P195. The Impact of Direct and Robotic Minimally Invasive Lung Transplant on Pulmonary Function at One Year

Seattle Convention Center | Summit 

Objective: Direct and robotic minimally invasive lung transplant (MILTx) techniques offer enhanced recovery and improved early pulmonary function when compared to traditional approaches, but the impact on pulmonary function after 3 months is unknown. We sought to characterize the impact of surgical approach on pulmonary function at 1-year in a large single center cohort of lung transplant patients.

Methods: A prospective institutional registry was used to identify patients who underwent lung transplants between January 2017 and October 2023. Patients were stratified by surgical approach, MILTx (mini-thoracotomy 6-8cm +/-robotic assistance) or traditional (sternotomy, clamshell, thoracotomy). Post-COVID acute respiratory distress syndrome, preoperative ECMO, and repeat or multiorgan transplants were excluded. The primary outcome was mean 1-year FEV1. Secondary outcomes included: severe primary graft dysfunction within 72-hours, ICU length of stay, and 1-year mortality. Multivariate logistic and linear regression models were applied to adjust for clinically relevant characteristics.

Results: Of the 227 patients undergoing lung transplant, 40% (n=91) underwent MILTx and 60% (n=136) underwent traditional approach. MILTx patients were older (66 [61.0-70.0] vs 63 [53.0-68.5], p<0.05) with better functional status (severe: 12% vs 22%, p<0.05) receiving fewer bilateral lungs (49% vs 63%, p<0.05) from younger donors (34 [22-46] vs 39 [28.5-48], p<0.05). Restrictive lung disease was more common in the MILTx cohort (89% vs 72%, p<0.05). There was no difference in 1-year mortality between groups (94% vs 89%, p=0.18). Pulmonary function was improved in MILTx at 6-months (FEV1 83 [78-88] vs 73 [69-77], p<0.05) and 1-year (FEV1 83 [77-88] vs 75 [71-80], p<0.05). The maximum FEV1 was higher in MILTx (89 [84-94] vs 82 [78-85], p<0.05) and was achieved early (223 days [167-279] vs 310 days [266-354], p<0.05) after transplant. The ICU length of stay was shorter with MILTx by 3 days (4.7 [3.6-8] vs 7.7 [4-16], p<0.05) Adjusted rates of severe primary graft dysfunction (OR 0.48 [0.19-1.22], p=0.12) and 30-day readmission (OR 0.89 [0.39-2.00], p=0.76) were similar between groups.

Conclusion: Direct and robotic minimally invasive lung transplant was associated with shorter ICU length of stay, earlier, and sustained improvements in pulmonary function at up to 1-year without compromising morbidity, mortality, or graft function.

Authors
Allen Razavi (1), Aminah Sallam (2), Derrick Tam (3), Kevin Japardi (1), Vikram Krishna (1), Lucas Weiser (2), Claire Perez (1), Reinaldo Rampolla (1), Dominic Emerson (1), Pedro Catarino (2), Dominick Megna (4)
Institutions
(1) Cedars-Sinai Medical Center, Los Angeles, CA, (2) Cedars Sinai Medical Center, Los Angeles, CA, (3) Cedars Sinai Medical Center, Toronto, ON, (4) UW Medical Center - Montlake, N/A