Left atrial pressure continuous monitoring improves early postoperative outcomes after double-lung transplantation for pulmonary hypertension.
6 affiliations
- 1Université Paris-Saclay, Hypertension Pulmonaire: Physiopathologie et Innovation Thérapeutique (HPPIT), Faculté de Médecine, Le Kremlin-Bicêtre, France.
- 2INSERM UMR_S 1358, Marie Lannelongue Hospital, FHU André Cournand, Le Plessis Robinson, France.
- 3Department of Thoracic Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, Le Plessis Robinson, France.
- 4Department of Respiratory and Intensive Care Medicine, AP-HP, ERN-LUNG, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.
- 5Department of Anesthesiology, Marie Lannelongue Hospital, Le Plessis Robinson, France.
- 6Intensive Care Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France.
Abstract
Objectives
Double-lung transplantation (DLTx) has become the treatment of choice for patients with end-stage pulmonary hypertension (PH). However, DLTx remains a demanding procedure, associated with a greater incidence of severe primary graft dysfunction (PGD) compared with other indications. PH-induced cardiac remodeling includes diastolic left heart dysfunction, which may increase the risk of PGD. We hypothesized that continuous monitoring of left atrial pressure (LAP) could improve early outcomes.Methods
We retrospectively reviewed the chart of patients who underwent DLTx for PH between 2015 and 2022. The use of postoperative LAP monitoring was left to the discretion of the attending transplant surgeon.Results
A total of 135 patients underwent DLTx for PH. Among them, 72 were managed either with prophylactic postoperative extracorporeal membrane oxygenation (ECMO) or with ECMO weaning guided by transesophageal echocardiography and Swan-Ganz catheter, whereas 63 underwent systematic ECMO weaning after the placement of a LAP catheter maintained for 3 to 5 days. Both groups were comparable regarding age, PH diagnoses, and disease severity. The LAP group showed significantly less postoperative ECMO use (25% vs 83%, P < .001), shorter duration of mechanical ventilation (5 days [2-13] vs 17.5 days [7-35], P < .001), shorter stay in the intensive care unit (10 days [6-25] vs 28 days [14-49], P < .001), and lower rates of bleeding, groin infection, and overall complications (P ≤ .05). Intraoperative red blood cell transfusion was identified as an independent predictor of LAP monitoring strategy failure. Ninety-day postoperative mortality was not significantly different between groups (1.5% vs 8.3%, P = .12).Conclusions
Continuous postoperative monitoring of LAP after DLTx for PH was associated with improved early outcomes. This strategy may help reduce the incidence of severe postoperative complications in this high-risk population.
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BibTeX
@article{mercier2026left,
title = {{Left atrial pressure continuous monitoring improves early postoperative outcomes after double-lung transplantation for pulmonary hypertension.}},
author = {Olaf Mercier and Luce Dedier and Justin Issard and Laurent Savale and Emeline Plubel and Dominique Fabre and Delphine Mitilian and Jean Baptiste Menager and Thibaut Genty and Iolanda Ion and Jérôme Le Pavec and Elie Fadel and Marie Lannelongue Transplantation Program},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101967},
url = {https://europepmc.org/article/MED/42948114},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Left atrial pressure continuous monitoring improves early postoperative outcomes after double-lung transplantation for pulmonary hypertension.
AU - Olaf Mercier
AU - Luce Dedier
AU - Justin Issard
AU - Laurent Savale
AU - Emeline Plubel
AU - Dominique Fabre
AU - Delphine Mitilian
AU - Jean Baptiste Menager
AU - Thibaut Genty
AU - Iolanda Ion
AU - Jérôme Le Pavec
AU - Elie Fadel
AU - Marie Lannelongue Transplantation Program
PY - 2026
DA - 2026/07/16
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101967
UR - https://europepmc.org/article/MED/42948114
AB - Objectives Double-lung transplantation (DLTx) has become the treatment of choice for patients with end-stage pulmonary hypertension (PH). However, DLTx remains a demanding procedure, associated with a greater incidence of severe primary graft dysfunction (PGD) compared with other indications. PH-induced cardiac remodeling includes diastolic left heart dysfunction, which may increase the risk of PGD. We hypothesized that continuous monitoring of left atrial pressure (LAP) could improve early outcomes.Methods We retrospectively reviewed the chart of patients who underwent DLTx for PH between 2015 and 2022. The use of postoperative LAP monitoring was left to the discretion of the attending transplant surgeon.Results A total of 135 patients underwent DLTx for PH. Among them, 72 were managed either with prophylactic postoperative extracorporeal membrane oxygenation (ECMO) or with ECMO weaning guided by transesophageal echocardiography and Swan-Ganz catheter, whereas 63 underwent systematic ECMO weaning after the placement of a LAP catheter maintained for 3 to 5 days. Both groups were comparable regarding age, PH diagnoses, and disease severity. The LAP group showed significantly less postoperative ECMO use (25% vs 83%, P < .001), shorter duration of mechanical ventilation (5 days [2-13] vs 17.5 days [7-35], P < .001), shorter stay in the intensive care unit (10 days [6-25] vs 28 days [14-49], P < .001), and lower rates of bleeding, groin infection, and overall complications (P ≤ .05). Intraoperative red blood cell transfusion was identified as an independent predictor of LAP monitoring strategy failure. Ninety-day postoperative mortality was not significantly different between groups (1.5% vs 8.3%, P = .12).Conclusions Continuous postoperative monitoring of LAP after DLTx for PH was associated with improved early outcomes. This strategy may help reduce the incidence of severe postoperative complications in this high-risk population.
SN - 2666-2736
ER -