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- W2332100068 abstract "Background: Bilateral lung transplantation (LTx) for idiopathic pulmonary artery hypertension (IPAH) is an established treatment, but weaning off the respirator following surgery is more demanding as compared with LTx for other indications. This is widely attributed to a PAH-associated problem, impaired right heart function. We hypothesize that this assumption is wrong, but instead, impaired left heart function causes the problem and suggest an effective weaning strategy. Methods: A novel surgical and intensive care approach was routinely assigned to all LTx for PAH (n=15) performed since 2010. Minimally invasive bilateral sequential lung transplantation was performed via anterolateral thoracotomies on extracorporeal circulation executed as veno-arterial ECMO. ECMO was left in place and maintained with 3-4 l/min flow after surgery. Early extubation on the first or second day after transplantation was achieved, but ECMO was not removed before postoperative day 6-10 routinely. Results: The patients in this cohort had severely reduced CI of 1.5-2 l/min/m2 before transplant. Early after transplant, left atrial pressures(LAP) were low and left ventricular ejection fraction (LVEF) satisfactorily under full ECMO support. Upon reduction of ECMO flow, LAP increased and LVEF decreased. Five - 10 days later, LAP and LVEF remained stable upon reduction of ECMO flow, thus, ECMO was removed. All patients survived and were eventually discharged from hospital. Conclusion: Continuous v.-a. ECMO in spontaneously breathing patients enables LV-remodelling after LTx for IPAH. This strategy safes donor hearts and leads to superior early survival in this LTx recipient subgroup." @default.
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- W2332100068 date "2012-11-01" @default.
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- W2332100068 title "The Problem after Lung Transplantation for Idiopathic Pulmonary Artery Hypertension Is not the Right Ventricle - Awake ECMO for LV Remodelling" @default.
- W2332100068 doi "https://doi.org/10.1097/00007890-201211271-00393" @default.
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