Meyers and colleagues Afatinib molecular weight reported 21 of their 500 LTx procedures (4.2%) were performed for preoperative ventilator-dependent recipients during an observation period of 12 years [14]. Half of them required CPB support during the transplant and three hospital deaths (14%) occurred. Baz and colleagues reported their results of nine LTx procedures for ventilator-dependent patients who were ambulatory and able to undergo exercise therapy prior to LTx in their study period of five years at two well-known centers [15]. The one-year survival rate was 78% and the author emphasized that their recipients were selected from medically stable patients, not including more critically or acutely ill recipients. Contrary to their selected study individuals, all of our 10 consecutive recipients enrolled in the two-year study period were almost completely bed-ridden without being able to exercise before LTx.
Although our in-hospital mortality rate and one-year survival rate were better than in the reports by Meyer and colleagues and Baz and colleagues, the long-term survival status still needs further observation.The feasibility, benefits and complications of replacing CPB with ECMO in LTx operations have been well documented [7,16-19]. A German group reported their two-year experience of eight patients receiving LTx under ECMO support with an increased 90-day mortality rate (37.5%) due to infectious complications [18]. They discussed the advantages of femoral cannulation of ECMO circuits rather than conventional central connections of CPB in LTx procedures, which led to an undisturbed operative field.
The Vienna group reported their large ECMO experience for intraoperative hemodynamic support in 147 LTx patients with excellent three-month (85.4%), one-year (74.2%), and three-year (67.6%) survival rates [19]. However, 33 of their 147 patients (22%) developed postoperative bleeding complications. Two patients developed major complications of cerebral bleeding intraoperatively and 31 patients needed postoperatively surgical revision due to bleeding problems. Although using the heparin-bound tubing sets, the Vienna group routinely administered an additional intravenous bolus of 75 IU/kg heparin before ECMO cannulation and they suspected that the level of systemic heparinization was too low to cause these bleeding complications.
In contrast to their policy of giving an extra bolus of heparin for systemic heparinization, we did not add systemic heparin during the ECMO cannulation and intraoperative period.Based Batimastat on our previous ECMO life-support experience, we believe that the intraoperative complications of symptomatic thrombosis due to lack of systemic heparinization in the heparin-bound ECMO circuits with short duration usage (within 12 hours) was very low. In our cases, there was actually no sign of systemic or localized thrombosis developing during the LTx operation.
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