Chest
Original ResearchTransplantationCombining Tricuspid Valve Repair With Double Lung Transplantation in Patients With Severe Pulmonary Hypertension, Tricuspid Regurgitation, and Right Ventricular Dysfunction
Section snippets
Patients
Human subject approval for this study was obtained from the University of Pittsburgh Medical Center prior to obtaining data (IRB approval number 000511). From January 2004 to April 2009, we performed primary LTx in 558 patients with end-stage lung disease at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, exclusive of heart-lung transplantation cases. Of these, 82 recipients with severe pulmonary hypertension underwent DLTx. The diagnosis of severe pulmonary hypertension
Operative Data
Intraoperative data are shown in Table 4. The operative time was longer in the TVR group than in the non-TVR group (P < .05). Ischemic time was not significantly different between the TVR and non-TVR groups (362 min vs 352 min). There were no significant differences in cardiopulmonary bypass time between the groups. In the non-TVR group, 49 patients (84%) required a bypass; among these cases, the mean bypass time was 195 min.
Postoperative Outcomes
Postoperative outcomes are shown in Table 5. The TVR group required
Discussion
Presently, there are only two surgical options available for patients with end-stage severe pulmonary hypertension disease: DLTx and heart-lung transplantation. Appropriate surgical options for patients with severe pulmonary hypertension have been a topic of longstanding debate. Throughout most of the 1990s, we performed single LTx for pulmonary hypertension.10, 11 After reviewing outcomes in 1998, however, we changed to a DLTx or heart-lung transplantation procedure for affected patients.2
Acknowledgments
Author contributions: Dr Shigemura had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Shigemura: contributed to the data collection, data analysis, and the writing of the manuscript.
Dr Sareyyupoglu: contributed to the data collection and analysis and final approval of the manuscript.
Dr Bhama: contributed to the data collection and final approval of the manuscript.
Dr Bonde: contributed to the data
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Cited by (12)
Regression of Tricuspid Valve Regurgitation After Lung Transplant: A Single-Center Experience
2022, Transplantation ProceedingsSingle Lung Transplantation With Concomitant Cardiac Surgery in a Patient With Cystic Fibrosis: A Case Report
2020, Transplantation ProceedingsCitation Excerpt :However, our case required switching between these 2 devices, as the patient required ECMO during preparation of the pulmonary hilum followed by CPB support in order to perform removal of the masses from the RA. After successful completion of this part, blood flow was provided by the ECMO circuit in order to finish the LT. Cardiac operations concomitant with LT do not seem to increase a risk of death as reported by Shigemura et al, who noted several cases of patients who underwent tricuspid valvuloplasty followed by LT [8]. Their oxygenation and circulation support was provided by CPB during the valvuloplasty and implantation of the first lung.
Extracorporeal Membrane Oxygenation as a Postoperative Left Ventricle Conditioning Tool After Lung Transplantation in Patients With Primary Pulmonary Artery Hypertension: First Polish Experience
2020, Transplantation ProceedingsCitation Excerpt :This finding indicates that tricuspid valve plasty is not always necessary among such patients. On the other hand, the study by Shigemura et al assessed that combined tricuspid valve plasty and bilateral lung transplantation were successfully performed without an increase in morbidity or mortality and contributed to decreased primary graft dysfunction [19]. This study describes the first Polish experience with consecutive intra- and postoperative prolonged VA-ECMO as a tool of heart conditioning.
Single Lung Transplant for Secondary Pulmonary Hypertension: The Right Option for the Right Patient
2023, Journal of Clinical MedicineIntegrated cardiothoracic team approach for complex lung transplantation procedures in Japan—current status and future direction
2023, Journal of Thoracic Disease
Funding/Support: The authors have reported to CHEST that no funding was received for this study.
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