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Primary graft dysfunction (PGD) is still a major complication in patients undergoing lung transplantation (LTx). Much is unknown about the effect of postoperative mechanical ventilation on outcomes, with debate on the best approach to ventilation.The goal of this study was to generate hypotheses on the association between postoperative mechanical ventilation settings and allograft size matching in PGD development.This is a retrospective study of LTx patients between September 2011 and September 2018 (n = 116). PGD was assessed according to the International Society of Heart and Lung Transplantation (ISHLT) criteria. Data were collected from medical records, including chest x-ray assessments, blood gas analysis, mechanical ventilator parameters and spirometry.Positive end-expiratory pressures (PEEP) of 5 cm HOur results highlight a need for greater investigation of the role donor characteristics play in determining post-operative ventilation of a lung transplant recipient. The mechanical ventilation settings on postoperative LTx recipients may have an implication for the development of acute graft dysfunction. Severe PGD was associated with the use of a PEEP higher than 5 and lower tidal volumes and oversized lungs were associated with lower long-term mortality. Lack of association between ventilatory settings and survival may point to the importance of other variables than ventilation in the development of PGD.

OBJECTIVES To assess whether sevoflurane provides better haemodynamic stability than propofol in acute right ventricular (RV) ischaemia–reperfusion. METHODS Open-chest pigs (mean ± standard deviation, 68.8 ± 4.2 kg) anaesthetized with sevoflurane (n = 6) or propofol (n = 6) underwent 60 min of RV free wall ischaemia and 150 min of reperfusion. Haemodynamic parameters and blood flow in the 3 major coronary arteries were continuously monitored. Biomarkers of cardiac ischaemia were analysed. RESULTS Mean arterial pressure and stroke volume decreased, whereas pulmonary vascular resistance increased equally in both groups. Heart rate increased 7.5% with propofol (P 0.05). Circumflex and left anterior descending coronary artery blood flow decreased in both groups. Right coronary artery blood flow (ml·min−1) decreased with propofol (38 ± 9 to 28 ± 9, P 0.05). Biomarkers of cardiac ischaemia increased in both groups. CONCLUSIONS Compared to propofol, sevoflurane-anaesthetized pigs showed higher RV stroke work, cardiac output and right coronary artery blood flow during reperfusion. These findings warrant a clinical trial of sevoflurane in RV ischaemia in humans.

Lung transplantation is an accepted treatment for end stage lung diseases and performed at two national centers in Sweden - Gothenburg and Lund. Since the start in 1990 over 1 200 patients have been transplanted. The indications are severe progressive lung diseases with short expected survival or severe negative effects on daily life. There are several contraindications among which severe other organ disease, recent malignancy or psychiatric disease are most important. The most common causes for lung transplantation are chronic obstructive pulmonary disease (COPD), interstitial pulmonary disease, cystic fibrosis and pulmonary hypertension. Long term survival after 5 years is 63 %, and after 10 years 48 %, which is better than the results reported in the international registry (57 % and 36 % respectively). Lung transplantation is today a therapy for end stage pulmonary diseases with acceptable survival results. It is likely that the number of patients will increase in the future.

Item does not contain fulltext BACKGROUND: The Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial was a non-inferiority trial that compared percutaneous coronary intervention (PCI) using first-generation paclitaxel-eluting stents with coronary artery bypass grafting (CABG) in patients with de-novo three-vessel and left main coronary artery disease, and reported results up to 5 years. We now report 10-year all-cause death results. METHODS: The SYNTAX Extended Survival (SYNTAXES) study is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries. Patients with de-novo three-vessel and left main coronary artery disease were randomly assigned (1:1) to the PCI group or CABG group. Patients with a history of PCI or CABG, acute myocardial infarction, or an indication for concomitant cardiac surgery were excluded. The primary endpoint of the SYNTAXES study was 10-year all-cause death, which was assessed according to the intention-to-treat principle. Prespecified subgroup analyses were performed according to the presence or absence of left main coronary artery disease and diabetes, and according to coronary complexity defined by core laboratory SYNTAX score tertiles. This study is registered with ClinicalTrials.gov, NCT03417050. FINDINGS: From March, 2005, to April, 2007, 1800 patients were randomly assigned to the PCI (n=903) or CABG (n=897) group. Vital status information at 10 years was complete for 841 (93%) patients in the PCI group and 848 (95%) patients in the CABG group. At 10 years, 244 (27%) patients had died after PCI and 211 (24%) after CABG (hazard ratio 1.17 [95% CI 0.97-1.41], p=0.092). Among patients with three-vessel disease, 151 (28%) of 546 had died after PCI versus 113 (21%) of 549 after CABG (hazard ratio 1.41 [95% CI 1.10-1.80]), and among patients with left main coronary artery disease, 93 (26%) of 357 had died after PCI versus 98 (28%) of 348 after CABG (0.90 [0.68-1.20], pinteraction=0.019). There was no treatment-by-subgroup interaction with diabetes (pinteraction=0.66) and no linear trend across SYNTAX score tertiles (ptrend=0.30). INTERPRETATION: At 10 years, no significant difference existed in all-cause death between PCI using first-generation paclitaxel-eluting stents and CABG. However, CABG provided a significant survival benefit in patients with three-vessel disease, but not in patients with left main coronary artery disease. FUNDING: German Foundation of Heart Research (SYNTAXES study, 5-10-year follow-up) and Boston Scientific Corporation (SYNTAX study, 0-5-year follow-up).

Obliterative bronchiolitis (OB) is a potentially fatal complication of rheumatoid arthritis (RA), which is challenging in terms of both diagnosis and management. We report the case of a 53-year-old...

BACKGROUND Development of bronchiolitis obliterans syndrome (BOS) is a great limitation for patient survival in lung transplantation (LTx). A curative treatment for BOS is still missing, and in terminal stages re-transplantation (Re-LTx) is the only salvation. It is possible to slow the progress of BOS if it is detected at an early stage. This might be possible by assessing pulmonary function pattern. MATERIAL AND METHODS Between 1990 and 2014, 278 patients underwent LTx at Skane University Hospital, Sweden. Pulmonary function was followed using spirometry (FEV1) and 6-minute walking test (6MWT) measured at 3, 6, and 12 months and annually. The endpoint used was freedom from BOS (BOS grade ≤1), BOS (BOS grade ≥2), and death or Re-LTx. RESULTS Double-lung transplantation (DLTx) showed a hazard ratio (HR) of 0.514 (p=0.001) versus recipients who underwent single-lung transplantation (SLTx). Regarding freedom from BOS, FEV1 showed an HR of 0.597 and 6MWT an HR of 0.982 (p

Objective Lung transplantation is hampered by the lack of organs resulting in deaths on the waiting list. The usage of donation after circulatory death (DCD) lungs would dramatically increase donor availability. The most optimal organ preservation method, and the need for antithrombotic and fibrinolytic treatment to prevent thrombosis in the donor lungs is currently on debate. The present study investigated, in a simulated clinical DCD situation, whether the addition of alteplase in the flush-perfusion solution at the time of pulmonary graft harvesting could prevent thrombosis in the donor lung and thereby improve pulmonary graft function. Methods Twelve Swedish domestic pigs were randomized into two groups. All animals underwent ventricular fibrillation and were then left untouched for 1 h after declaration of death. None of the animals received heparin. The lungs were then harvested and flush-perfused with Perfadex® solution and the organs were then stored at 8 °C for 4 h. In one group alteplase was added to the Perfadex® solution (donation after cardiac death with alteplase (DCD-A)) and in the other, it was not (DCD). Lung function was evaluated, using ex vivo lung perfusion (EVLP), with blood gases at different oxygen levels, pulmonary vascular resistance (PVR), lung weight, and macroscopic appearance. Results During EVLP, there were no significant differences between groups in PaO2 at any investigated FiO2 level (1.0, 0.5, or 0.21). At FiO2 1.0, the PaO2 in the DCD and DCD-A was 51.7 ± 2.05 kPa and 60.3 ± 3.67 kPa, respectively (p = 0.1320). There were no significant differences between groups PVR levels, in the DCD (372 ± 31 dyne x s/cm5) and in the DCD-A (297 ± 37 dyne x s/cm5) groups (p = 0.1720). There was no significant difference between groups in macroscopic appearance. Conclusions All the lungs showed excellent blood gases after EVLP, and they all meet the criteria's for clinical lung transplantation. The use of alteplase did not seem to have any obvious benefit to the donor lungs in a DCD situation. The donor lungs treated with alteplas showed slightly better blood gases and slightly lower PVR compared to the group without alteplas, however the difference was not significant. DCD appears to be a safe and effective method to expand the donor pool.

OBJECTIVES The use of donation after cardiac death (DCD) to overcome organ shortage is slowly moving into the clinic. In this study, we compare the protective effect of warm ischaemia versus cold ischaemia on thrombotic formation in non-heparinized pulmonary grafts. METHODS Twelve Landrace pigs were randomized into two groups: warm ischaemia and cold ischaemia. Ventricular fibrillation without the administration of heparin was induced to mimick an uncontrolled DCD situation. The animals were then exposed to either 1 h of cold ischaemia (insertion of drain and installation of cold fluid in the pleuras) or warm ischaemia (body temperature). After 1 h, the pulmonary artery was opened and the pulmonary arterial branches were then macroscopically studied for thrombotic material. RESULTS After 60 min, the temperature was 36.6 ± 0.0°C in the warm ischaemic group and 14.6 ± 0.1°C in the cold ischaemic group (P < 0.001). In the warm ischaemic group, no thrombotic material could be found in the pulmonary artery in the animals examined and in the cold ischaemic group 6.8 ± 0.2 ml thrombotic material was found in the pulmonary artery (P < 0.001). In the warm ischaemic group, no thrombotic material could be found in the arterial branches of the pulmonary artery and in the cold ischaemic group 2.3 ± 0.1 ml thrombotic material was found in the arterial branches of the pulmonary artery (P < 0.001). CONCLUSIONS Warm ischaemia rather than cold ischaemia seems to protect the pulmonary graft from thrombosis in uncontrolled non-heparinized DCD pigs.

Objective To evaluate the hemostatic system in patients undergoing surgery for acute type A aortic dissection (ATAAD) compared with those undergoing elective aortic procedures. Design This was a prospective, observational study. Setting The study was performed at a single university hospital. Participants Twenty-five patients with ATAAD were compared with 20 control patients undergoing elective surgery of the ascending aorta or the aortic root. Interventions No interventions were performed. Measurements and Main Results Platelet count and levels of fibrinogen, D-dimer, prothrombin time/international normalized ratio, activated partial thromboplastin time, and antithrombin were analyzed perioperatively and compared between the 2 groups. Patients with ATAAD had lower preoperative levels of platelets (188 [156-217] × 109/L v 221 [196-240] × 109/L; p = 0.018), fibrinogen (1.9 [1.6-2.4] g/L v 2.8 [2.2-3.0] g/L; p = 0.003), and antithrombin (0.81 [0.73-0.94] kIU/L v 0.96 [0.92-1.00] kIU/L; p = 0.003) and significantly higher levels of D-dimer (2.9 [1.7-9.7] mg/L v 0.1 [0.1-0.2] mg/L; p Conclusions This study demonstrates that ATAAD is associated with a coagulopathic state. Surgery causes additional damage to the hemostatic system in ATAAD patients, but also in patients undergoing elective surgery of the ascending aorta or the aortic root.

Objectives: The aim of this study was to establish the top 10 research uncertainties in aortic dissection together with the patient organization Aortic Dissection Association Scandinavia using the James Lind Alliance concept. Methods: A pilot survey aiming to identify uncertainties sent to 12 patients was found to have high content validity (scale content validity index = 0.91). An online version of the survey was thereafter sent to 30 patients in Aortic Dissection Association Scandinavia and 45 caregivers in the field of aortic dissection. Research uncertainties of aortic dissection were gathered, collated and processed. Results: Together with research priorities retrieved from five different current guidelines, 94 uncertainties were expressed. A shortlist of 24 uncertainties remained after processing for the final workshop. After the priority-setting process, using facilitated group format technique, the ranked final top 10 research uncertainties included diagnostic tests for aortic dissection; patient information and care continuity; quality of life; endovascular and medical treatment; surgical complications; rehabilitation; psychological consequences; self-care; and how to improve prognosis. Conclusion: These ranked top 10 important research priorities may be used to justify specific research in aortic dissection and to inform healthcare research funding decisions.

Massive bleeding is a serious complication associated with impaired survival after surgery for acute type A aortic dissection (ATAAD). There are no previous reports evaluating the effect of ATAAD and associated surgery on von Willebrand factor (VWF). The aim of the present study was to analyze VWF activity (VWF:GPIbM) and thus the potential of Factor (F) VIII/VWF concentrate as a treatment for refractory bleeding in surgery for acute type A aortic dissection.We prospectively compared serial measurements of VWF:GPIbM in 25 patients with ATAAD to 20 control patients undergoing elective surgery of the ascending aorta or the aortic root. In 10 of the ATAAD patients, high molecular weight multimer distribution was measured.Preoperatively, ATAAD patients demonstrated significantly higher VWF:GPIbM (1.58 (1.40-2.05) kIU/L vs 1.25 (1.02-1.42) kIU/L, p = 0.003). In the ATAAD group, VWF:GPIbM significantly decreased to 1.24 (0.98-1.44) kIU/L at lowest core temperature (T0 vs T1 p 0.001), but remained unchanged in the elective group (1.25 (1.04-1.43) kIU/L, T0 vs T1 p 0.625). Neither aortic dissection nor hypothermia caused any changes to the proportion of high molecular weight multimers when compared to control patients. Both groups demonstrated supernormal VWF:GPIbM on the first and fifth day after surgery.This report showed that patients with acute aortic dissection had increased levels of VWF:GPIbM before surgery that decreased slightly during surgery. Our study could not provide evidence that would encourage administration of FVIII/VWF concentrate for major bleeding in patients undergoing surgery for ATAAD as well as elective aortic procedures.

BackgroundOrgan donation guidelines recommend a “clear” conventional bedside chest radiograph before lung transplantation despite only moderate accuracy for cardiopulmonary abnormalities.PurposeTo evaluate the influence of donor image interpretation on lung transplantation outcome in recipients by following early and late complications, one-year survival, and to correlate imaging findings and blood gas analysis with lung transplantation outcome in recipients.Material and MethodsIn 35 lung donors from a single institution clinical reports and study reviews of imaging findings of the mandatory bedside chest radiographs and blood gas analyses were compared with clinical outcome in 38 recipients. Hospitalization time, peri- and postoperative complications, early complications (primary graft dysfunction, infection), 30-day and one-year survival, and forced expiratory volume in 1 s percentage of predicted normal value (FEV1%) at one-year follow-up were analyzed.ResultsFindings in clinical reports and study reviews differed substantially, e.g. regarding reported decompensation, edema, infection, and atelectasis. No correlation was shown between imaging findings in clinical report or study review and blood gas analyses in the lung donors compared to postoperative outcome in recipients.ConclusionThe interpretation of the mandatory chest radiograph in its present form does not influence one-year outcome in lung transplantation. Larger imaging studies or a change in clinical routine including computed tomography may provide evidence for future guidelines.

Recent studies indicate acceptable survival rates in elderly patients treated surgically for acute type A aortic dissection (aTAAD). However, the impact of preoperative hemodynamic compromise or organ malperfusion on outcomes of such patients is still unclear.

The purpose was to estimate the proportion of current open aortic arch reconstructions that might be feasible for endovascular repair. From all elective repair made in Southern Sweden in one center between 2005 and 2012, 129 open and eight endovascular aortic arch repairs were identified. The anatomy of the ascending arch and descending aorta as well as the arch vessels was categorized from multiplanar and axial computed tomography scans. Of 129 open cases, only two (1.5%) were suitable for endovascular repair. Among 137 all arch open and endovascular arch reconstructions performed during the study period, only 10 (7%) were candidates for endovascular repair. The most common exclusion for endovascular repair was an excessively large ascending aortic diameter. In conclusion, only a small proportion of patients having an open arch repair are suitable for endovascular arch repair, a finding related to the large diameter of the ascending aorta.

Objective Right ventricular rupture, resulting in serious bleeding, is a life-threatening complication associated with negative-pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier between the heart and the sharp sternal edges has been successfully tested on pigs. In the present article, we demonstrate increased safety in NPWT through the use of the HeartShield device. Methods Six patients were treated with a specially designed device in combination with NPWT. The device consists of a horizontally placed disk covered in foam. The back of the T-shaped device sticks up between the sternal edges and up above skin level. This part of the device is also covered in foam. Drainage is performed through two holes at the top of the device. The device and foam are changed every second to third day, and −120 mm Hg of continuous therapy is used. Six patients were treated with traditional NPWT, serving as control group. Results No signs of calluslike formation were seen on the right ventricle in the group treated with the HeartShield device. In the conventional NPWT control group, all six patients had calluslike formation (>1 × 2 cm2) on the anterior part of the right ventricle. All patients in the HeartShield group had grade 1 epicardial petechial bleeding (2) on the right ventricle. In the control group, one patient had grade 1 (2), three patients had grade 2 (0.5–2.0 cm2), and two patients had grade 3 (>2.0 cm2) epicardial petechial bleeding on the right ventricle. No major bleeding or mortality was observed in either group during the course of the study. Conclusions The use of the HeartShield device significantly minimizes the contact between the right ventricle and the sternal edges, thereby decreasing the risk for life-threatening complications due to bleeding.

Negative pressure wound therapy is a concept introduced initially to assist in the treatment of chronic open wounds. Recently, there has been growing interest in using the technique on closed incisions after surgery to prevent potentially severe surgical site infections and other wound complications in high-risk patients. Negative pressure wound therapy uses a negative pressure unit and specific dressings that help to hold the incision edges together, redistribute lateral tension, reduce edema, stimulate perfusion, and protect the surgical site from external infectious sources. Randomized, controlled studies of negative pressure wound therapy for closed incisions in orthopedic settings (which also is a clean surgical procedure in absence of an open fracture) have shown the technology can reduce the risk of wound infection, wound dehiscence, and seroma, and there is accumulating evidence that it also improves wound outcomes after cardiothoracic surgery. Identifying at-risk individuals for whom prophylactic use of negative pressure wound therapy would be most cost-effective remains a challenge; however, several risk-stratification systems have been proposed and should be evaluated more fully. The recent availability of a single-use, closed incision management system offers surgeons a convenient and practical means of delivering negative pressure wound therapy to their high-risk patients, with excellent wound outcomes reported to date. Although larger, randomized, controlled studies will help to clarify the precise role and benefits of such a system in cardiothoracic surgery, limited initial evidence from clinical studies and from the authors' own experiences appears promising. In light of the growing interest in this technology among cardiothoracic surgeons, a consensus meeting, which was attended by a group of international experts, was held to review existing evidence for negative pressure wound therapy in the prevention of wound complications after surgery and to provide recommendations on the optimal use of negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery.

It has been debated whether or not heparin infusion before or after non-heart-beating donors are declared dead improves the quality of pulmonary grafts. In clinical lung transplantation with heart-beating donors (HBDs) heparin is routinely infused prior to organ harvesting since it is believed to improve pulmonary grafts by minimizing thrombosis formation in the pulmonary grafts. Here, we raise the question of whether or not the use of heparin in HBDs improves the quality of the pulmonary grafts.Twelve landrace pigs were divided into two groups of six animals; heparin was given prior to lung harvesting in one group, while the other group did not receive any heparin. The lungs were evaluated using an ex vivo lung perfusion (EVLP) method.No significant difference in arterial oxygen partial pressure (PaO2) was observed between the two groups at an inspired oxygen fraction (FiO2) of 1.0 (mean 69.2 kPa, range 46.1-77.0 in the non-heparin group, and 61.6 kPa, range 47.9-71.4 in the heparin group, p = 0.44), neither in pulmonary vascular resistance: mean 543 ((dyne × s)/cm(5)) (range 280-615) in the non-heparin group and 533 ((dyne × s)/cm(5)) (320-762) in the heparin group (p = 0.99).Heparin did not seem to improve pulmonary graft function in our animal model using conventional HBDs.

Right ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier disc (HeartShield™) has been suggested to offer protection against this lethal complication by preventing the heart from being drawn up by the negative pressure and damaged by the sharp sternum bone edges. Seven patients treated with conventional NPWT and seven patients treated with NPWT with a protective barrier disc (HeartShield) were compared with regard to bacterial clearance and infection parameters including C‐reactive protein levels and leucocyte counts. C‐reactive protein levels and leucocyte counts dropped faster and bacterial clearance occurred earlier in the HeartShield® group compared with the conventional NPWT group. Negative biopsy cultures were shown after 3·1 ± 0·4 NPWT dressing changes in the HeartShield group, and after 5·4 ± 0·6 NPWT dressing changes in the conventional NPWT group (P

Background Surgery for acute type A aortic dissection (ATAAD) is often complicated by excessive bleeding. Recombinant factor VIIa (rFVIIa) effectively treats refractory bleeding associated with ATAAD surgery; however, adverse effects of rFVIIa in these patients have not been fully assessed. Here we evaluated rFVIIa treatment in ATAAD surgery using the Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database. Methods This was a multicenter, propensity score–matched, retrospective study. Information about rFVIIa use was available for 761 patients, of whom 171 were treated with rFVIIa. We successfully matched 120 patients treated with rFVIIa with 120 controls. Primary endpoints were in-hospital mortality, postoperative stroke, and renal replacement therapy (RRT). Survival data were presented using Kaplan-Meier estimates. Results Compared with controls, patients treated with rFVIIa received more transfusions of packed red blood cells (median, 9.0 U [4.0-17.0 U] vs 5.0 U [2.0-11.0 U]; P = .008), platelets (4.0 U [2.0-8.0 U] vs 2.0 U [1.0-4.4 U]; P P = .01) underwent reexploration for bleeding more often (31.0% vs 16.8%; P = .014); and had greater 24-hour chest tube output (1500 L [835-2500 mL] vs 990 mL [520-1720 mL]). Treatment with rFVIIa was not associated with significantly increased rates of in-hospital mortality (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.34-1.55; P = .487), postoperative stroke (OR, 1.75; 95% CI, 0.82-3.91; P = .163), or RRT (OR, 1.18; 95% CI, 0.48-2.92; P = .839). Conclusions In this propensity-matched cohort study of patients undergoing ATAAD surgery, treatment with rFVIIa for major bleeding was not associated with a significantly increased risk of stroke, RRT, or mortality.

Objectives: Lung transplant patients and their next of kin share the experiences of illness but little is known in the face of a lung re-transplantation. To describe patients’ and next of kin’s experiences of supportive care while awaiting lung re-transplantation and the objective was to highlight a small group with special circumstances and needs. Methods: Using qualitative content analysis, seven adult patients and seven next of kin were consecutively selected from a regional lung transplantation centre and individually interviewed shortly after decision about lung re-transplantation. Results: The experiences of supportive care were captured in one main category: ‘once again haunted by death’ and three sub-categories: ‘when life turns and death once again snorts down your neck’, ‘the importance of information’, and ‘perceptions of support’. A complex interaction between the experience of waiting, and communication patterns, emotional states, and social support was shown. Conclusion: This study provides insights into the complex interaction between the experience of waiting for a second lung transplant and communication patterns, emotional states, social support and social roles between patients, next of kin, healthcare professionals, and the health and social welfare system. There is a need for developing supportive care programme to achieve the best possible care.

PURPOSE:: The aim of the study was to retrospectively evaluate the diagnostic imaging that potential lung donors undergo, the reader variability of image interpretation and its relevance for donation, and the potential information gained from imaging studies not primarily intended for lung evaluation but partially including them. MATERIALS AND METHODS:: Bedside chest radiography and computed tomography (CT), completely or incompletely including the lungs, of 110 brain-dead potential organ donors in a single institution during 2007 to 2014 were reviewed from a donation perspective. Two chest radiologists in consensus analyzed catheters and cardiovascular, parenchymal, and pleural findings. Clinical reports and study review were compared for substantial differences in findings that could have led to a treatment change, triggered additional examinations such as bronchoscopy, or were considered important for donation. RESULTS:: Among 136 bedside chest radiographs, no differences between clinical reports and study reviews were found in 37 (27%), minor differences were found in 28 (21%), and substantial differences were found in 71 (52%) examinations (P

Background: The method of ex vivo lung perfusion (EVLP) has been suggested as a reliable means of differentiating between “good” and “poor” pulmonary grafts in marginal donors as, when grafts identified as good by this method are transplanted, the results do not differ from those using lungs fulfilling standard criteria. The EVLP method is also thought to improve pulmonary grafts by reducing lung edema and eliminating lung atelectasis. In the present study, we investigated whether the pulmonary graft could be further improved by extending the duration of EVLP. Methods and Materials: Six Landrace pigs were used. The lungs were reconditioned and evaluated, using the EVLP method, as double lungs. After the initial evaluation, EVLP was continued for a further 90 minutes. Results: The arterial oxygen level (pO2) was 60.8 ± 4.8 kPa after the standard 60 minutes of EVLP and 67.1 ± 2.2 kPa after 150 minutes (p = 0.48). The pulmonary vascular resistance was 453 ± 78 dyne*s/cm5 after 60, 90, 120 and 150 minutes of EVLP (p = 1.0). The pulmonary artery pressure was 17.8 ± 1.0 mmHg after 60, 90, 120, and 150 minutes of EVLP (p = 1.0) and the pulmonary artery flow was 3.5 ± 0.4 l/min after 60, 90, 120, and 150 minutes of EVLP (p = 1.0). The mean weight of the pulmonary grafts after harvesting was 574 ± 20 g at the beginning of EVLP 541 ± 24 g and, after 150 min of EVLP, 668 ± 33 (p = 0.011). Conclusions: The blood gases and hemodynamic parameters in the pulmonary grafts did not improve as a result of the extra 90 minutes of EVLP. However, the weight of the pulmonary graft increased significantly with increasing duration of EVLP, indicating lung perfusion injury.

Bacteria- and fungus-binding mesh binds with and inactivates bacteria and fungus, which makes it an interesting alternative, wound filler for negative pressure wound therapy (NPWT). This study was conducted to compare the performance of pathogen-binding mesh, foam and gauze as wound fillers in NPWT with regard to pressure transduction, fluid retention, wound contraction and microvascular blood flow. Wounds on the backs of 16 pigs were filled with pathogen-binding mesh, foam or gauze and treated with NPWT. The immediate effects of 0, -40, -60, -80 and -120 mmHg, on pressure transduction and blood flow were examined in eight pigs using laser Doppler velocimetry. Wound contraction and fluid retention were studied during 72 hours of NPWT at -80 and -120 mmHg in the other eight pigs. Pathogen-binding mesh, gauze and foam provide similar pressure transduction to the wound bed during NPWT. Blood flow was found to decrease 0.5 cm laterally from the wound edge and increase 2.5 cm from the wound edge, but was unaltered 5.0 cm from the wound edge. The increase in blood flow was similar with all wound fillers. The decrease in blood flow was more pronounced with foam than with gauze and pathogen-binding mesh. Similarly, wound contraction was more pronounced with foam, than with gauze and pathogen-binding mesh. Wound fluid retention was the same in foam and pathogen-binding mesh, while more fluid was retained in the wound when using gauze. The blood flow 0.5-5 cm from the wound edge and the contraction of the wound during NPWT were similar when using pathogen-binding mesh and gauze. Wound fluid was efficiently removed when using pathogen-binding mesh, which may explain previous findings that granulation tissue formation is more rapid under pathogen-binding mesh than under gauze. This, in combination with its pathogen-binding properties, makes this mesh an interesting wound filler for use in NPWT.

Summary Background Negative pressure wound therapy (NPWT) contracts the wound and alters the microvascular blood flow in the wound edge, which may be crucial in promoting wound healing. The aim of the present study was to examine these biological effects in the wound edge using different types of wound fillers. Methods Wounds were created on the backs of pigs and filled with green foam, black foam or gauze. Dressings for NPWT were then applied. The immediate effects of continuous NPWT, including pressure transmission to the wound bed and microvascular blood flow (using laser Doppler velocimetry), were studied in eight pigs that were anaesthetised for 12 h. In another eight pigs, wound contraction was studied during 72 h of NPWT. Results Pressure transduction to the wound bed was similar through green foam, black foam and gauze, with only small pressure drop. Wound contraction was more pronounced for green and black foam than for gauze. Blood flow was found to decrease 0.5 cm from the wound edge and increase 2.5 cm from the wound edge. The increase in blood flow was similar with all wound fillers, while the decrease was less pronounced with gauze than with both foams. Conclusions The biological effects of NPWT depend on the type of wound filler. Green and black foam have similar effects, while gauze results in less pronounced wound contraction and hypoperfusion. NPWT may be tailored to the individual wound type to optimise the effects and minimise the complications by choosing different wound fillers.

The effects of negative pressure wound therapy (NPWT) on wound edge microvascular blood flow are not clear. The aim of the present study was therefore to further elucidate the effects of NPWT on periwound blood flow in a porcine peripheral wound model using different blood flow measurement techniques. NPWT at -20, -40, -80, and -125 mmHg was applied to a peripheral porcine wound (n = 8). Thermodiffusion, transcutaneous, and invasive laser Doppler velocimetry were used to measure the blood perfusion 0.5, 1.0, and 2.5 cm from the wound edge. Thermodiffusion (an invasive measurement technique) generally showed a decrease in perfusion close to the wound edge (0.5 cm), and an increase further from the edge (2.5 cm). Invasive laser Doppler velocimetry showed a similar response pattern, with a decrease in blood flow 0.5 cm from the wound edge and an increase further away. However, 1.0 cm from the wound edge blood flow decreased with high pressure levels and increased with low pressure levels. A different response pattern was seen with transcutaneous laser Doppler velocimetry, showing an increase in blood flow regardless of the distance from the wound edge (0.5, 1.0, and 2.5 cm). During NPWT, both increases and decreases in blood flow can be seen in the periwound tissue depending on the distance from the wound edge and the pressure level. The pattern of response depends partly on the measurement technique used. The combination of hypoperfusion and hyperperfusion caused by NPWT may accelerate wound healing.

A method to evaluate and recondition lungs ex vivo has been tested on donor lungs that have been rejected for transplantation. In the present paper, we compare early postoperative course between the six patients who received reconditioned lungs and the patients who received conventional donor lungs during the same period of time. During 2006 and 2007, a total of 21 patients underwent double sequential lung transplantation at the University Hospital of Lund. Six of those patients received reconditioned lungs. The other 15 patients received conventional donor lungs for transplantation without reconditioning ex vivo. The results are presented as median and interquartile range. Time in intensive care unit (days) between recipients of reconditioned lungs [13 (5-24) days], and recipients of conventional donor lungs [7 (5-12) days], P=0.44. Total hospital stay after transplantation (days) between recipients of reconditioned lungs [52 (47-60) days] and recipients of conventional donor lungs [44 (37-48) days], P=0.9. Ex vivo lung evaluation and reconditioning might not prolong early postoperative course in double lung transplantation. However, given the small number of patients, there might be a failure to detect a difference between the two groups. Keywords: Double lung transplantation; Reconditioned lungs; Clinical outcome. (Less)

Pressure transduction to the wound bed in negative pressure wound therapy (NPWT) is crucial in stimulating the biological effects ultimately resulting in wound healing. In clinical practice, either foam or gauze is used as wound filler. Furthermore, two different drainage techniques are frequently employed. One involves the connection of a non‐perforated drainage tube to the top of the dressing, while the other involves the insertion of perforated drains into the dressing. The aim of this study was to examine the efficacy of these two different wound fillers and drainage systems on pressure transduction to the wound bed in a challenging wound (the sternotomy wound). Six pigs underwent median sternotomy. The wound was sealed for NPWT using different wound fillers (foam or gauze) and drainage techniques (see earlier). Pressures between 0 and −175 mmHg were applied and the pressure in the wound was measured using saline‐filled catheters sutured to the bottom of the wound (over the anterior surface of the heart) and to the side of the wound (on the thoracic wall). The negative pressure on the wound bed increased linearly with the negative pressure delivered by the vacuum source. In a dry wound, the pressure transduction was similar when using the different wound fillers (foam and gauze) and drainage techniques. In a wet wound, pressure transduction was better when using a perforated drainage tube inserted into the wound filler than a non‐perforated drainage tube connected to the top of the dressing (−116 ± 1 versus −73 ± 4 mmHg in the wound at a delivered pressure of −125 mmHg for foam, P < 0·01), regardless of the type of wound filler. Gauze and foam are equally effective at delivering negative pressure to the wound bed. Perforated drainage tubes inserted into the wound filler are more efficient than a non‐perforated drainage tubes connected to the top of the dressing. The choice of drainage technique may be particularly important in wounds with a large volume of exudate.

BACKGROUND: Sternocutaneous fistulas (SCFs) after cardiac surgery represent a complex surgical problem involving multiple hospital admissions, prolonged antibiotic treatment, and repeated debridements. Our objective was to identify the incidence of and risk factors for SCF, and to evaluate long-term survival. METHODS: A total of 12,297 patients underwent sternotomy for cardiac surgery between January 1999 and December 2008, and 32 patients were diagnosed as having SCF during follow-up. Risk factors were identified with multivariate analysis and survival was compared using the log-rank test. RESULTS: The cumulative incidence of SCF at one year was 0.23%. There was no significant difference in mean time from sternal closure after cardiac surgery to intervention for SCF with (n = 9) or without (n = 23) preceding sternal wound infection (SWI); 6.1 +/- 4.2 versus 6.9 +/- 4.6 months, (p = ns). Risk factors for developing SCF were previous SWI (odds ratio [OR] = 15.7), renal failure (OR = 12.5), smoking (OR = 4.7), and use of bone wax during cardiac surgery (OR = 4.2). Negative-pressure wound therapy was applied in 20 cases of extensive SCFs. Five-year survival of SCF patients was 58% +/- 1% as compared with 85% +/- 4% in the control group (p = 0.003). CONCLUSIONS: Sternocutaneous fistula is a devastating diagnosis with significant morbidity and mortality. Previous SWI, renal failure, smoking, and use of bone wax are major risk factors. However, in a majority of patients SCF is not preceded by SWI and our results indicate that SCF may be a foreign body infection that develops in susceptible patients with risk factors for poor wound healing. Negative-pressure wound therapy may be a valuable adjunct in the treatment of extensive SCF. (Less)

Negative-pressure wound therapy (NPWT), also known as topical negative-pressure therapy, is widely used to manage wounds and accelerate healing. NPWT has so far been delivered mainly via open-cell polyurethane foam, but increasing interest has been directed toward delivering NPWT via gauze. In the present study, the early effects of NPWT on pressure transduction and wound contraction were examined in wounds filled with either polyurethane foam or gauze. An experimental setup of a porcine wound model was used, in which the animals were anesthetized for 12-14 hours. Negative pressures between -50 and -175 mmHg were applied in -25 mmHg increments. Wound bed pressure was measured using a saline filled catheter sutured to the bottom of the wound. The contraction of the wound edges was also determined. The recordings were performed upon reaching steady state, which typically occurred within 1 minute. For both fillers, wound bed negative pressure increased linearly with delivered vacuum with little deviation from set pressure (correlation coefficient 0.99 in both cases). Similar tissue contraction was observed when using foam and gauze. The most prominent contraction was observed in the range of 0 to -50 mmHg with greater vacuum only producing minor further movement of the wound edge. In conclusion, the present experimental study shows that gauze and foam are equally effective at delivering negative pressure and creating mechanical deformation of the wound.

Previous research has shown -125 mmHg to be the optimal negative pressure for creating an environment that promotes wound healing, and this has therefore been adopted as a standard pressure for patients with deep sternal wound infection. However, it has not yet been clearly shown that -125 mmHg is the optimal pressure from a haemodynamic point of view. Furthermore, there have been reports of cardiac rupture during -125 mmHg negative pressure therapy. We therefore studied the effects of a lower pressure: -75 mmHg. Twelve pigs were used. After median sternotomy, sealed negative pressure therapy of -75 mmHg was applied. Baseline measurements were made and continuous recording of the cardiac output, end-tidal CO(2) production, mean arterial pressure, mean pulmonary pressure (pulmonary artery pressure), systemic vascular resistance, pulmonary vascular resistance, left atrial pressure and central venous pressure was started. Six pigs served as controls. No statistically significant difference was observed in any of the haemodynamic parameters studied, compared with the controls. The present study shows that, with a suitable foam application technique, -75 mmHg can be applied without compromising the central haemodynamics.

BACKGROUND: A major problem in clinical lung transplantation is the shortage of donor lungs. Only about 20% of donor lungs are accepted for transplantation. A method to evaluate and recondition lungs ex vivo has been tested on donor lungs that have been rejected for transplantation. METHODS: The donor lungs were reconditioned ex vivo in an extracorporeal membrane oxygenation (ECMO) circuit with STEEN solution (Vitrolife AB, Kungsbacka, Sweden) mixed with erythrocytes. The hyperoncotic solution dehydrates edematous lung tissue. Functional evaluations were performed with deoxygenated perfusate by varying the inspired fraction of oxygen. After the reconditioning, the lungs were kept immersed at 8 degrees C in extracorporeal membrane oxygenation until transplantation was performed. RESULTS: Six of nine initially rejected donor lungs were reconditioned to acceptable function, and in six recipients, double lung transplantation was performed. Three-month survival was 100%. One patient has since died due to sepsis after 95 days, and one due to rejection after 9 months. Four recipients are alive and well without any sign of bronchiolitis obliterans syndrome 24 months after the transplantation. CONCLUSIONS: The result from the present study is promising, and we continue to transplant reconditioned lungs.

The present study was performed to examine pressure transduction to the thoracic cavity during topical negative pressure (TNP) therapy of a sternotomy wound. Seven pigs underwent median sternotomy. Pressure transduction catheters were placed on the anterior surface of the heart (under the foam), in the pericardium (under the heart), in the left pleura and in the oesophagus at the level of the heart. The wound was sealed as for TNP therapy. The vacuum source was set to deliver negative pressures between -50 and -200 mmHg. The pressure on the anterior surface of the heart changed in a linear relationship with the applied negative pressure and was slightly lower than the applied negative pressure (-102 +/- 9 mmHg at delivered -125 mmHg). Further down in the thoracic cavity, in the pericardium (under the heart), in the left pleura and in the oesophagus, the wound pressure was only slightly affected by TNP therapy. In conclusion during TNP therapy, negative pressure is effectively transmitted to anterior portions of the heart. This may explain our recent findings that TNP increases microvascular blood flow in the myocardium. The pressure difference between the anterior and the posterior portions of the heart causes the right ventricle to be sucked up towards the posterior parts of the sternum, where it might be exposed to the sharp edges of the sternal bone, which may result in heart injury.

The aim of this study was to evaluate the possible learning curve effects on survival during the introduction of vacuum-assisted closure (VAC) therapy in patients with deep sternal wound infection (DSWI). Furthermore, predictors of late mortality were analysed and causes of late death were examined. Fifty-three patients (early Group, n = 26, January 1999 to July 2001 versus late group, n = 27, August 2001 to March 2003) were all treated with VAC for DSWI. A follow-up was carried out in September 2006. Multivariate analyses were used to evaluate the predictors of late mortality. The 90-day mortality was 0% in both groups. The survival rates at 5 years were 69.2 +/- 9.1% (early group) versus 58.5 +/- 11.7% (late group), P = ns (non significant). The time interval from cardiac surgery to diagnosis of DSWI and prolonged VAC therapy were identified as independent predictors of late mortality. Our concept for VAC therapy in DSWI seems to be readily introduced in clinical practice. There was no difference in survival between our initial cases and later cases. Late diagnosis and prolonged wound therapy were identified as predictors for late mortality.

Objectives. Hypothermia protects the myocardium from oxidative injury during ischemic stress and reperfusion. We have previously shown that topical negative pressure (TNP) of -50 mmHg significantly increases microvascular blood flow in the underlying myocardium in normal, ischemic, and reperfused porcine myocardium. The present study was designed to elucidate the effect of TNP between -50 mmHg and -150 mmHg on microvascular blood flow in ischemic myocardium during hypothermia. Design. The microvascular blood flow in the myocardium was recorded, in seven pigs, using laser Doppler velocimetry. Analyses were performed in the epicardium and in the myocardium, after 40 minutes of occlusion of the LAD followed by cooling to 31 degrees C. Results. A TNP of -50 mmHg applied to the epicardium, from 23.3+/-3.8 PU to 104.2+/-31.3 PU (*p

Culture of intact arteries is a frequently employed experimental model for investigating the mechanisms governing the regulation of vascular endothelin receptors. Endothelin type A (ET(A)) and type B (ET(B)) receptors on vascular smooth muscle cells are up-regulated in organ culture and the enhanced vasoconstriction mimics the changes that occur in cardiovascular disease. The effect of organ culture on endothelial dilatory endothelin ET(B) receptors is not known. We hypothesize that organ culture decreases the endothelin receptor-mediated dilatation and that this is one possible mechanism by which the effects of the endothelin in blood vessels are altered during culture. Porcine coronary arteries were studied before and after 24 h of culture, using in vitro pharmacology and immunofluorescence. Sarafotoxin 6c and endothelin-1 were used to examine the endothelin ET(A) and ET(B) receptor effects, and the antagonists, Nomega-nitro-l-arginine (l-NOARG) for nitric oxide (NO), indomethacin for prostaglandins and charybdotoxin in combination with apamin for endothelium-derived hyperpolarizing factor (EDHF), were used to study the endothelium-derived dilatory mediators. Organ culture induced up-regulation of the sarafotoxin 6c (ET(B) receptor agonist) and endothelin-1 (ET(A) receptor agonist) elicited vasoconstriction. The sarafotoxin 6c contraction was stronger after endothelium denudation, suggesting endothelium-dependent dilatation. The endothelin-1 contraction was not affected by endothelium denudation. The increase in sarafotoxin 6c contraction after removal of the endothelium was more pronounced before than after organ culture, suggesting down-regulated endothelial endothelin ET(B) receptors. Also, the immunofluorescence staining intensities for endothelial endothelin ET(B) receptors were higher before than after organ culture. Pre-incubation with inhibitors for dilatory mediators suggested that both NO and EDHF play a vasodilatory role, while prostaglandins are not involved. In conclusion, endothelial endothelin ET(B) receptors induce NO and EDHF mediated vasodilatation in porcine coronary arteries. In organ culture, endothelial endothelin ET(B) receptors are down-regulated, mimicking the changes that occur in cardiovascular disease. Down-regulation of endothelial endothelin ET(B) receptors may in part explain the increased endothelin ET(B) receptor-mediated vasoconstriction frequently studied in organ culture.

Objectives. Surgical sites infections are very expensive and the total costs for coronary artery bypass grafting (CABG) surgery followed by deep sternal wound infection (DSWI) with conventional therapy are estimated to be 2.8 times that for normal, CABG surgery. Promising results have been reported with vacuum-assisted closure (VAC) therapy in patients with DSWI. This study presents the cost of VAC therapy in patients with DSWI after CABG surgery. Design. Thirty-eight CABG patients with DSWI, between 2001 and 2005, were treated with VAC therapy. The cost of surgery, intensive care, ward care, laboratory tests and other costs were analyzed. Results. No three-month mortality or recurrent infection was observed. The average cost of CABG procedure and treatment of DSWI was 2.5 times higher than the mean cost of CABG alone. No significant correlations were found between the preoperative EuroSCORE and the cost of DSWI therapy. Conclusions. VAC therapy for patients who underwent CABG surgery followed by DSWI seems to be cost effective, and has low mortality rate.

Background:The intention of the present study was to evaluate possible cardioprotective properties of inhalation anesthesia with sevoflurane.Methods and Materials:A porcine, open-chest model of right ventricular ischemia was used in 7 pigs receiving inhalation anesthesia with sevoflurane. The model was earlier developed and published by our group, using pigs receiving intravenous anesthesia with propofol. They served as controls. The animals were observed for three hours after the induction of right ventricular ischemia by ligation of the main branches supplying the right ventricular free wall.Results:In the sevoflurane group, the cardiac output recovered 2 hours after the induction of ischemia and intact right ventricular stroke work was observed. In the propofol group, no such recovery occurred. The release of troponin T was significantly lower than in the sevoflurane group.Conclusions:Inhalation anesthesia with sevoflurane seems superior to intravenous anesthesia with propofol in acute right ventricular ischemic dysfunction.

Vacuum-assisted closure has been adopted as the first-line treatment for poststernotomy mediastinitis as a result of the excellent clinical outcome achieved with its use. Scientific evidence regarding the mechanisms by which vacuum-assisted closure promotes wound healing has started to emerge, although knowledge regarding the effects on heart and lung function is still limited. The organs in the mediastinum are hemodynamically crucial, and in patients with poststernotomy mediastinitis, vulnerable bypass grafts and reduced cardiac function must be taken into consideration during vacuum-assisted closure therapy. This article provides an overview of the effects of vacuum-assisted closure on heart and lung function and summarizes the current knowledge on the mechanisms by which vacuum-assisted closure therapy promotes wound healing.

Objective Hypothermia is known to limit the extent of myocardial infarction. The earlier hypothermia is applied to an ischemic myocardium, the more tissue can be salvaged. Topical negative pressure (TNP) is known to increase blood flow and stimulate angiogenesis in subcutaneous tissue and skeletal muscle. We have previously shown that a myocardial TNP of −50 mm Hg significantly increases microvascular blood flow in the underlying myocardium in ischemic and reperfused porcine myocardium. The present study was designed to elucidate the effect of different TNP levels on microvascular blood flow in reperfused myocardium during hypothermia. Methods Seven pigs underwent median sternotomy. The microvascular blood flow in the myocardium was recorded before and after the application of −50, −75, −100, −125, and −150 mm Hg using laser Doppler velocimetry. Analysis was performed in the epicardium and at a depth of 6 to 8 mm in the myocardium after 40 minutes of occlusion of the left anterior descending artery followed by cooling to 31°C, and reperfusion for another 20 minutes. Results A TNP of −50 mm Hg significantly increased blood the flow in the epicardium, from 116.7 ± 10.0 PU to 244.5 ± 52.6 PU (*P < 0.05) at 31°C. A TNP of −50 mm Hg significantly increased microvascular blood flow in the myocardium, from 155.0 ± 8.4 PU to 236.7 ± 61.5 PU (*P < 0.05). Conclusions Only a TNP of −50 mm Hg, applied over the left anterior descending artery region in reperfused hypothermic myocardium significantly increased the microvascular blood flow in the epicardium and in the myocardium.

Background. Topical negative pressure (TNP) therapy has been adopted as a first-line treatment for wound healing. One of the mechanisms by which TNP improves healing is by stimulating blood flow to the wound edge. Among patients with ischemic heart disease, it is of great importance to improve the microvascular blood flow in the myocardium during episodes of ischemia to protect the myocardium from infarction. The present study was designed to elucidate the effect of TNP on microvascular blood flow in the myocardium. Methods. Six pigs underwent median sternotomy. The microvascular blood flow in the myocardium was recorded, before and after the application of TNP, by using laser Doppler velocimetry. Analyses were performed before left anterior descending artery ( LAD) occlusion ( normal myocardium), after 20 minutes of LAD occlusion ischemic myocardium), and after 20 minutes of reperfusion (reperfused myocardium). Results. TNP at -0 mm Hg increased microvascular blood flow in the normal myocardium from 14.7 +/- 3.9 perfusion units (PU) before to 25.8 +/- 6.1 PU after TNP application ( p < 0.05), in the ischemic myocardium from 7.2 +/- 1.5 PU before to 13.8 +/- 2.6 PU after TNP application ( p < 0.05), and in the reperfused myocardium from 10.8 +/- 2.0 PU before to 19.3 +/- 5.6 PU after TNP application ( p < 0.05). Conclusions. TNP increases the microvascular blood flow significantly in normal, ischemic, and reperfused myocardium and may provide a novel therapeutic tool in the treatment of ischemic myocardium. (Less)

OBJECTIVES: In Sweden, two centres perform lung transplantation for a population of about 9 million and the entire population is covered for lung transplantation by government health insurance. Lund University Hospital is one of these centres. This retrospective report reviews the 25-year experience of the Skane University Hospital Lung Transplant Program with particular emphasis on short-term outcome and long-term survival but also between different subgroups of patients and types of transplant [single-lung transplantation (SLTx) versus double-lung transplantation (DLTx)] procedure performed.METHODS: Between January 1990 and June 2014, 278 patients underwent lung transplantation at the Skane University Hospital Sweden. DLTx was performed in 172 patients, SLTx was performed in 97 patients and heart-lung transplantation was performed in 9 patients. In addition, 15 patients required retransplantation (7 DLTx and 8 SLTx).RESULTS: Overall 1-, 5-, 10-, 15- and 20-year survival rates were 88, 65, 49, 37 and 19% for the whole cohort. DLTx recipients showed 1-, 5-, 10- and 20-year survival rates of 90, 71, 60 and 30%, compared with SLTx recipients with 1-, 5-, 10- and 20-year survival rates of 83, 57, 34 and 6% (P < 0.05), respectively. Comparing the use of intraoperative extracorporeal membrane oxygenation, extracorporeal circulation (ECC) and no circulatory support in the aspect of survival, a significant difference in favour of intraoperative ECC was seen.CONCLUSIONS: Superior long-term survival rates were seen in recipients diagnosed with cystic fibrosis, α1-antitrypsin deficiency and pulmonary hypertension. DLTx showed better results compared with SLTx especially at 10 years post-transplant. In the present study, we present cumulative incidence rates of bronchiolitis obliterans syndrome of 15% at 5 years, 26% at 10 years and 32% at 20 years post-transplant; these figures are in line with the lowest rates presented internationally. (Less)

Recent studies indicate acceptable survival rates in elderly patients treated surgically for acute type A aortic dissection (aTAAD). However, the impact of preoperative hemodynamic compromise or organ malperfusion on outcomes of such patients is still unclear.In a retrospective study of 341 patients, 101 qualified as elderly (≥70 years old). Subjects were further grouped by clinical presentation, using the Penn classification. Univariate and multivariable analyses were conducted to identify variables reflecting in-hospital and long-term mortality.Relative to younger subjects, elderly patients showed significantly higher rates of in-hospital mortality (24.8% vs. 14.6%, p = 0.025) and DeBakey type 2 dissections at presentation (40% vs. 18% p 0.001), with significantly fewer presenting as Penn class Ab (p = 0.010). Penn class Ac was identified as an independent predictor of in-hospital mortality at all ages. Estimated long-term survival was poorer in the elderly (log rank p 0.001); but in-hospital mortality, based on Penn classification, was similar for both age groups. Survival rates of Penn class Aa subjects at one, five, and 10 years were lower in elderly (vs. younger) patients (79 ± 5.6% vs. 90 ± 2.7%, 68 ± 6.7% vs. 80 ± 3.9%, and 39 ± 10.3% vs. 75 ± 4.6%, respectively; log rank p 0.001).Overall in-hospital mortality is higher in elderly patients surgically treated for aTAAD. Malperfusion and/or hemodynamic instability at presentation confer a dismal prognosis, independent of patient age.