Impact of cerebrovascular accidents on lung transplant survival.
cardiovascular research
transplant
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
revised:
27
09
2022
received:
06
08
2022
accepted:
15
10
2022
pubmed:
9
11
2022
medline:
6
1
2023
entrez:
8
11
2022
Statut:
ppublish
Résumé
Cerebrovascular accidents (CVA) are a source of postoperative morbidity. Existing data on CVA after lung transplantation (LT) are limited. We aimed to evaluate the impact of CVA on LT survival. A retrospective analysis of LT recipients at the University of Texas Southwestern Medical Center was performed. Data was obtained from the institutional thoracic transplant database between January 2012 and December 2018, which consisted of 476 patients. Patients were stratified by the presence of a postoperative CVA. Univariate comparisons of baseline characteristics, operative variables, and postoperative outcomes between the cohorts were performed. Survival was analyzed by Kaplan-Meier method. Aalen's additive regression model was utilized to assess mortality hazard over time. The incidence of CVA was 4.2% (20/476). Lung allocation score was higher in the CVA cohort (46.2 [41.7, 57.3] vs. 41.5 [35.8, 52.2], p = 0.04). There were no significant differences in operative variables. CVA patients had longer initial intensive care unit (ICU) stays (316 h [251, 557] vs. 124 [85, 218], p < 0.001) and longer length of stay (22 days [17, 53] vs. 15 [11, 26], p = 0.007). CVA patients required more ICU readmissions (35% vs. 15%, p = 0.02) and had a lower rates of home discharge (35% vs. 71%, p < 0.001). Thirty-day mortality was higher in the CVA cohort (20% vs. 1.3%, p < 0.001). Overall survival was lower in the CVA cohort (log rank p = 0.044). Postoperative CVA following LT was associated with longer ICU stays, more ICU readmissions, longer length of stay, and fewer home discharges. Thirty day and long-term mortality were significantly higher in the CVA group.
Sections du résumé
BACKGROUND
BACKGROUND
Cerebrovascular accidents (CVA) are a source of postoperative morbidity. Existing data on CVA after lung transplantation (LT) are limited. We aimed to evaluate the impact of CVA on LT survival.
METHODS
METHODS
A retrospective analysis of LT recipients at the University of Texas Southwestern Medical Center was performed. Data was obtained from the institutional thoracic transplant database between January 2012 and December 2018, which consisted of 476 patients. Patients were stratified by the presence of a postoperative CVA. Univariate comparisons of baseline characteristics, operative variables, and postoperative outcomes between the cohorts were performed. Survival was analyzed by Kaplan-Meier method. Aalen's additive regression model was utilized to assess mortality hazard over time.
RESULTS
RESULTS
The incidence of CVA was 4.2% (20/476). Lung allocation score was higher in the CVA cohort (46.2 [41.7, 57.3] vs. 41.5 [35.8, 52.2], p = 0.04). There were no significant differences in operative variables. CVA patients had longer initial intensive care unit (ICU) stays (316 h [251, 557] vs. 124 [85, 218], p < 0.001) and longer length of stay (22 days [17, 53] vs. 15 [11, 26], p = 0.007). CVA patients required more ICU readmissions (35% vs. 15%, p = 0.02) and had a lower rates of home discharge (35% vs. 71%, p < 0.001). Thirty-day mortality was higher in the CVA cohort (20% vs. 1.3%, p < 0.001). Overall survival was lower in the CVA cohort (log rank p = 0.044).
CONCLUSIONS
CONCLUSIONS
Postoperative CVA following LT was associated with longer ICU stays, more ICU readmissions, longer length of stay, and fewer home discharges. Thirty day and long-term mortality were significantly higher in the CVA group.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4719-4725Informations de copyright
© 2022 Wiley Periodicals LLC.
Références
Chambers DC, Yusen RD, Cherikh WS, et al. The Registry of the International Society for Heart and Lung Transplantation: thirty-fourth adult lung and heart-lung transplantation report-2017; focus theme: allograft ischemic time. J Heart Lung Transplant. 2017;36(10):1047-1059.
Valapour M, Lehr CJ, Skeans MA, et al. OPTN/SRTR 2018 annual data report: lung. Am J Transplant. 2020;20(s1):427-508.
Thabut G, Mal H. Outcomes after lung transplantation. J Thorac Dis. 2017;9(8):2684-2691.
Vlisides P, Mashour GA. Perioperative stroke. Can J Anaesth. 2016;63(2):193-204.
Hogue CW, Gottesman RF, Stearns J. Mechanisms of cerebral injury from cardiac surgery. Crit Care Clin. 2008;24(1):83-98.
Raghavan D, Gao A, Ahn C, et al. Contemporary analysis of incidence of post-operative atrial fibrillation, its predictors, and association with clinical outcomes in lung transplantation. J Heart Lung Transplant. 2015;34(4):563-570.
STS Adult Cardiac Surgery Database Data Specifications. 2020. (4.20.1).
Heid CA, Khoury MK, Maaraoui K, et al. Acute kidney injury in patients undergoing cardiopulmonary bypass for lung transplantation. J Surg Res. 2020;255:332-338.
Therneau TM, Lumley T. Package ‘survival’. R Top Doc. 2015;128:112.
R: A language and environment for statistical computing [computer program]. R Foundation for Statistical Computing; 2020.
Smith PJ, Stonerock GL, Ingle KK, et al. Neurological sequelae and clinical outcomes after lung transplantation. Transplant Direct. 2018;4(4):e353.
Heid C, Khoury M, Vela R, et al. Non-home discharge is not associated with mortality following bilateral lung transplant. J Heart Lung Transplant. 2020;39(4):S386.
Mashour GA, Shanks AM, Kheterpal S. Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery. Anesthesiology. 2011;114(6):1289-1296.
Bucerius J, Gummert JF, Borger MA, et al. Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg. 2003;75(2):472-478.
Smilowitz NR, Guo Y, Rao S, Gelb B, Berger JS, Bangalore S. Perioperative cardiovascular outcomes of non-cardiac solid organ transplant surgery. Eur Heart J Qual Care Clin Outcomes. 2019;5(1):72-78.
Courtwright AM, Rubin E, Robinson EM, et al. In-hospital and subsequent mortality among lung transplant recipients with a prolonged initial hospitalization. Am J Transplant. 2019;19(2):532-539.
Chaaya G, Vishnubhotla P. Pulmonary vein thrombosis: a recent systematic review. Cureus. 2017;9(1):e993.
Jessen ME, Meyer DM, Moncrief CL, Wait MA, Melamed NB, Ring WS. Reducing neurological complications after cardiac transplantation: technical considerations. J Card Surg. 1993;8(5):546-553.
Egan TM, Murray S, Bustami RT, et al. Development of the new lung allocation system in the United States. Am J Transplant. 2006;6(5 Pt 2):1212-1227.
Li SS, Miller R, Tumin D, Stewart WCL, Tobias JD, Hayes D Jr.. Lung allocation score thresholds prioritize survival after lung transplantation. Chest. 2019;156(1):64-70.
Shigemura N, Sclabassi RJ, Bhama JK, et al. Early major neurologic complications after lung transplantation: incidence, risk factors, and outcome. Transplantation. 2013;95(6):866-871.
Mateen FJ, Dierkhising RA, Rabinstein AA, van de Beek D, Wijdicks EFM. Neurological complications following adult lung transplantation. Am J Transplant. 2010;10(4):908-914.
Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited. Lancet. 2009;373(9658):155-166.
Khafagy HF, Hussein NA, Madkour ME, et al. Perioperative effects of anesthesia and surgery on inflammation-coagulation interaction. Life Sci J. 2014;11(12):900-906.