Case report: Paracorporeal lung assist device for 215 days as a bridge-to-lung transplantation in a patient with bronchopulmonary dysplasia and severe pulmonary hypertension

Pulmonary hypertension (PH) is a known and life limiting complication of preterm born young adults with bronchopulmonary dysplasia (BPD), ultimately leading to progressive right ventricular (RV) failure. Prognosis remains poor, especially in patients unresponsive to modern vasoactive pharmacotherapy. Therefore, lung transplantation presents the treatment of choice to avert cardiac failure. With limited donor organ availability and long waiting times, the implantation of a paracorporeal lung assist device (PLAD) is a way to bridge the patient as an alternative to veno-arterial ECMO. Herein, we present the case of a prematurely born 23-year-old female, who developed severe PH due to BPD and consequently experienced therapy refractory RV failure. Urgent PLAD implantation was performed and the patient successfully underwent double-lung transplantation after 215 days of PLAD support. No major PLAD-associated complications occurred and full recovery of RV function could be observed after double-lung transplantation.

[1]  M. Humbert,et al.  2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. , 2022, European heart journal.

[2]  A. Bos,et al.  Fate of pulmonary hypertension associated with bronchopulmonary dysplasia beyond 36 weeks postmenstrual age , 2020, Archives of Disease in Childhood.

[3]  G. Hansmann,et al.  Pulmonary hypertension in bronchopulmonary dysplasia , 2020, Pediatric Research.

[4]  D. Rios,et al.  Pulmonary Hypertension Associated with Bronchopulmonary Dysplasia: A Review , 2019, Pediatric allergy, immunology, and pulmonology.

[5]  I. Schulze-Neick,et al.  The Creation of an Interatrial Right-To-Left Shunt in Patients with Severe, Irreversible Pulmonary Hypertension: Rationale, Devices, Outcomes , 2019, Current Cardiology Reports.

[6]  P. Corris,et al.  Intensive care, right ventricular support and lung transplantation in patients with pulmonary hypertension , 2019, European Respiratory Journal.

[7]  P. Wearden,et al.  Paracorporeal Lung Devices: Thinking Outside the Box , 2018, Front. Pediatr..

[8]  M. Palta,et al.  Early Pulmonary Vascular Disease in Young Adults Born Preterm , 2018, American journal of respiratory and critical care medicine.

[9]  A. Bos,et al.  Identification of gaps in the current knowledge on pulmonary hypertension in extremely preterm infants: A systematic review and meta‐analysis , 2018, Paediatric and perinatal epidemiology.

[10]  S. Keshavjee,et al.  Extracorporeal life support as a bridge to lung transplantation–experience of a high‐volume transplant center , 2017, The Journal of thoracic and cardiovascular surgery.

[11]  G. Hansmann,et al.  Treatment of children with pulmonary hypertension. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK , 2016, Heart.

[12]  S. Berkelhamer,et al.  Pulmonary hypertension in bronchopulmonary dysplasia. , 2013, Seminars in perinatology.

[13]  S. Keshavjee,et al.  Impact of extracorporeal life support on outcome in patients with idiopathic pulmonary arterial hypertension awaiting lung transplantation. , 2011, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[14]  H. Holtby,et al.  Emergency interventional lung assist for pulmonary hypertension. , 2009, Anesthesia and analgesia.

[15]  T. Welte,et al.  Bridge to Thoracic Organ Transplantation in Patients with Pulmonary Arterial Hypertension Using a Pumpless Lung Assist Device , 2009, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[16]  M. Humbert,et al.  Long-Term Response to Calcium Channel Blockers in Idiopathic Pulmonary Arterial Hypertension , 2005, Circulation.

[17]  J. Coalson Pathology of new bronchopulmonary dysplasia. , 2003, Seminars in neonatology : SN.

[18]  P. Eghtesady,et al.  Paracorporeal lung assist devices as a bridge to recovery or lung transplantation in neonates and young children. , 2014, The Journal of thoracic and cardiovascular surgery.