UCLA lung transplant program performs landmark 1,000th surgery
TheUCLA Lung Transplant program performed its 1,000th transplant surgery in mid-September, becoming the first program on the West Coast, and one of only seven centers nationwide, to achieve this milestone.The recipient of the donor lungs was Elba De Contreras, 59, from Goleta, California, who suffered from idiopathic pulmonary fibrosis and pulmonary hypertension. The six-hour surgery took place at Ronald Reagan UCLA Medical Center, led by Dr. Abbas Ardehali, surgical director of the lung and heart transplant programs.De Contreras, who relied on an oxygen tank prior to her surgery, is recuperating well and said she feels happy and energetic. With three sons and four grandkids, De Contreras said she looks forward to resuming her social life. Her husband, Willy, said that the donor lungs have given his wife “new life” and she looks 20 years younger.“This is a big milestone for UCLA’s lung transplant program” said Ardehali, a professor of cardiothoracic surgery. “Achieving 1,000 lung transplants is a reflection of the experience and dedication of our team.”Lung transplantation has come a long way since UCLA performed its first operation in 1988. While the procedure used to have a significant morbidity rate, as new techniques were developed the 30-day survival rate improved dramatically, reaching 98 percent at UCLA currently, compared to the national average of 96.5 percent.These advances in patient outcomes are attributable to several fac...
We present a series of patients with sarcoidosis associated PH and describe correlation between the pre-transplant hemodynamic data from a right heart catheterization (RHC) and vascular morphologic changes in the native explanted lungs.
Central veno-arterial (VA) ECMO provides reliable cardiopulmonary support in selected patients with end-stage lung diseases and severe pulmonary hypertension or cardiac instability. Ambulation dramatically improves patient outcomes. We investigated the outcomes of a new technique of ambulatory central VA ECMO via tunneled cannula insertion and right thoracotomy.
Pre-transplant irreversible pulmonary hypertension (PH) is a contraindication to heart transplantation (HTx) due to the high risk of post-transplant right ventricular (RV) dysfunction. When ventricular assist devices (VAD) are not available, HTx may be considered in selected patients PH.
There is a lack of evidence to guide appropriate donor sizing in recipients with moderate pulmonary hypertension (PH) awaiting transplant. Best practice suggests to oversize hearts for such recipients to prevent post-operative right ventricular failure.
Cardiac allograft vasculopathy (CAV) is a highly prevalent vaso-occlusive disease that is a leading cause of graft failure and mortality after heart transplantation. While the pathogenesis of CAV remains incompletely understood, histologic evidence suggests that macrophages, which constitute an important part of the innate immune response, may play an important role. Prior studies in pulmonary hypertension have shown that macrophage-derived leukotriene B4 (LTB4) induces proliferation and hypertrophy of human pulmonary artery smooth muscle cells.
ISHLT guidelines recommend serial right heart catheterization (RHC) to survey pulmonary hypertension in patients awaiting heart transplant. In LVAD as BTT patients the ideal surveillance frequency is unknown in those without prior pulmonary hypertension or whose pre-LVAD PVR normalized after surgery. Here, we review the utility of our surveillance RHC protocol.
Pulmonary hypertension (PH) is frequent in HT candidates; identifying patients (pts) with urgent need of HT is challenging. Guidelines suggest diastolic transpulmonary gradient (DPG) ≥ 7 mmHg to differentiate combined (CpC) and isolated (IpC) post-capillary PH, but its clinical relevance in this setting is unknown. The aim of our study is to analyze the prognostic impact of PH classification in pts referred for HT, and the interplay of CpC and IpC with markers of ventricular f unction.
We examined our single-center experience using ECLS as bridge to recovery (BTR), non-transplant surgery (BTNTS), or lung transplantation (BTT) in patients with PH.
Although the surgical level of disease in chronic thromboembolic pulmonary hypertension (CTEPH) is routinely described, no study has systematically correlated the preoperative computed tomography pulmonary angiogram (CTPA) with surgical level.
Chronic thromboembolic pulmonary hypertension (CTEPH) can develop in 1 out of 25 (4%) patients following an acute pulmonary embolism (PE). It is recommended that high risk patients on anticoagulants, who have persistent shortness of breath post-PE, should be screened for CTEPH. Ventilation-perfusion scan is considered a gold standard tool for screening for CTEPH. This retrospective study sought to describe the use of CTEPH-related diagnostic and medical procedures post-PE in the United States.