JTCVS open · 2026
Reassessing delayed chest closure in lung transplantation: Outcomes from a propensity score-matched cohort.
СтатьяНазвание и аннотация: Перевод в очереди
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Keogan Andrew, Shacker Mark, Rybachok Artur, Chang Lucia, Wang Lucas, Lin Theodore, Biswas Roy Sreeja, Arjuna Ashwini, Walia Rajat, Hashimi Samad, Bremner Ross M, Schaheen Lara W, Huang Jasmine, Smith Michael A
Аннотация
OBJECTIVE: Delayed chest closure (DCC) is a strategy for managing complex lung transplantation cases. We compared the influences as well as short- and long-term outcomes of DCC to those of primary chest closure (PCC).
METHODS: We retrospectively analyzed lung transplantation procedures between September 15, 2014, and February 25, 2024, at a single center, excluding single-lung, redo, and multiorgan cases. Propensity score matching balanced donor, recipient, and intraoperative factors. Outcomes and survival were evaluated using univariable/multivariable and Kaplan-Meier analyses, respectively.
RESULTS: Of 692 patients, 127 (18%) underwent DCC and 565 (82%) underwent PCC; 86 well-matched pairs were generated. Factors independently associated with DCC included increasing mean pulmonary artery pressure at registration (adjusted odds ratio [aOR], 1.028; 95% CI, 1.002-1.056; P = .038), extracorporeal membrane oxygenation bridge to transplant (aOR, 2.796; 95% CI, 1.138-6.869; P = .025), donation after circulatory death allograft (aOR, 3.263; 95% CI, 1.620-6.571; P < .001), cardiopulmonary bypass during transplant (aOR, 2.613; 95% CI, 1.454-4.696; P = .001), greater transfusion volume (aOR, 1.354 per unit of packed red blood cells; 95% CI, 1.233-1.487; P < .001), and prolonged ischemic time (aOR, 1.192 per hour; 95% CI, 1.063-1.336; P = .003). Postoperatively, DCC recipients experienced higher rates of grade 3 primary graft dysfunction at 72 hours (49% vs 23%; P = .008), mechanical ventilation at 72 hours, extracorporeal membrane oxygenation use, tracheostomy, prolonged ventilatory support, dialysis, and longer hospitalizations (all P values < .05). Rates of sternal disunion, empyema, and unplanned return to operating room (all P values > .3) and overall survival (P = .505) were comparable between groups.
CONCLUSIONS: Well-matched patients who underwent DCC or PCC had comparable rates of pleural space infection, sternal nonunion, and overall survival, although DCC patients had higher rates of early postoperative morbidity.
METHODS: We retrospectively analyzed lung transplantation procedures between September 15, 2014, and February 25, 2024, at a single center, excluding single-lung, redo, and multiorgan cases. Propensity score matching balanced donor, recipient, and intraoperative factors. Outcomes and survival were evaluated using univariable/multivariable and Kaplan-Meier analyses, respectively.
RESULTS: Of 692 patients, 127 (18%) underwent DCC and 565 (82%) underwent PCC; 86 well-matched pairs were generated. Factors independently associated with DCC included increasing mean pulmonary artery pressure at registration (adjusted odds ratio [aOR], 1.028; 95% CI, 1.002-1.056; P = .038), extracorporeal membrane oxygenation bridge to transplant (aOR, 2.796; 95% CI, 1.138-6.869; P = .025), donation after circulatory death allograft (aOR, 3.263; 95% CI, 1.620-6.571; P < .001), cardiopulmonary bypass during transplant (aOR, 2.613; 95% CI, 1.454-4.696; P = .001), greater transfusion volume (aOR, 1.354 per unit of packed red blood cells; 95% CI, 1.233-1.487; P < .001), and prolonged ischemic time (aOR, 1.192 per hour; 95% CI, 1.063-1.336; P = .003). Postoperatively, DCC recipients experienced higher rates of grade 3 primary graft dysfunction at 72 hours (49% vs 23%; P = .008), mechanical ventilation at 72 hours, extracorporeal membrane oxygenation use, tracheostomy, prolonged ventilatory support, dialysis, and longer hospitalizations (all P values < .05). Rates of sternal disunion, empyema, and unplanned return to operating room (all P values > .3) and overall survival (P = .505) were comparable between groups.
CONCLUSIONS: Well-matched patients who underwent DCC or PCC had comparable rates of pleural space infection, sternal nonunion, and overall survival, although DCC patients had higher rates of early postoperative morbidity.