Association of Intraoperative ECMO Cannulation Strategy with Primary Graft Dysfunction and Vascular Complications after Lung Transplantation
Presented During:
Saturday, May 6, 2023: 8:00AM - Tuesday, May 9, 2023: 11:45AM
Los Angeles Convention Center
Posted Room Name:
Outside of Room 408
Abstract No:
PS052
Submission Type:
Abstract Submission
Authors:
Ethan D'Silva (1), Amir Emtiazjoo (2), Andres Leon-Pena (1), Tiago N. Machuca (3), Fabio Ius (4), Qianzi Zhang (1), Nathaniel Langer (5), Yoshiya Toyoda (6), Mohammed Kashem (7), Matthew Hartwig (8), Kamrouz Ghadimi (8), Pablo Sanchez (9), Kathirvel Subramaniam (9), Dirk Van Raemdonck (10), Arne Neyrinck (10), Stephen Huddleston (11), Gabriel Loor (1)
Institutions:
(1) Baylor College of Medicine, Houston, TX, (2) University of Florida, Gainesville, FL, (3) University of Miami, Miami, FL, (4) Hannover Medical School, Hannover, Germany, (5) Massachusetts General Hospital, Boston, MA, (6) Temple University Hospital, Philadelphia, PA, (7) Temple University Hospital, Mount Laurel, NJ, (8) Duke University Medical Center, Durham, NC, (9) University of Pittsburgh Medical Center, Pittsburgh, PA, (10) University Hospitals Leuven, Leuven, Flanders, (11) University of Minnesota Medical School, Maplewood, MN
Submitting Author:
Ethan D'Silva
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Baylor College of Medicine
Baylor College of Medicine
Co-Author(s):
Amir Emtiazjoo
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University of Florida
University of Florida
Andres Leon-Pena
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Baylor College of Medicine
Baylor College of Medicine
Tiago Machuca
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University of Miami
University of Miami
Fabio Ius
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Hannover Medical School
Hannover Medical School
Qianzi Zhang
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Baylor College of Medicine
Baylor College of Medicine
Nathaniel Langer
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Massachusetts General Hospital
Massachusetts General Hospital
*Yoshiya Toyoda
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Temple University Hospital
Temple University Hospital
Mohammed Kashem
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Temple University Hospital
Temple University Hospital
*Matthew Hartwig
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Duke University Medical Center
Duke University Medical Center
Kamrouz Ghadimi
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Duke University Medical Center
Duke University Medical Center
*Pablo Sanchez
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Kathirvel Subramaniam
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
*Dirk Van Raemdonck
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University Hospitals Leuven
University Hospitals Leuven
Arne Neyrinck
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University Hospitals Leuven
University Hospitals Leuven
Stephen Huddleston
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University of Minnesota Medical School
University of Minnesota Medical School
*Gabriel Loor
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Baylor College of Medicine
Baylor College of Medicine
Presenting Author:
Ethan D'Silva
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Abstract:
Objective: A recent report from the Extracorporeal Life Support in Lung Transplant (ECLS) Registry showed that lung transplantation (LT) using extracorporeal membrane oxygenation (ECMO) was associated with a greater incidence of primary graft dysfunction (PGD) compared to LT performed off-pump. We examined the association between cannulation strategy and the incidence of both PGD and cannulation-related vascular complications.
Methods: The ECLS registry includes entries from 7 US and 2 European centers each performing >40 LT per year. We retrospectively reviewed this registry to identify our study cohort, which included double LT performed on patients >13 years of age using intraoperative veno-arterial (VA) ECMO between January 1, 2016 and May 31, 2022. We excluded entries with multi-organ transplants and preoperative ECMO use. Our primary outcome was PGD defined as Grade 3 PGD at 48-72 hours after LT. Secondary outcomes included incidence of aortic dissection, femoral artery dissection, limb ischemia requiring surgical intervention, and stroke. We divided the study cohort into two groups based on intraoperative ECMO cannulation strategy: (1) central, defined as using aortic arterial inflow, and (2) peripheral, defined as using a peripheral arterial inflow. To evaluate the association between cannulation strategy and PGD, we used both a multivariate regression model, as well as optimal pair propensity score matching (PSM). We compared secondary outcomes using chi-square and Fisher's exact test.
Results: We identified 201 patients in the central group and 111 patients in the peripheral group. The incidence of PGD was 41 (20.4%) in the central group and 42 (37.8%) in the peripheral group (P<0.001). After adjusting for clinical differences (Table 1) using a multivariate regression model, the probability of developing PGD in the central group was 13% lower than in the peripheral group [odds ratio 0.87 (95% CI: 0.78-0.98, P=0.033)]. PSM analysis was consistent showing PGD incidence of 19 (20.7%) in the central group compared to 35 (38.0%) in the peripheral group (P=0.009). The peripheral group showed significantly greater incidence of femoral artery dissection and limb ischemia. There was no significant difference in aortic dissection and stroke incidence (Table 1).
Conclusions: This analysis of the ECLS registry suggests that a central aortic cannulation strategy may be preferred over peripheral arterial cannulation when VA ECMO is used during LT.
Methods: The ECLS registry includes entries from 7 US and 2 European centers each performing >40 LT per year. We retrospectively reviewed this registry to identify our study cohort, which included double LT performed on patients >13 years of age using intraoperative veno-arterial (VA) ECMO between January 1, 2016 and May 31, 2022. We excluded entries with multi-organ transplants and preoperative ECMO use. Our primary outcome was PGD defined as Grade 3 PGD at 48-72 hours after LT. Secondary outcomes included incidence of aortic dissection, femoral artery dissection, limb ischemia requiring surgical intervention, and stroke. We divided the study cohort into two groups based on intraoperative ECMO cannulation strategy: (1) central, defined as using aortic arterial inflow, and (2) peripheral, defined as using a peripheral arterial inflow. To evaluate the association between cannulation strategy and PGD, we used both a multivariate regression model, as well as optimal pair propensity score matching (PSM). We compared secondary outcomes using chi-square and Fisher's exact test.
Results: We identified 201 patients in the central group and 111 patients in the peripheral group. The incidence of PGD was 41 (20.4%) in the central group and 42 (37.8%) in the peripheral group (P<0.001). After adjusting for clinical differences (Table 1) using a multivariate regression model, the probability of developing PGD in the central group was 13% lower than in the peripheral group [odds ratio 0.87 (95% CI: 0.78-0.98, P=0.033)]. PSM analysis was consistent showing PGD incidence of 19 (20.7%) in the central group compared to 35 (38.0%) in the peripheral group (P=0.009). The peripheral group showed significantly greater incidence of femoral artery dissection and limb ischemia. There was no significant difference in aortic dissection and stroke incidence (Table 1).
Conclusions: This analysis of the ECLS registry suggests that a central aortic cannulation strategy may be preferred over peripheral arterial cannulation when VA ECMO is used during LT.
THORACIC:
End Stage Lung Disease and Lung Transplantation
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