AATS announces the publication of an Expert Consensus Documents (ECD) in the January issue of JTCVS on "The Use of Mechanical Circulatory Support in Lung Transplantation". The function of an ECD is to provide recommendations and options about procedures, interventions, case management, pertinent research, best practices, and other aspects of the field of Cardiothoracic surgery. International specialists are brought together by AATS Clinical Practice Standards Committees to conduct rigorous studies of the literature and, through a strict consensus process, produce documents that will guide and direct practitioners throughout the world.
The Use of Mechanical Circulatory Support in Lung Transplantation: 2022 AATS Expert Consensus Document
The use of mechanical circulatory support (MCS) in lung transplantation has increased as strategies evolve to incorporate support in the pre-, intra-, and postoperative settings. There is significant practice variability, however, in use of these techniques and relatively limited data to help establish institutional protocols. The AATS Clinical Practice Standard Committee assembled an international panel of 16 lung transplant physicians to develop a consensus document with recommendations for the use of MCS before, during, and after lung transplantation.
Achieving optimal results in lung transplantation requires a wide range of strategies. MCS is an important mechanism for helping critically ill patients through the peri-transplant period. The panel performed a focused review of the literature about MCS for pre-operative stabilization, facilitation of the operation, and postoperative support. Despite the complexity of the decision-making process about treatment of these patients, the panel achieved consensus on 36 recommendations for how and when to use mechanical circulatory support in lung transplantation. These recommendations included the use of veno-venous extra-corporeal membrane oxygenation (ECMO) as a bridging strategy in the pre-operative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplant, and the benefit of supporting selected patients with MCS postoperatively.
These recommendations are intended to provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation. As the field continues to gain experience with this patient population and additional data become available, some of these recommendations may require revision. Until that time, this document is a useful reference for practitioners navigating the complicated courses that lung transplant patients can exhibit.
