consortium, Cleveland, OH, USA
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9
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Jing L, Chen W, Zhai Z, Pan X, Tao X, Cao L, Zhao L, Guo L, Liang C, Chen J, Wang C. Pulmonary vein stenosis after lung transplantation: a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:181. [PMID: 33569483 PMCID: PMC7867883 DOI: 10.21037/atm-20-3972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary vein stenosis (PVS) is a rare event following lung transplantation which increases the risk of morbidity and mortality. Early detection and rapid treatment of this condition is crucial for its management. Although several reports on PVS have been published, there is little consensus regarding its diagnosis and the methods of management. Here we present our experience with PVS. A 31-year-old man received a left lung transplant for chronic hypersensitivity pneumonitis. One year after his single-lung transplant, he began to develop persistent progressive hypoxemia. Computed tomography (CT) of the chest showed left pleural effusion and thickening of the interlobular septa. The results of bronchoscopy and transbronchial biopsies excluded the possibility of acute rejection or infection. The pleural effusion was transudative with lymphocyte predominance. Computed tomography angiography (CTA) in the left atrium and pulmonary veins demonstrated obvious stenosis of both the upper and lower left pulmonary veins (LLPVs) at the transplant anastomotic site. The patient underwent a catheter-guide stent implantation into the stenotic segment of the upper left pulmonary vein (ULPV), and his pleural effusion and hypoxemia problems were ameliorated. Ten months after the intervention, the patient was in excellent clinical condition. In a literature review, we discuss the importance of identifying PVS early after transplantation, the utility of CTA for diagnosis and the use of pulmonary vein stenting intervention. This review provides a basis for further diagnostic strategies and treatments for PVS following lung transplantation.
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Affiliation(s)
- Lei Jing
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Wenhui Chen
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Zhenguo Zhai
- Department of Respiratory and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xin Pan
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Xincao Tao
- Department of Respiratory and Critical Care Medicine, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Lei Cao
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Li Zhao
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Lijuan Guo
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Chaoyang Liang
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Jingyu Chen
- Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Chen Wang
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
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10
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Bhatt A, Kumar N, Hussain N, Iyer MH, Essandoh M. Pulmonary Vein Velocities: A Useful Tool for Cardiac Anesthesiologists in the Management of Lung Transplantation. J Cardiothorac Vasc Anesth 2020; 34:2280-2281. [DOI: 10.1053/j.jvca.2020.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/10/2020] [Indexed: 11/11/2022]
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Wakefield BJ, Alfirevic A. Pulmonary Venous Flow After Lung Transplantation: Turbulence and High Velocities. J Cardiothorac Vasc Anesth 2020; 34:1985-1989. [DOI: 10.1053/j.jvca.2020.01.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/11/2022]
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12
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Nicoara A, Skubas N, Ad N, Finley A, Hahn RT, Mahmood F, Mankad S, Nyman CB, Pagani F, Porter TR, Rehfeldt K, Stone M, Taylor B, Vegas A, Zimmerman KG, Zoghbi WA, Swaminathan M. Guidelines for the Use of Transesophageal Echocardiography to Assist with Surgical Decision-Making in the Operating Room: A Surgery-Based Approach: From the American Society of Echocardiography in Collaboration with the Society of Cardiovascular Anesthesiologists and the Society of Thoracic Surgeons. J Am Soc Echocardiogr 2020; 33:692-734. [PMID: 32503709 DOI: 10.1016/j.echo.2020.03.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Intraoperative transesophageal echocardiography is a standard diagnostic and monitoring tool employed in the management of patients undergoing an entire spectrum of cardiac surgical procedures, ranging from "routine" surgical coronary revascularization to complex valve repair, combined procedures, and organ transplantation. Utilizing a protocol as a starting point for imaging in all procedures and all patients enables standardization of image acquisition, reduction in variability in quality of imaging and reporting, and ultimately better patient care. Clear communication of the echocardiographic findings to the surgical team, as well as understanding the impact of new findings on the surgical plan, are paramount. Equally important is the need for complete understanding of the technical steps of the surgical procedures being performed and the complications that may occur, in order to direct the postprocedure evaluation toward aspects directly related to the surgical procedure and to provide pertinent echocardiographic information. The rationale for this document is to outline a systematic approach describing how to apply the existing guidelines to questions on cardiac structure and function specific to the intraoperative environment in open, minimally invasive, or hybrid cardiac surgery procedures.
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Affiliation(s)
| | | | - Niv Ad
- White Oak Medical Center and University of Maryland, Silver Spring, Maryland
| | - Alan Finley
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Feroze Mahmood
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | - Bradley Taylor
- University of Maryland Medical Center, Baltimore, Maryland
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Abrams BA, Melnyk V, Allen WL, Subramaniam K, Scott CD, Mitchell JD, Seres T, Martin AK. TEE for Lung Transplantation: A Case Series and Discussion of Vascular Complications. J Cardiothorac Vasc Anesth 2020; 34:733-740. [DOI: 10.1053/j.jvca.2019.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/04/2019] [Indexed: 11/11/2022]
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14
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Iyer MH, Bhatt A, Kumar N, Hussain N, Essandoh MK. Transesophageal Echocardiography for Lung Transplantation: A New Standard of Care? J Cardiothorac Vasc Anesth 2020; 34:741-743. [DOI: 10.1053/j.jvca.2019.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/12/2019] [Indexed: 11/11/2022]
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15
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Porter T, Shillcutt S, Adams M, Desjardins G, Glas K, Olson J, Troughton R. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the american society of echocardiography. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2020. [DOI: 10.4103/2543-1463.282192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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16
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Tan Z, Roscoe A, Rubino A. Transesophageal Echocardiography in Heart and Lung Transplantation. J Cardiothorac Vasc Anesth 2019; 33:1548-1558. [DOI: 10.1053/j.jvca.2019.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Indexed: 02/04/2023]
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17
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Sher Y, Maldonado JR. Medical Course and Complications After Lung Transplantation. PSYCHOSOCIAL CARE OF END-STAGE ORGAN DISEASE AND TRANSPLANT PATIENTS 2018. [PMCID: PMC7122723 DOI: 10.1007/978-3-319-94914-7_26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung transplant prolongs life and improves quality of life in patients with end-stage lung disease. However, survival of lung transplant recipients is shorter compared to patients with other solid organ transplants, due to many unique features of the lung allograft. Patients can develop a multitude of noninfectious (e.g., primary graft dysfunction, pulmonary embolism, rejection, acute and chronic, renal insufficiency, malignancies) and infectious (i.e., bacterial, fungal, and viral) complications and require complex multidisciplinary care. This chapter discusses medical course and complications that patients might experience after lung transplantation.
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Geube M, Anandamurthy B, Yared JP. Perioperative Management of the Lung Graft Following Lung Transplantation. Crit Care Clin 2018; 35:27-43. [PMID: 30447779 DOI: 10.1016/j.ccc.2018.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Perioperative management of patients undergoing lung transplantation is one of the most complex in cardiothoracic surgery. Certain perioperative interventions, such as mechanical ventilation, fluid management and blood transfusions, use of extracorporeal mechanical support, and pain management, may have significant impact on the lung graft function and clinical outcome. This article provides a review of perioperative interventions that have been shown to impact the perioperative course after lung transplantation.
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Affiliation(s)
- Mariya Geube
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Clinic, 9500 Euclid Avenue, J4-331, Cleveland, OH 44195, USA.
| | - Balaram Anandamurthy
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland Clinic, 9500 Euclid Avenue, J4-331, Cleveland, OH 44195, USA
| | - Jean-Pierre Yared
- Department of Cardiothoracic Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue, J4-331, Cleveland, OH 44195, USA
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19
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Complete white out of a single transplanted lung in the immediate postoperative period. Heart Lung 2018; 48:258-260. [PMID: 30219593 DOI: 10.1016/j.hrtlng.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 08/20/2018] [Indexed: 11/23/2022]
Abstract
Vascular complications are rare but serious events following lung transplantation. Of the potential adverse events post lung transplant, pulmonary vein thrombosis is rare but often fatal. Our case describes a 54 year-old male who underwent single left lung transplantation and suddenly became hemodynamically unstable shortly after the procedure. The diagnosis of acute pulmonary vein thrombosis was made with the use of trans-esophageal echocardiography identifying complete occlusion of the left upper pulmonary vein which led to successful surgical thrombectomy and revision of the anastomosis.
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20
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Batra K, Chamarthy MR, Reddick M, Roda MS, Wait M, Kalva SP. Diagnosis and interventions of vascular complications in lung transplant. Cardiovasc Diagn Ther 2018; 8:378-386. [PMID: 30057884 DOI: 10.21037/cdt.2018.03.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Though rare, pulmonary vascular complications after lung transplantation carry high morbidity and mortality. Knowledge of the normal and abnormal appearance of lung transplant vasculature is essential for timely and appropriate diagnosis and management of complications. Appropriate selection of surgical and endovascular treatments depend on the availability of expertise and requires a multidisciplinary approach to ensure the best outcomes.
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Affiliation(s)
- Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Murthy R Chamarthy
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mark Reddick
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Manohar S Roda
- Department of Radiology, The University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michael Wait
- Department of Cardiothoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P Kalva
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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21
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Sellers D, Cassar-DeMajo W, Keshavjee S, Slinger P. Response: The Evolution of Lung Transplant Anesthesia. J Cardiothorac Vasc Anesth 2018; 32:e1. [DOI: 10.1053/j.jvca.2017.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Indexed: 11/11/2022]
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22
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Jobanputra YB, Kapadia SR, Johnston DR, Ahmed V, Jones BM, Budev M, Lane CR, Mehta AC. Pulmonary Vein Stenosis Following Single-Lung Transplantation Successfully Treated with Intravascular Ultrasound-Guided Angioplasty and Stent Placement. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1289-1295. [PMID: 29203761 PMCID: PMC5726145 DOI: 10.12659/ajcr.905726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Female, 60 Final Diagnosis: Pulmonary vein stenosis following single lung transplant Symptoms: Dyspnea on exertion and dry cough Medication: — Clinical Procedure: Balloon angioplasty and stenting of the left common pulmonary vein Specialty: Cardiology
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Affiliation(s)
- Yash B Jobanputra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Vaseem Ahmed
- Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, USA
| | - Brandon M Jones
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - Marie Budev
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, USA
| | - Charles Randall Lane
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, USA
| | - Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, USA
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23
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Essandoh M, Bhatt A, Flores A, Whitson B. Transesophageal Echocardiography Monitoring During Lung Transplantation. J Cardiothorac Vasc Anesth 2017; 31:e98-e99. [DOI: 10.1053/j.jvca.2017.03.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 11/11/2022]
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24
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Garijo JM, Mashari A, Meineri M. Role of Transesophageal Echocardiography in General Anesthesia. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0221-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Kachulis B, Mitrev L, Jordan D. Intraoperative anesthetic management of lung transplantation patients. Best Pract Res Clin Anaesthesiol 2017; 31:261-272. [DOI: 10.1016/j.bpa.2017.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 11/15/2022]
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26
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Tokman S, Smith MA, Hashimi AS, Omar A. A 46-Year-Old Man With Dyspnea, Hypoxemia, and Radiographic Asymmetry After Redo Bilateral Lung Transplantation. Chest 2017; 151:e91-e94. [PMID: 28390643 DOI: 10.1016/j.chest.2016.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/23/2016] [Accepted: 09/21/2016] [Indexed: 10/19/2022] Open
Abstract
CASE PRESENTATION A 46-year-old man underwent redo bilateral sequential lung transplantation for rapidly progressive bronchiolitis obliterans syndrome that developed 3.5 years after initial transplantation. In the operating room, he was sedated and intubated with a dual lumen endotracheal tube with subsequent single right-lung ventilation and left allograft implantation. His pulmonary arterial pressure became elevated with reperfusion of the newly implanted left lung, which required initiation of cardiopulmonary bypass to facilitate implantation of the right lung. After implantation and reperfusion of the right lung, the patient was weaned from cardiopulmonary bypass. His chest was closed and he was transferred to the thoracic intensive care unit. On arrival to the intensive care unit, the patient was intubated, sedated, and had an oxygen saturation of 92% on a fraction of inspired oxygen of 100%, positive end-expiratory pressure of 10 cm H2O, and 20 parts per million of inhaled nitric oxide. He had a Swan-Ganz catheter in the right internal jugular vein that measured a mean pulmonary arterial pressure of 33 mm Hg and a pulmonary arterial systolic pressure of 63 mm Hg, which remained persistently elevated and prompted further diagnostic evaluation.
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Affiliation(s)
- Sofya Tokman
- Division of Pulmonary and Critical Care Medicine, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ.
| | - Michael A Smith
- Division of Thoracic Surgery, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - A Samad Hashimi
- Division of Thoracic Surgery, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
| | - Ashraf Omar
- Division of Pulmonary and Critical Care Medicine, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ
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Gómez López A, García Luján R, De Pablo Gafas A, Hernández Hernández F, Villena Garrido V, Valipour A, Meneses Pardo JC, De Miguel Poch E. First use of Amplatzer device for bronchopleural fistula after lung transplantation. Thorax 2017; 72:668-670. [PMID: 28044004 DOI: 10.1136/thoraxjnl-2016-209543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/22/2016] [Accepted: 11/30/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Antolina Gómez López
- Department of Respiratory Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Ricardo García Luján
- Department of Respiratory Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | - Alicia De Pablo Gafas
- Department of Respiratory Medicine, University Hospital 12 de Octubre, Madrid, Spain
| | | | | | - Arschang Valipour
- Department of Respiratory and Critical Care Medicine, Otto-Wagner-Spital, Vienna, Austria
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28
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Long B, Koyfman A. The emergency medicine approach to transplant complications. Am J Emerg Med 2016; 34:2200-2208. [DOI: 10.1016/j.ajem.2016.08.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 02/07/2023] Open
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29
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Imaging in Thoracic Surgery. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Lung Transplantation. PATHOLOGY OF TRANSPLANTATION 2016. [PMCID: PMC7153460 DOI: 10.1007/978-3-319-29683-8_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The therapeutic options for patients with advanced pulmonary parenchymal or vascular disorders are currently limited. Lung transplantation remains one of the few viable interventions, but on account of the insufficient donor pool only a minority of these patients actually undergo the procedure each year. Following transplantation there are a number of early and late allograft complications such as primary graft dysfunction, allograft rejection, infection, post-transplant lymphoproliferative disorder and late injury that is now classified as chronic lung allograft dysfunction. The pathologist plays an essential role in the diagnosis and classification of these myriad complications. Although the transplant procedures are performed in selected centers patients typically return to their local centers. When complications arise it is often the responsibility of the local pathologist to evaluate specimens. Therefore familiarity with the pathology of lung transplantation is important.
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31
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Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: a report from the American Society of Echocardiography. J Am Soc Echocardiogr 2015; 28:40-56. [PMID: 25559474 DOI: 10.1016/j.echo.2014.09.009] [Citation(s) in RCA: 284] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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32
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Copelan A, George D, Kapoor B, Nghiem HV, Lorenz JM, Erly B, Wang W. Iatrogenic-related transplant injuries: the role of the interventional radiologist. Semin Intervent Radiol 2015; 32:133-55. [PMID: 26038621 DOI: 10.1055/s-0035-1549842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As advances in surgical techniques and postoperative care continue to improve outcomes, the use of solid organ transplants as a treatment for end-stage organ disease is increasing. With the growing population of transplant patients, there is an increasing need for radiologic diagnosis and minimally invasive procedures for the management of posttransplant complications. Typical complications may be vascular or nonvascular. Vascular complications include arterial stenosis, graft thrombosis, and development of fistulae. Common nonvascular complications consist of leaks, abscess formation, and stricture development. The use of interventional radiology in the management of these problems has led to better graft survival and lower patient morbidity and mortality. An understanding of surgical techniques, postoperative anatomy, radiologic findings, and management options for complications is critical for proficient management of complex transplant cases. This article reviews these factors for kidney, liver, pancreas, islet cell, lung, and small bowel transplants.
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Affiliation(s)
- Alexander Copelan
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Daniel George
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Baljendra Kapoor
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hahn Vu Nghiem
- Department of Diagnostic Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Jonathan M Lorenz
- Section of Interventional Radiology, The University of Chicago, Chicago, Illinois
| | - Brian Erly
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio ; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Weiping Wang
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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33
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de la Torre M, Fernández R, Fieira E, González D, Delgado M, Méndez L, Borro JM. Postoperative surgical complications after lung transplantation. REVISTA PORTUGUESA DE PNEUMOLOGIA 2015; 21:36-40. [PMID: 25854134 DOI: 10.1016/j.rppnen.2014.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 01/24/2023] Open
Abstract
This is a review article on the main postoperative complications after lung transplantation: airways complications, vascular complications, pleural complications, surgical wound complications, and abdominal complications. Incidence data, severity, and major management regimens are reported. Postoperative complications after lung transplantation result in a significantly increased morbidity and mortality, with early diagnosis and therapy being extremely important.
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Affiliation(s)
- M de la Torre
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain.
| | - R Fernández
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
| | - E Fieira
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
| | - D González
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
| | - M Delgado
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
| | - L Méndez
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
| | - J M Borro
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
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34
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de la Torre M, Fernández R, Fieira E, González D, Delgado M, Méndez L, Borro JM. WITHDRAWN:Postoperative surgical complications after lung transplantation. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014:S0873-2159(14)00123-8. [PMID: 25444515 DOI: 10.1016/j.rppneu.2014.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/20/2022] Open
Abstract
This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.09.007. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- M de la Torre
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain.
| | - R Fernández
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
| | - E Fieira
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
| | - D González
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
| | - M Delgado
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
| | - L Méndez
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
| | - J M Borro
- Department of Thoracic Surgery and Lung Transplantation, University Hospital of A Coruña, A Coruña, Spain
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35
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Farooki AM, Bazick-Cuschieri H, Gordon EK, Lee JC, Cantu EC, Augoustides JG. CASE 7--2014 Rescue therapy with early extracorporeal membrane oxygenation for primary graft dysfunction after bilateral lung transplantation. J Cardiothorac Vasc Anesth 2014; 28:1126-32. [PMID: 23999325 PMCID: PMC3969394 DOI: 10.1053/j.jvca.2013.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Indexed: 01/24/2023]
Affiliation(s)
- Ali M Farooki
- Departments of Anesthesiology and Critical Care, Cardiothoracic and Vascular Section
| | | | - Emily K Gordon
- Departments of Anesthesiology and Critical Care, Cardiothoracic and Vascular Section
| | | | - Edward C Cantu
- Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.AMF was a cardiac anesthesia fellow
| | - John G Augoustides
- Departments of Anesthesiology and Critical Care, Cardiothoracic and Vascular Section
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Siddique A, Bose AK, Özalp F, Butt TA, Muse H, Morley KE, Dark JH, Parry G, Clark SC. Vascular anastomotic complications in lung transplantation: a single institution's experience. Interact Cardiovasc Thorac Surg 2013; 17:625-31. [PMID: 23788195 DOI: 10.1093/icvts/ivt266] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Lung transplant recipients were reviewed to compare our early and current experience of vascular complications. Since 1995, we have had a policy of early identification and intervention. METHODS We undertook a retrospective review of all adult lung transplants performed at our centre. Patients with pulmonary vascular complications before and after 1995 were identified and reviewed to determine changes in management and outcome. RESULTS We identified a total of 13 patients with either pulmonary artery or venous obstruction out of a total of 720 adult lung transplants (1.8%). There were 9 females and 4 males with an age range of 25-64 years. Complications were more common in patients with fibrotic lung disease and involved 15 vascular anastomoses, most commonly the pulmonary arterial anastomosis. Prior to 1995, 5 cases were identified, all postoperatively. In this group, the mean time for identification of the complication was 9.4 (range 4-14) days. Only 1 patient survived to discharge. After 1995, vascular complications were identified intraoperatively in 4 cases and corrected immediately. Four cases were identified postoperatively (at <1-17 days) by a computed tomography pulmonary angiogram. Three were treated surgically within 24 h of diagnosis (using cardiopulmonary bypass with cold preservation). One patient was managed conservatively. Among patients identified after 1995, 5 survived to discharge. CONCLUSIONS Though rare, pulmonary vascular complications after lung transplantation carry high mortality. In our opinion, early identification and intervention improves outcome. Intraoperative assessment by pressure gradient measurement and transoesophageal echocardiography is recommended. Despite this, mortality remains high and prevention is better than cure.
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Affiliation(s)
- Aleem Siddique
- Department of Cardiothoracic Transplantation and Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Sullivan B, Puskas F, Fernandez-Bustamante A. Transesophageal echocardiography in noncardiac thoracic surgery. Anesthesiol Clin 2013; 30:657-69. [PMID: 23089501 DOI: 10.1016/j.anclin.2012.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In high-risk surgeries with medically complicated patients, transesophageal echocardiography (TEE) adds an additional level of monitoring with which few can disagree. This article presents multiple applications of TEE that can assist both the anesthesiologist and the surgeon through major noncardiac thoracic surgery. It highlights how TEE can be used as an adjuvant to lung resection surgery; TEE as a monitor during lung transplantation; TEE to assess patients for extracorporeal membrane oxygenation; TEE for thoracic aortic surgery; and TEE in the assessment of patients with acute pulmonary hypertension undergoing noncardiac thoracic surgery.
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Affiliation(s)
- Breandan Sullivan
- Department of Anesthesiology and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA.
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38
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Esper SA. Role of Transesophageal Echocardiography in Perioperative Patient Management of Lung Transplantation Surgery. ACTA ACUST UNITED AC 2013. [DOI: 10.5005/jp-journals-10034-1008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Lung transplantation is the only option for patients with end-stage lung disease. Chronic obstructive lung disease, idiopathic pulmonary fibrosis, cystic fibrosis and primary pulmonary hypertension are few common indications for lung transplantation. Patients with end-stage lung disease may have pre-existing cardiovascular compromise related to pulmonary hypertension and other cardiovascular lesions, such as coronary artery disease or valvular heart disease. Preoperative evaluation and optimization of hemodynamics is expected to improve outcomes from lung transplantation. Intraoperative hemodynamic instability is common during lung transplantation and requires highest level of cardiovascular monitoring. After transplantation, vascular anastomosis should be evaluated for flow patterns to rule out obstruction from stenosis or thrombosis. Postoperative complications are common and include bleeding, cardiac failure and hypoxemia from right to left shunt. Primary graft dysfunction may necessitate mechanical cardiorespiratory support. Transesophageal echocardiography plays a central role in preoperative evaluation, intraoperative hemodynamic management, evaluation of pulmonary vascular anastomosis, diagnosis of postoperative complications and also in the critical care management of mechanical cardiorespiratory support.
How to cite this article
Subramaniam K, Esper SA. Role of Transesophageal Echocardiography in Perioperative Patient Management of Lung Transplantation Surgery. J Perioper Echocardiogr 2013;1(2):48-56.
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Felten ML, Michel-Cherqui M, Sage E, Fischler M. Transesophageal and Contact Ultrasound Echographic Assessments of Pulmonary Vessels in Bilateral Lung Transplantation. Ann Thorac Surg 2012; 93:1094-100. [DOI: 10.1016/j.athoracsur.2012.01.070] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 01/19/2012] [Accepted: 01/23/2012] [Indexed: 11/29/2022]
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