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J Thorac Cardiovasc Surg 2006;131:719-723
© 2006 The American Association for Thoracic Surgery

Cardiothoracic Transplantation

Bridge to lung transplantation with the novel pumpless interventional lung assist device NovaLung

^a Hannover Thoracic Transplant Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
^b Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany

Received for publication June 27, 2005; revisions received September 22, 2005; accepted for publication October 10, 2005.

^_* Address for reprints: Martin Strueber, MD, Director, Hannover Thoracic Transplant and Cardiac Assist Program, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany (Email: strueber{at}thg.mh-hannover.de).

BACKGROUND: Worsening of lung failure in patients awaiting a lung transplantation might lead to ventilation-refractory hypercapnia and respiratory acidosis. Most transplant centers consider pretransplantation extracorporeal membrane oxygenation as a contraindication for lung transplantation because of the poor outcome. We have, for the first time, applied the novel pumpless interventional lung assist NovaLung for bridge to lung transplantation in patients with severe ventilation-refractory hypercapnia. We report on our initial experience.

METHODS: Between March 2003 and March 2005, 176 lung transplantations were performed, of which 60% were high-urgency lung transplantations. Twelve of the high-urgency recipients had severe ventilation-refractory hypercapnia and respiratory acidosis. These patients were connected to the novel pumpless interventional lung assist NovaLung for bridge to lung transplantation.

RESULTS: The length of interventional lung assist NovaLung support was 15 ± 8 days (4-32 days). PaO ₂, pH, and PaCO ₂ levels in arterial blood prior to interventional lung assist NovaLung implantation were 71 ± 27 mm Hg, 7.121 ± 0.1, and 128 ± 42 mm Hg, respectively. Six hours after interventional lung assist NovaLung implantation, PaO ₂, pH, and PaCO ₂ levels had changed to 83 ± 17 mm Hg (ns), 7.344 ± 0.1 (P < .05), and 52 ± 5 mm Hg (P < .05), respectively. Four patients died of multiorgan failure, 2 patients before and 2 after lung transplantation. Thus, 10 out of 12 patients were successfully bridged to lung transplantation, and 8 are still alive (1-year survival, 80%).

CONCLUSIONS: This report suggests that interventional lung assist NovaLung implantation is an effective bridge to lung transplantation strategy in patients with ventilation-refractory hypercapnia.

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