Transplantation |

Lung Transplantation in Patients With Severe Mitral Regurgitation FREE TO VIEW

Juan Rojas-Gomez; Perry Nystrom
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Wright State University, Dayton, OH

Chest. 2014;146(4_MeetingAbstracts):977A. doi:10.1378/chest.1962886
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SESSION TITLE: Lung Transplantation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: To survey opinion among and within US transplant centers regarding proper management of a lung transplant candidate with severe mitral regurgitation (SMR)

METHODS: Letters were sent to transplant centers throughout the US. Transplant pulmonologists (PCCM) and transplant CT surgeons (CTS) were presented with comprehensive clinical information about a lung transplant (LTx) candidate with SMR. Two questions were asked: 1. Would SMR be a contraindication to LTx? 2. If not, which would you perform: (a) lung transplant only and medically manage SMR, (b) LTx before mitral valve (MV) repair/replacement, (c) MV repair before LTx, or (d) combined MVR and LTx? Comments and alternatives were also solicited.

RESULTS: Letters were sent to 146 physicians (73 PCCMs and 73 CTS) at 53 transplant centers identified in spring 2012. The number of letters sent to each center ranged from 1 to 7 depending on the number of faculty members identified as being associated with the LTx program. At least one response was received from 46 of 53 (87%) centers; Sixty-nine (38 PCCMs and 31 CTSs) [47%] physicians responded. The responses were as follows 1. Would SMR be a contraindication to LTx? PCCMs: contraindicated: 34.2%; relative contraindication: 5.3% CTSs: contraindicated: 19.4%; relative contraindication: 0% 2. If not contraindicated, which would you perform? PCCMs: LTx alone: 0%; LTx before MVR: 0%; MVR before LTx: 5.3%; concomitant LTx and MVR: 23.7%; suggested combined Heart-Lung transplant (HTx-LTx): 7.9%; other: 23.7% CTS: LTx alone: 3.2%; LTx before MVR: 0%; MVR before LTx: 9.7%; concomitant LTx and MVR: 41.9%; combined HT-LTx: 9.7%; other: 16.1% Other responses included MV clip (MitraClip) prior to LTx, request further evaluation/review, and defer to other center/clinicians with more experience in complex procedures.

CONCLUSIONS: While concomitant lung transplantation and MVR was the most frequently chosen approach in this case, opinions across the US varied extensively among physicians who treat these patients.

CLINICAL IMPLICATIONS: Proper management of a lung transplant candidate with concomitant severe mitral regurgitation requires careful multidisciplinary discussion. Currently, there is a paucity of evidence (including case series) to assist clinicians in managing such patients, and definitive treatment is center specific.

DISCLOSURE: The following authors have nothing to disclose: Juan Rojas-Gomez, Perry Nystrom

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