Management of Severe Pulmonary Arterial Hypertension

 

 Buy Article Permissions and Reprints

Abstract

Despite advances in medical therapies, pulmonary arterial hypertension (PAH), continues to cause significant morbidity and mortality. Although, the right ventricle can adapt to an increase in afterload, progression of the pulmonary vasculopathy that characterizes PAH causes many patients to develop progressive right ventricular (RV) failure. Furthermore, acute RV decompensation may develop from disorders that lead to either an acute increase in cardiac demand or an increase in ventricular afterload including interruptions in medical therapy, arrhythmia, or pulmonary embolism. The poor reserve of the right ventricle, RV ischemia, and adverse RV influence on left ventricular filling may lead to a global reduction in oxygen delivery and multiorgan failure. The authors present an approach to patients with advanced PAH focusing on both medical and surgical strategies to improve RV function based upon current evidence and physiological principles.

Note

All authors contributed equally to this work. They drafted parts of the article and worked together on the complete article.

• References

• 1 Kawut SM, Horn EM, Berekashvili KK , et al. New predictors of outcome in idiopathic pulmonary arterial hypertension. Am J Cardiol 2005; 95 (2) 199-203
  CrossrefPubMedGoogle Scholar
• 2 Rana MS, Christoffels VM, Moorman AFM. A molecular and genetic outline of cardiac morphogenesis. Acta Physiol (Oxf) 2013; 207 (4) 588-615
  CrossrefPubMedGoogle Scholar
• 3 Sheehan F, Redington A. The right ventricle: anatomy, physiology and clinical imaging. Heart 2008; 94 (11) 1510-1515
  CrossrefPubMedGoogle Scholar
• 4 Drake JI, Bogaard HJ, Mizuno S , et al. Molecular signature of a right heart failure program in chronic severe pulmonary hypertension. Am J Respir Cell Mol Biol 2011; 45 (6) 1239-1247
  CrossrefPubMedGoogle Scholar
• 5 Hoffman D, Sisto D, Frater RW, Nikolic SD. Left-to-right ventricular interaction with a noncontracting right ventricle. J Thorac Cardiovasc Surg 1994; 107 (6) 1496-1502
  PubMedGoogle Scholar
• 6 Santamore WP, Dell'Italia LJ. Ventricular interdependence: significant left ventricular contributions to right ventricular systolic function. Prog Cardiovasc Dis 1998; 40 (4) 289-308
  CrossrefPubMedGoogle Scholar
• 7 Sarnoff SJ, Mitchell JH, Gilmore JP, Remensnyder JP. Homeometric autoregulation in the heart. Circ Res 1960; 8: 1077-1091
  CrossrefPubMedGoogle Scholar
• 8 Hon JK, Steendijk P, Khan H, Wong K, Yacoub M. Acute effects of pulmonary artery banding in sheep on right ventricle pressure-volume relations: relevance to the arterial switch operation. Acta Physiol Scand 2001; 172 (2) 97-106
  CrossrefPubMedGoogle Scholar
• 9 Gaynor SL, Maniar HS, Bloch JB, Steendijk P, Moon MR. Right atrial and ventricular adaptation to chronic right ventricular pressure overload. Circulation 2005; 112 (9, Suppl): I212-I218
  PubMedGoogle Scholar
• 10 Grothoff M, Hoffmann J, Abdul-Khaliq H , et al. Right ventricular hypertrophy after atrial switch operation: normal adaptation process or risk factor? A cardiac magnetic resonance study. Clin Res Cardiol 2012; 101 (12) 963-971
  CrossrefPubMedGoogle Scholar
• 11 Jurcut R, Giusca S, Ticulescu R , et al. Different patterns of adaptation of the right ventricle to pressure overload: a comparison between pulmonary hypertension and pulmonary stenosis. J Am Soc Echocardiogr 2011; 24 (10) 1109-1117
  PubMedGoogle Scholar
• 12 Sim M-M. Adaptation of the systemic right ventricle in a congenitally corrected transposition of the great arteries. Circulation 2013; 127 (7) e448-e450
  CrossrefPubMedGoogle Scholar
• 13 Bartelds B, Borgdorff MA, Smit-van Oosten A , et al. Differential responses of the right ventricle to abnormal loading conditions in mice: pressure vs. volume load. Eur J Heart Fail 2011; 13 (12) 1275-1282
  CrossrefPubMedGoogle Scholar
• 14 Szabó G, Soós P, Bährle S , et al. Adaptation of the right ventricle to an increased afterload in the chronically volume overloaded heart. Ann Thorac Surg 2006; 82 (3) 989-995
  CrossrefPubMedGoogle Scholar
• 15 Grignola JC, Ginés F, Bia D, Armentano R. Improved right ventricular-vascular coupling during active pulmonary hypertension. Int J Cardiol 2007; 115 (2) 171-182
  CrossrefPubMedGoogle Scholar
• 16 Piazza G, Goldhaber SZ. The acutely decompensated right ventricle: pathways for diagnosis and management. Chest 2005; 128 (3) 1836-1852
  CrossrefPubMedGoogle Scholar
• 17 Rich S. Right ventricular adaptation and maladaptation in chronic pulmonary arterial hypertension. Cardiol Clin 2012; 30 (2) 257-269
  CrossrefPubMedGoogle Scholar
• 18 Benza RL, Miller DP, Gomberg-Maitland M , et al. Predicting survival in pulmonary arterial hypertension: Insights from the registry to evaluate early and long-term pulmonary arterial hypertension disease management (reveal). Circulation 2010; 122 (2) 164-172
  CrossrefPubMedGoogle Scholar
• 19 Swiston JR, Johnson SR, Granton JT. Factors that prognosticate mortality in idiopathic pulmonary arterial hypertension: a systematic review of the literature. Respir Med 2010; 104 (11) 1588-1607
  CrossrefPubMedGoogle Scholar
• 20 Hoeper MM, Granton J. Intensive care unit management of patients with severe pulmonary hypertension and right heart failure. Am J Respir Crit Care Med 2011; 184 (10) 1114-1124
  CrossrefPubMedGoogle Scholar
• 21 Balik M, Pachl J, Hendl J, Martin B, Jan P, Jan H. Effect of the degree of tricuspid regurgitation on cardiac output measurements by thermodilution. Intensive Care Med 2002; 28 (8) 1117-1121
  CrossrefPubMedGoogle Scholar
• 22 Fares WH, Blanchard SK, Stouffer GA , et al. Thermodilution and Fick cardiac outputs differ: impact on pulmonary hypertension evaluation. Can Respir J 2012; 19 (4) 261-266
  PubMedGoogle Scholar
• 23 Nuñez S, Maisel A. Comparison between mixed venous oxygen saturation and thermodilution cardiac output in monitoring patients with severe heart failure treated with milrinone and dobutamine. Am Heart J 1998; 135 (3) 383-388
  CrossrefPubMedGoogle Scholar
• 24 van de Veerdonk MC, Kind T, Marcus JT , et al. Progressive right ventricular dysfunction in patients with pulmonary arterial hypertension responding to therapy. J Am Coll Cardiol 2011; 58 (24) 2511-2519
  CrossrefPubMedGoogle Scholar
• 25 Forfia PR, Vachiéry J-L. Echocardiography in pulmonary arterial hypertension. Am J Cardiol 2012; 110 (6, Suppl): 16S-24S
  CrossrefPubMedGoogle Scholar
• 26 Howard LS, Grapsa J, Dawson D , et al. Echocardiographic assessment of pulmonary hypertension: standard operating procedure. Eur Respir Rev 2012; 21 (125) 239-248
  CrossrefPubMedGoogle Scholar
• 27 Denault AY, Haddad F, Jacobsohn E, Deschamps A. Perioperative right ventricular dysfunction. Curr Opin Anaesthesiol 2013; 26 (1) 71-81
  CrossrefPubMedGoogle Scholar
• 28 Haddad F, Peterson T, Fuh E , et al. Characteristics and outcome after hospitalization for acute right heart failure in patients with pulmonary arterial hypertension. Circ Heart Fail 2011; 4 (6) 692-699
  CrossrefPubMedGoogle Scholar
• 29 Huynh TN, Weigt SS, Sugar CA, Shapiro S, Kleerup EC. Prognostic factors and outcomes of patients with pulmonary hypertension admitted to the intensive care unit. J Crit Care 2012; 27 (6) e7-e13
  CrossrefPubMedGoogle Scholar
• 30 Sztrymf B, Souza R, Bertoletti L , et al. Prognostic factors of acute heart failure in patients with pulmonary arterial hypertension. Eur Respir J 2010; 35 (6) 1286-1293
  CrossrefPubMedGoogle Scholar
• 31 Lahm T, McCaslin CA, Wozniak TC , et al. Medical and surgical treatment of acute right ventricular failure. J Am Coll Cardiol 2010; 56 (18) 1435-1446
  CrossrefPubMedGoogle Scholar
• 32 Belenkie I, Dani R, Smith ER, Tyberg JV. Effects of volume loading during experimental acute pulmonary embolism. Circulation 1989; 80 (1) 178-188
  CrossrefPubMedGoogle Scholar
• 33 Mercat A, Diehl JL, Meyer G, Teboul JL, Sors H. Hemodynamic effects of fluid loading in acute massive pulmonary embolism. Crit Care Med 1999; 27 (3) 540-544
  CrossrefPubMedGoogle Scholar
• 34 Benoist D, Stones R, Drinkhill MJ , et al. Cardiac arrhythmia mechanisms in rats with heart failure induced by pulmonary hypertension. Am J Physiol Heart Circ Physiol 2012; 302 (11) H2381-H2395
  CrossrefPubMedGoogle Scholar
• 35 Medi C, Kalman JM, Ling L-H , et al. Atrial electrical and structural remodeling associated with longstanding pulmonary hypertension and right ventricular hypertrophy in humans. J Cardiovasc Electrophysiol 2012; 23 (6) 614-620
  CrossrefPubMedGoogle Scholar
• 36 Mak S, Witte KK, Al-Hesayen A, Granton JJ, Parker JD. Cardiac sympathetic activation in patients with pulmonary arterial hypertension. Am J Physiol Regul Integr Comp Physiol 2012; 302 (10) R1153-R1157
  CrossrefPubMedGoogle Scholar
• 37 McGowan CL, Swiston JS, Notarius CF , et al. Discordance between microneurographic and heart-rate spectral indices of sympathetic activity in pulmonary arterial hypertension. Heart 2009; 95 (9) 754-758
  CrossrefPubMedGoogle Scholar
• 38 Tongers J, Schwerdtfeger B, Klein G , et al. Incidence and clinical relevance of supraventricular tachyarrhythmias in pulmonary hypertension. Am Heart J 2007; 153 (1) 127-132
  CrossrefPubMedGoogle Scholar
• 39 Olsson KM, Nickel NP, Tongers J, Hoeper MM. Atrial flutter and fibrillation in patients with pulmonary hypertension. Int J Cardiol 2012;
  PubMedGoogle Scholar
• 40 Gan CT, Lankhaar JW, Marcus JT , et al. Impaired left ventricular filling due to right-to-left ventricular interaction in patients with pulmonary arterial hypertension. Am J Physiol Heart Circ Physiol 2006; 290 (4) H1528-H1533
  PubMedGoogle Scholar
• 41 Marcus JT, Vonk Noordegraaf A, Roeleveld RJ , et al. Impaired left ventricular filling due to right ventricular pressure overload in primary pulmonary hypertension: noninvasive monitoring using MRI. Chest 2001; 119 (6) 1761-1765
  CrossrefPubMedGoogle Scholar
• 42 Nelson GS, Sayed-Ahmed EY, Kroeker CA , et al. Compression of interventricular septum during right ventricular pressure loading. Am J Physiol Heart Circ Physiol 2001; 280 (6) H2639-H2648
  PubMedGoogle Scholar
• 43 Kasner M, Westermann D, Steendijk P , et al. Left ventricular dysfunction induced by nonsevere idiopathic pulmonary arterial hypertension: a pressure-volume relationship study. Am J Respir Crit Care Med 2012; 186 (2) 181-189
  CrossrefPubMedGoogle Scholar
• 44 Grant DA, Kondo CS, Maloney JE, Tyberg JV. Pulmonary and pericardial limitations to diastolic filling of the left ventricle of the lamb. Am J Physiol 1994; 266 (6 Pt 2) H2327-H2333
  PubMedGoogle Scholar
• 45 Marcus JT, Gan CT-J, Zwanenburg JJM , et al. Interventricular mechanical asynchrony in pulmonary arterial hypertension: left-to-right delay in peak shortening is related to right ventricular overload and left ventricular underfilling. J Am Coll Cardiol 2008; 51 (7) 750-757
  CrossrefPubMedGoogle Scholar
• 46 Aqel RA, Aljaroudi W, Hage FG, Tallaj J, Rayburn B, Nanda NC. Left ventricular collapse secondary to pericardial effusion treated with pericardicentesis and percutaneous pericardiotomy in severe pulmonary hypertension. Echocardiography 2008; 25 (6) 658-661
  CrossrefPubMedGoogle Scholar
• 47 Hemnes AR, Gaine SP, Wiener CM. Poor outcomes associated with drainage of pericardial effusions in patients with pulmonary arterial hypertension. South Med J 2008; 101 (5) 490-494
  CrossrefPubMedGoogle Scholar
• 48 Handoko ML, Lamberts RR, Redout EM , et al. Right ventricular pacing improves right heart function in experimental pulmonary arterial hypertension: a study in the isolated heart. Am J Physiol Heart Circ Physiol 2009; 297 (5) H1752-H1759
  CrossrefPubMedGoogle Scholar
• 49 Hardziyenka M, Surie S, de Groot JR , et al. Right ventricular pacing improves haemodynamics in right ventricular failure from pressure overload: an open observational proof-of-principle study in patients with chronic thromboembolic pulmonary hypertension. Europace 2011; 13 (12) 1753-1759
  CrossrefPubMedGoogle Scholar
• 50 Ciarka A, Vachièry J-L, Houssière A , et al. Atrial septostomy decreases sympathetic overactivity in pulmonary arterial hypertension. Chest 2007; 131 (6) 1831-1837
  CrossrefPubMedGoogle Scholar
• 51 Diller G-P, Lammers AE, Haworth SG , et al. A modelling study of atrial septostomy for pulmonary arterial hypertension, and its effect on the state of tissue oxygenation and systemic blood flow. Cardiol Young 2010; 20 (1) 25-32
  CrossrefPubMedGoogle Scholar
• 52 Koeken Y, Kuijpers NHL, Lumens J, Arts T, Delhaas T. Atrial septostomy benefits severe pulmonary hypertension patients by increase of left ventricular preload reserve. Am J Physiol Heart Circ Physiol 2012; 302 (12) H2654-H2662
  CrossrefPubMedGoogle Scholar
• 53 Rothman A, Beltran D, Kriett JM, Smith C, Wolf P, Jamieson SW. Graded balloon dilation atrial septostomy as a bridge to lung transplantation in pulmonary hypertension. Am Heart J 1993; 125 (6) 1763-1766
  CrossrefPubMedGoogle Scholar
• 54 Sandoval J, Gaspar J, Peña H , et al. Effect of atrial septostomy on the survival of patients with severe pulmonary arterial hypertension. Eur Respir J 2011; 38 (6) 1343-1348
  CrossrefPubMedGoogle Scholar
• 55 Doyle RL, McCrory D, Channick RN, Simonneau G, Conte J. American College of Chest Physicians. Surgical treatments/interventions for pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest 2004; 126 (1, Suppl): 63S-71S
  CrossrefPubMedGoogle Scholar
• 56 Reichenberger F, Pepke-Zaba J, McNeil K, Parameshwar J, Shapiro LM. Atrial septostomy in the treatment of severe pulmonary arterial hypertension. Thorax 2003; 58 (9) 797-800
  CrossrefPubMedGoogle Scholar
• 57 Gibbons Kroeker CA, Adeeb S, Shrive NG, Tyberg JV. Compression induced by RV pressure overload decreases regional coronary blood flow in anesthetized dogs. Am J Physiol Heart Circ Physiol 2006; 290 (6) H2432-H2438
  CrossrefPubMedGoogle Scholar
• 58 Wong YY, Ruiter G, Lubberink M , et al. Right ventricular failure in idiopathic pulmonary arterial hypertension is associated with inefficient myocardial oxygen utilization. Circ Heart Fail 2011; 4 (6) 700-706
  CrossrefPubMedGoogle Scholar
• 59 Shehata ML, Lossnitzer D, Skrok J , et al. Myocardial delayed enhancement in pulmonary hypertension: pulmonary hemodynamics, right ventricular function, and remodeling. AJR Am J Roentgenol 2011; 196 (1) 87-94
  CrossrefPubMedGoogle Scholar
• 60 Granton J, Moric J. Pulmonary vasodilators—treating the right ventricle. Anesthesiol Clin 2008; 26 (2) 337-353 , vii
  PubMedGoogle Scholar
• 61 Price LC, Wort SJ, Finney SJ, Marino PS, Brett SJ. Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review. Crit Care 2010; 14 (5) R169
  CrossrefPubMedGoogle Scholar
• 62 Kwak YL, Lee CS, Park YH, Hong YW. The effect of phenylephrine and norepinephrine in patients with chronic pulmonary hypertension*. Anaesthesia 2002; 57 (1) 9-14
  CrossrefPubMedGoogle Scholar
• 63 Evora PRB, Pearson PJ, Rodrigues AJ, Viaro F, Schaff HV. Effect of arginine vasopressin on the canine epicardial coronary artery: experiments on V1-receptor-mediated production of nitric oxide. Arq Bras Cardiol 2003; 80 (5) 483-494
  PubMedGoogle Scholar
• 64 Holmes CL, Landry DW, Granton JT. Science review: Vasopressin and the cardiovascular system part 1—receptor physiology. Crit Care 2003; 7 (6) 427-434
  CrossrefPubMedGoogle Scholar
• 65 Leather HA, Segers P, Berends N, Vandermeersch E, Wouters PF. Effects of vasopressin on right ventricular function in an experimental model of acute pulmonary hypertension. Crit Care Med 2002; 30 (11) 2548-2552
  CrossrefPubMedGoogle Scholar
• 66 Zamanian RT, Haddad F, Doyle RL, Weinacker AB. Management strategies for patients with pulmonary hypertension in the intensive care unit. Crit Care Med 2007; 35 (9) 2037-2050
  CrossrefPubMedGoogle Scholar
• 67 Apitz C, Honjo O, Humpl T , et al. Biventricular structural and functional responses to aortic constriction in a rabbit model of chronic right ventricular pressure overload. J Thorac Cardiovasc Surg 2012; 144 (6) 1494-1501
  CrossrefPubMedGoogle Scholar
• 68 Nagendran J, Archer SL, Soliman D , et al. Phosphodiesterase type 5 is highly expressed in the hypertrophied human right ventricle, and acute inhibition of phosphodiesterase type 5 improves contractility. Circulation 2007; 116 (3) 238-248
  CrossrefPubMedGoogle Scholar
• 69 Borgdorff MAJ, Bartelds B, Dickinson MG , et al. Sildenafil enhances systolic adaptation, but does not prevent diastolic dysfunction, in the pressure-loaded right ventricle. Eur J Heart Fail 2012; 14 (9) 1067-1074
  CrossrefPubMedGoogle Scholar
• 70 Ebade AA, Khalil MA, Mohamed AK. Levosimendan is superior to dobutamine as an inodilator in the treatment of pulmonary hypertension for children undergoing cardiac surgery. J Anesth 2012;
  PubMedGoogle Scholar
• 71 Lee TS, Hou X. Vasoactive effects of ketamine on isolated rabbit pulmonary arteries. Chest 1995; 107 (4) 1152-1155
  CrossrefPubMedGoogle Scholar
• 72 Williams GD, Philip BM, Chu LF , et al. Ketamine does not increase pulmonary vascular resistance in children with pulmonary hypertension undergoing sevoflurane anesthesia and spontaneous ventilation. Anesth Analg 2007; 105 (6) 1578-1584 , table of contents
  CrossrefPubMedGoogle Scholar
• 73 McCaul C, Kornecki A, Engelberts D, McNamara P, Kavanagh BP. Positive end-expiratory pressure improves survival in a rodent model of cardiopulmonary resuscitation using high-dose epinephrine. Anesth Analg 2009; 109 (4) 1202-1208
  CrossrefPubMedGoogle Scholar
• 74 Barst RJ, Rubin LJ, Long WA , et al; Primary Pulmonary Hypertension Study Group. A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. N Engl J Med 1996; 334 (5) 296-301
  CrossrefPubMedGoogle Scholar
• 75 Nagendran J, Sutendra G, Paterson I , et al. Endothelin axis is upregulated in human and rat right ventricular hypertrophy. Circ Res 2013; 112 (2) 347-354
  CrossrefPubMedGoogle Scholar
• 76 Christie JD, Edwards LB, Kucheryavaya AY , et al; International Society of Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: 29th adult lung and heart-lung transplant report-2012. J Heart Lung Transplant 2012; 31 (10) 1073-1086
  CrossrefPubMedGoogle Scholar
• 77 Lordan JL, Corris PA. Pulmonary arterial hypertension and lung transplantation. Expert Rev Respir Med 2011; 5 (3) 441-454
  CrossrefPubMedGoogle Scholar
• 78 Orens JB, Estenne M, Arcasoy S , et al; Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. International guidelines for the selection of lung transplant candidates: 2006 update—a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant 2006; 25 (7) 745-755
  CrossrefPubMedGoogle Scholar
• 79 Benza RL, Miller DP, Barst RJ, Badesch DB, Frost AE, McGoon MD. An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL Registry. Chest 2012; 142 (2) 448-456
  CrossrefPubMedGoogle Scholar
• 80 Diller G-P, Dimopoulos K, Broberg CS , et al. Presentation, survival prospects, and predictors of death in Eisenmenger syndrome: a combined retrospective and case-control study. Eur Heart J 2006; 27 (14) 1737-1742
  CrossrefPubMedGoogle Scholar
• 81 Dimopoulos K, Inuzuka R, Goletto S , et al. Improved survival among patients with Eisenmenger syndrome receiving advanced therapy for pulmonary arterial hypertension. Circulation 2010; 121 (1) 20-25
  CrossrefPubMedGoogle Scholar
• 82 Chen H, Shiboski SC, Golden JA , et al. Impact of the lung allocation score on lung transplantation for pulmonary arterial hypertension. Am J Respir Crit Care Med 2009; 180 (5) 468-474
  CrossrefPubMedGoogle Scholar
• 83 Dandel M, Lehmkuhl HB, Mulahasanovic S , et al. Survival of patients with idiopathic pulmonary arterial hypertension after listing for transplantation: impact of iloprost and bosentan treatment. J Heart Lung Transplant 2007; 26 (9) 898-906
  CrossrefPubMedGoogle Scholar
• 84 Bermudez CA, Rocha RV, Zaldonis D , et al. Extracorporeal membrane oxygenation as a bridge to lung transplant: midterm outcomes. Ann Thorac Surg 2011; 92 (4) 1226-1231 , discussion 1231–1232
  CrossrefPubMedGoogle Scholar
• 85 Crotti S, Iotti GA, Lissoni A , et al. The organ allocation waiting time during extracorporeal bridge to lung transplantation affects outcomes. Chest 2013;
  PubMedGoogle Scholar
• 86 Fuehner T, Kuehn C, Hadem J , et al. Extracorporeal membrane oxygenation in awake patients as bridge to lung transplantation. Am J Respir Crit Care Med 2012; 185 (7) 763-768
  CrossrefPubMedGoogle Scholar
• 87 Hoopes CW, Kukreja J, Golden J, Davenport DL, Diaz-Guzman E, Zwischenberger JB. Extracorporeal membrane oxygenation as a bridge to pulmonary transplantation. J Thorac Cardiovasc Surg 2013; 145 (3) 862-867 , discussion 867–868
  CrossrefPubMedGoogle Scholar
• 88 Nosotti M, Rosso L, Tosi D , et al. Extracorporeal membrane oxygenation with spontaneous breathing as a bridge to lung transplantation. Interact Cardiovasc Thorac Surg 2013; 16 (1) 55-59
  CrossrefPubMedGoogle Scholar
• 89 Toyoda Y, Bhama JK, Shigemura N , et al. Efficacy of extracorporeal membrane oxygenation as a bridge to lung transplantation. J Thorac Cardiovasc Surg 2013; 145 (4) 1065-1070 , discussion 1070–1071
  CrossrefPubMedGoogle Scholar
• 90 de Perrot M, Granton JT, McRae K , et al. Impact of extracorporeal life support on outcome in patients with idiopathic pulmonary arterial hypertension awaiting lung transplantation. J Heart Lung Transplant 2011; 30 (9) 997-1002
  CrossrefPubMedGoogle Scholar
• 91 Fischer S, Hoeper MM, Tomaszek S , et al. Bridge to lung transplantation with the extracorporeal membrane ventilator Novalung in the veno-venous mode: the initial Hannover experience. ASAIO J 2007; 53 (2) 168-170
  CrossrefPubMedGoogle Scholar
• 92 Hämmäinen P, Schersten H, Lemström K , et al. Usefulness of extracorporeal membrane oxygenation as a bridge to lung transplantation: a descriptive study. J Heart Lung Transplant 2011; 30 (1) 103-107
  CrossrefPubMedGoogle Scholar
• 93 Lang G, Taghavi S, Aigner C , et al. Primary lung transplantation after bridge with extracorporeal membrane oxygenation: a plea for a shift in our paradigms for indications. Transplantation 2012; 93 (7) 729-736
  CrossrefPubMedGoogle Scholar
• 94 Olsson KM, Simon A, Strueber M , et al. Extracorporeal membrane oxygenation in nonintubated patients as bridge to lung transplantation. Am J Transplant 2010; 10 (9) 2173-2178
  CrossrefPubMedGoogle Scholar
• 95 Strueber M, Hoeper MM, Fischer S , et al. Bridge to thoracic organ transplantation in patients with pulmonary arterial hypertension using a pumpless lung assist device. Am J Transplant 2009; 9 (4) 853-857
  CrossrefPubMedGoogle Scholar
• 96 Schmid C, Philipp A, Hilker M , et al. Bridge to lung transplantation through a pulmonary artery to left atrial oxygenator circuit. Ann Thorac Surg 2008; 85 (4) 1202-1205
  CrossrefPubMedGoogle Scholar
• 97 Javidfar J, Brodie D, Iribarne A , et al. Extracorporeal membrane oxygenation as a bridge to lung transplantation and recovery. J Thorac Cardiovasc Surg 2012; 144 (3) 716-721
  CrossrefPubMedGoogle Scholar
• 98 Rehder KJ, Turner DA, Hartwig MG , et al. Active rehabilitation during ECMO as a bridge to lung transplantation. Respir Care 2012;
  PubMedGoogle Scholar
• 99 Iacono A, Groves S, Garcia J, Griffith B. Lung transplantation following 107 days of extracorporeal membrane oxygenation. Eur J Cardiothorac Surg 2010; 37 (4) 969-971
  CrossrefPubMedGoogle Scholar