To identify predictors for the use of cardiopulmonary bypass (CPB) in patients (pts) undergoing lung transplantation.
We retrospectively reviewed the charts of pts, who underwent lung transplantation at the University of Florida from 1/2003 to 12/2008, to identify preoperative predictors for the use of CPB. Re-transplantations and pts with idiopathic pulmonary artery hypertension were excluded from this analysis.
A total of 283 pts completed lung transplant evaluation and 96 pts were transplanted. None of the pts who underwent unilateral transplantation (n=41) required the use of CPB. Of the pts that underwent bilateral transplantation (n=55), 35 patients required CPB. In bilateral lung transplanted pts, factors found to be associated with the use of CPB in univariate analysis were: the presence of restrictive versus obstructive disease (OR 6.5 [95%CI: 1.9–22.2), need to use >4 l/m of O2 (OR 9.5 [95% CI: 1.1–81], higher systolic pulmonary arterial pressure (sPAP) (OR 1.11 [95% CI: 1.03–1.16]), lower cardiac output (OR 0.46 [95% CI: 0.25–0.83]), higher pulmonary vascular resistance (PVR)(OR 2.1 [95% CI:1.28–3.4]) and presence of DLCO <35% of predicted (OR 7.8 [95% CI: 1.7–34.8]. In multivariate analysis only DLCO <35% was significantly associated with the use of CPB (OR 15.1 [95% CI: 1.3–172.8]). Using Classification and Regression Tree (CART) analysis, the variables that best predicted the use of CPB were PVR >3 Wood Units (OR 20.8 [95%CI: 4.5–95.9]), sPAP >50mmHg (OR 15.3 [95%CI 3–77]) and DLCO<35% (OR 7.8 [95%CI 1.7–34.8]).
In the population study, the use of CPB is limited to pts undergoing bilateral lung transplantation. A PVR above 3 Wood Units, sPAP >50 mmHg, DLCO <35% and the presence of restrictive versus obstructive lung disease are associated with the need of using cardiopulmonary bypass in patients undergoing bilateral lung transplantation.
The presence of restrictive lung disease, PVR above 3 Wood Units, sPAP >50 mmHg and DLCO <35% serve as reliable preoperative predictors of the need for CPB in lung transplantation.
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