SESSION TYPE: Lung Transplantation
PRESENTED ON: Monday, October 22, 2012 at 11:15 AM - 12:30 PM
PURPOSE: Delayed chest closure (DCC) following lung transplantation (LTx) is an option in the patients with prolonged cardiopulmonary bypass time, prolonged ischemic time, coagulopathic problems, and oversized donor lung grafts. Decision-making for DCC in the operating room remains challenging as the full spectrum of DCC in LTx and the impact of DCC on outcomes after LTx have not yet been fully elucidated.
METHODS: Out of all 873 lung transplantation cases performed between 2004 and 2011, 90 cases (10.3%) experienced DCC. A detailed retrospective review of those DCC cases was performed to clarify the reasons for DCC, overall complications and the risk factors for adverse outcomes as well as to determine optimal postoperative management during the open chest period (immunosuppression regimen, antibiotic coverage, anti-fungal therapy, etc). In addition, our technical tricks to prevent possible problems in DCC cases were described.
RESULTS: The 90-day and 1- and 3-year survival rates for the DCC group were 84%, 73%, and 62%. Early postoperative bleeding, respiratory and renal complications were higher in the DCC group (p<0.05) whereas long-term survival was not significantly different between DCC and Non-DCC groups. Posttransplant peak FEV1 was lower in the DCC group (69.8% vs. 82.2%, p<0.05). In multivariate analysis, requirement of ECMO and prolonged cardiopulmonary bypass use (>4 hours) were significantly associated with mortality (p<0.005), whereas performance of DCC and prolonged DCC duration (>5 days) were not.
CONCLUSIONS: Delayed chest closure is a simple but critical decision-making for complicated cases after LTx and safely performed without an increase in morbidity with a definite strategy. In our experience, this option contributes to optimize the transplant outcomes in challenging LTx cases.
CLINICAL IMPLICATIONS: Delayed chest closure is a critical decision-making which contributes to optimize the transplant outcomes in complicated, challenging lung transplantation cases.
DISCLOSURE: The following authors have nothing to disclose: Norihisa Shigemura, Yucel Orhan, Jay Bhama, Cynthia Gries, Maria Crespo, Joseph Pilewski, James Luketich, Christian Bermudez
No Product/Research Disclosure InformationUniversity of Pittsburgh Medical Center, Lung Transplant Program, Pittsburgh, PA