Six-Years Experience With High Priority Allocation Program for Lung ...

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The Journal of Heart and Lung Transplantation, Vol 34, No 4S, April 2015

improved RV function after BPA adds credibility to this treatment option in CTEPH patients. 

Results: In-hospital mortality was 15% (4/26) and in-hospital morbidity was 27% (7/26). Causes of death included cerebral hemorrhage (n= 1), pneumonia (n= 2) and right heart failure (n= 1). By univariate analysis, only residual pulmonary hypertension (mPAP > 30mmHg) (p= 0.03) was associated with early mortality. Survival at 1-year was 80% by Kaplan-Meier analysis. Conclusion: PEA for CTEPH in octogenarians provides acceptable postoperative mortality and excellent long-term survival in highly select patients. Advanced age should not be a contraindication for PEA in cases where good hemodynamic results are expected. 4( 19) Six-Years Experience With High Priority Allocation Program for Lung and Heart-Lung Transplantation in Pulmonary Hypertension L. Savale ,1 J. Le Pavec,2 O. Mercier,2 S. Mussot,2 D. Fabre,2 X. Jaïs,1 D. Montani,1 O. Sitbon,1 M. Humbert,1 G. Simonneau,1 P. Dartevelle,1 E. Fadel.1  1Hôpital Bicêtre, Le Kremlin Bicetre, France; 2Centre Chirurgical Marie Lannelongue, Le Plessis Robinson, France.

4( 18) Outcomes Following Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension in Octogenarians N.B. Langer ,1 O. Mercier,1 M. Glorion,1 D. Fabre,1 S. Mussot,1 L. Lamrani,1 J. Lepavec,1 X. Jais,2 G. Simonneau,2 P. Dartevelle,1 E. Fadel.1  1Department of Thoracic and Vascular Surgery and HeartLung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France; 2Department of Pulmonology and Critical Care Medicine, Kremlin-Bicetre Hospital, Le Kremlin-Bicetre, France. Purpose: Pulmonary endarterectomy (PEA) is the only curative treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Advanced age was once considered a contraindication for high-risk operations, however with improvements in technique and management, an increasing number of octogenarians are undergoing PEA. Yet, outcomes in these patients have not been well studied. We examined early and late outcomes of PEA in octogenarians to assess the benefit of PEA in this subset of patients. Methods: From 2004-2013, 890 consecutive patients underwent PEA at a single center. 26 patients (3%) who were older than 80 years and underwent PEA for treatment of CTEPH were included in the study. 9 patients were male and 17 female with a mean age of 81.6 years (range 80-85 years). The average pre-operative mean pulmonary arterial pressure (mPAP) was 45 mmHg and the mean pre-operative pulmonary vascular resistance (PVR) was 1000 dyne∙s∙cm-5. 19 patients (73%) had at least one major comorbidity, including diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease, chronic kidney disease or a hypercoaguable state. 19 patients had NYHA Class III symptoms (73%), 4 patients class II (15%) and 3 patients class IV (12%). Mean cardiopulmonary bypass, aortic cross clamp and deep hypothermic circulatory arrest times were 224, 99 and 25 minutes, respectively. 3 patients underwent concomitant procedures, including aortic valve replacement (n= 1) and coronary artery bypass grafting (n= 2). Gender, a hypercoaguable state, pre-operative NYHA class 3 or 4 symptoms, presence and number of medical comorbidities, concomitant procedures, and preoperative PVR greater than 900 dyne∙s∙cm-5 were examined for association with early death.

Purpose: French patients with severe pulmonary hypertension (PH) and imminent risk of death despite an optimal medical care in intensive care unit can access to heart-lung transplantation (HLT) or lung transplantation (LT) according to a high priority allocation program (HPAP) since September 2006 and July 2007 respectively. Impact of this program on wait-list and post-transplantation outcomes is still unknown. The purpose of this study is to report results of HLT and LT in patients with pulmonary arterial hypertension, pulmonary veno occlusive disease or inoperable chronic thromboembolic PH and listed for HPAP from 2007 to 2013. Methods: Characteristics and outcome of these patients were retrospectively analyzed and compared to the cohort of PH patients receiving non-urgent (NU) HLT or LT from 2007 to 2013 and to the cohort of patients receiving transplantation before HPAP from 2000 to 2006. All these patients were listed for transplantation in the department of thoracic surgery, hôpital Marie Lannelongue, Le plessis Robinson, France. Results: From 2007 to 2013, 26/50 (52%) LT and 31/45 (69%) HLT were performed according to the HPAP. 47/57 (82%) patients transplanted with HPAP received inotropic support and 17 (30%) were on extra corporeal membrane oxygenation for right heart failure before surgery. Postoperative survival was non significantly different between HPAP and NU groups (67%, 61%, 56% et 53% vs. 84%, 75%, 68% et 68% respectively at 1, 2, 3 and 5 years, p= 0,1). Both groups were also similar in terms of post transplant mechanical ventilation duration and primary graft dysfunction. Numbers of death on list and transplanted patients ratio significantly decreased during 2007-2013 compared to 2000-2006 periods (0.15±0.11 vs. 0.96±0.46, p