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Mid-Term Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation as a Bridge to Lung Transplantation: Comparison with Non-Bridged Recipients
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  • Davorin Sef,
  • Alessandra Verzelloni Sef,
  • Vladimir Trkulja,
  • Binu Raj,
  • Nicholas Lees,
  • Christopher Walker,
  • Jerry Mitchell,
  • Mario Petrou,
  • Fabio De Robertis,
  • Ulrich Stock,
  • Ian McGovern
Davorin Sef
Royal Brompton and Harefield NHS Foundation Trust
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Alessandra Verzelloni Sef
Royal Brompton and Harefield NHS Foundation Trust
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Vladimir Trkulja
Sveuciliste u Zagrebu Medicinski fakultet
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Binu Raj
Royal Brompton and Harefield NHS Foundation Trust
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Nicholas Lees
Royal Brompton and Harefield NHS Foundation Trust
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Christopher Walker
Royal Brompton and Harefield NHS Foundation Trust
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Jerry Mitchell
Royal Brompton and Harefield NHS Foundation Trust
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Mario Petrou
Royal Brompton and Harefield NHS Foundation Trust
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Fabio De Robertis
Royal Brompton and Harefield NHS Foundation Trust
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Ulrich Stock
Royal Brompton and Harefield NHS Foundation Trust
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Ian McGovern
Royal Brompton and Harefield NHS Foundation Trust
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Abstract

Objectives: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly being used in acutely deteriorating patients with end-stage lung disease as a bridge to transplantation (BTT). It can allow critically ill recipients to remain eligible for lung transplant (LTx) while reducing pretransplant deconditioning. We analyzed early and mid-term postoperative outcomes of patients on VV-ECMO as a BTT and the impact of preoperative VV-ECMO on posttransplant survival outcomes. Methods: All consecutive LTx performed at our institution between January 2012 and December 2018 were analyzed. After matching, BTT patients were compared with non-bridged LTx recipients. Results: Out of 297 transplanted patients, 21 (7.1%) were placed on VV-ECMO as a BTT. After matching, we observed a similar 30-day mortality between BTT and non-BTT patients (4.6% vs. 6.6%, p=0.083) despite a higher incidence of early postoperative complications (need for ECMO, delayed chest closure, acute kidney injury). Furthermore, preoperative VV-ECMO did not appear associated with 30-day or 1-year mortality in both frequentist and Bayesian analysis (OR 0.35, 95%CI 0.03-3.49, p=0.369; OR 0.27, 95%CrI 0.01-3.82, P=84.7%, respectively). In sensitivity analysis, both subgroups were similar in respect to 30-day (7.8% vs. 6.5%, p=0.048) and 1-year mortality (12.5% vs. 18%, p=0.154). Conclusions: Patients with acute refractory respiratory failure while waiting for LTx represent a high-risk cohort of patients. We observed that these patients can be successfully bridged to LTx with VV-ECMO with post-transplant mortality comparable to non-BTT patients.
11 Oct 2021Submitted to Journal of Cardiac Surgery
11 Oct 2021Submission Checks Completed
11 Oct 2021Assigned to Editor
02 Nov 2021Review(s) Completed, Editorial Evaluation Pending
02 Nov 2021Editorial Decision: Revise Minor
05 Nov 20211st Revision Received
05 Nov 2021Assigned to Editor
05 Nov 2021Submission Checks Completed
05 Nov 2021Review(s) Completed, Editorial Evaluation Pending
26 Nov 2021Editorial Decision: Revise Minor
29 Nov 20212nd Revision Received
29 Nov 2021Submission Checks Completed
29 Nov 2021Assigned to Editor
29 Nov 2021Review(s) Completed, Editorial Evaluation Pending
24 Dec 2021Editorial Decision: Accept