• Igor Tudorache, Wiebke Sommer, Christian Kühn, Olaf Wiesner, Johannes Hadem, Thomas Fühner, Fabio Ius, Murat Avsar, Nicolaus Schwerk, Dietmar Böthig, Jens Gottlieb, Tobias Welte, Christoph Bara, Axel Haverich, Marius M Hoeper, and Gregor Warnecke.
• 1 Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. 2 Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany. 3 Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. 4 Department of Pediatric Respiratory Medicine and Neonatology, Hannover Medical School, Hannover, Germany. 5 German Centre for Lung Research, Hannover, Germany.
• Transplantation. 2015 Feb 1; 99 (2): 451-8.

BackgroundBilateral lung transplantation (BLTx) is an established treatment for end-stage pulmonary hypertension (PH). Ventilator weaning failure and death are more common as in BLTx for other indications. We hypothesized that left ventricular (LV) dysfunction is the main cause of early postoperative morbidity or mortality and investigated a weaning strategy using awake venoarterial extracorporeal membrane oxygenation (ECMO).MethodsIn 23 BLTx for severe PH, ECMO used during BLTx was continued for a minimum of 5 days (BLTx-ECMO group). Echocardiography, left atrial (LA) and Swan-Ganz catheters were used for monitoring. Early extubation after transplantation was attempted under continued ECMO.ResultsPreoperatively, all patients had severely reduced cardiac index (mean, 2.1 L/min/m2). On postoperative day 2, reduction of ECMO flow resulted in increasing LA and decreasing systemic blood pressures. On the day of ECMO explantation (median, postoperative day 8), LV diameter had increased; LA and blood pressures remained stable. Survival rates at 3 and 12 months were 100% and 96%, respectively. Data were compared to two historic control groups of BLTx without ECMO (BLTx ventilation) or combined heart-lung transplantation for severe PH.ConclusionEarly after BLTx for severe PH, the LV may be unable to handle normalized LV preload. This can be effectively bridged with awake venoarterial ECMO.

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