-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Patients awaiting heart transplantation in Eurotransplant are prioritized by waiting time and medical urgency. To reduce mortality, the introduction of post-transplant survival in an allocation model based on the concept of survival benefit might be more appropriate. The aim of this study was to assess the prognostic accuracy of the Heart Failure Survival Score (HFSS), the Seattle Heart Failure Model (SHFM), the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) model, and the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score for predicting mortality. METHODS: The HFSS, SHFM, the adapted SHFM, and the INTERMACS model were evaluated for predicting waiting list mortality among heart transplant candidates, and the IMPACT score was tested for predicting post-transplant mortality in separate Cox regression models. Included were the 448 adult heart transplant candidates listed for an urgent status between October 2010 and June 2011 in Eurotransplant. A Cardiac Allocation Score (CAS) was calculated based on the estimated survival times as predicted by the scores. All analyses were performed for the total cohort and separately for ventricular assist device (VAD) and non-VAD patients. RESULTS: Mortality on the waiting list could significantly be predicted in the non-VAD cohort by HFSS (p = 0.005) and SHFM (p < 0.0001) and after transplant by IMPACT (p < 0.0001). None of the tested scores could predict mortality among VAD-supported patients. CONCLUSIONS: In non-VAD patients, the HFSS, SHFM, and IMPACT provide accurate risk stratification. Further studies will reveal whether these models should be considered as the basis for a new heart allocation policy in Eurotransplant.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 04/2013; · 3.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The durability of ventricular assist device (VAD) therapy improved steadily over the past years. However, driveline infections remain a challenge. To test whether an improved surgical implantation technique may lower the incidence of infections, we analyzed all patients receiving a VAD implantation in the years 2008 and 2009 (group 1) and compared them with all patients who received a VAD in 2011 (group 2) after we changed our implantation method. The new technique involves tunneling of the driveline into the fascia of the musculus rectus abdominis, resulting in a longer, intrafascial run to achieve a better resistance against ascending infections. We retrospectively analyzed 40 patients in group 1 and 41 patients in group 2. One year after implantation, the infection rate was markedly reduced (22.5% [n = 9] group 1 vs. 4.9% [n = 2] group 2, P < 0.001) by the new implantation method. There was, however, no significant improvement in overall mortality. The Cox regression model identified the implantation method as an independent risk factor for 1 year after implantation driveline infection (P < 0.05). In conclusion, the new tunneling technique marks a great leap forward in long-term VAD treatment. However, overall mortality remains high and needs further improvement.
Artificial Organs 01/2013; 37(1):102-7. · 2.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVES: From 2004 to 2009, rotary blood pumps were implanted for heart failure as a bridge to transplant or destination therapy in 101 male and 14 female patients at our institution. We report on our experiences of these patients with a follow-up of 132 patient years. METHODS: Seventy-four HeartMate II axial flow pumps and 41 HeartWare centrifugal pumps were implanted in patients with non-ischaemic (n = 70) or ischaemic cardiomyopathy (n = 45). The mean age of the patients was 50 ± 13 years. All patients were on inotropic support prior to implantation. Extracorporeal membrane oxygenation was used as a bridging procedure in 21 cases. RESULTS: The perioperative mortality was 14%. Hospital discharge occurred on average after 46 ± 33 days. Twenty-two patients of this cohort received a heart transplant 492 ± 342 days after implantation of the device. Two patients died after heart transplantation. A 1-year survival of 73% and a 2-year survival of 69% were recorded, despite a low incidence of transplant procedures. The longest support time was 1686 days. CONCLUSIONS: Modern left ventricular assist device technology can be used successfully for heart failure. The scarcity of donor hearts leads to prolonged periods on the device, and chronic ventricular assist device therapy has become a reality, although bridge to transplant was intended; therefore, sufficient support services for outpatient care of these patients are required.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 12/2012; · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study investigated the use of 2 Synergy Micro-Pumps for full biventricular assist device (BiVAD) support. We examined right-sided and left-sided hemodynamic parameters over a range of right-sided and left-sided pump speeds in an acute, fibrillating, non-beating-heart model in sheep.
Five juvenile sheep (43 ± 2 kg) were implanted with two Synergy Micro-Pumps (CircuLite Inc, Saddle Brook, NJ), 1 in the right (RV) and 1 in the left ventricle (LV), through a median sternotomy. The RVAD outflow graft was anastomosed end-to-side to the pulmonary artery and the LVAD outflow to the ascending aorta. After surgical implantation of both pumps, ventricular fibrillation was induced and hemodynamic parameters were measured at 9 different levels of RVAD pump speed (from 20,000 to 28,000 rpm at 1,000-rpm increments), while the speed of the LVAD was set constant at 24,000, then at 26,000, and finally, at 28,000 rpm.
At a fixed LVAD speed, RVAD and LVAD flow both increased identically as RVAD speed was increased. This was due to redistribution of blood volumes that resulted in resetting of pressure gradients across each pump and each vascular bed in a manner dictated by the pump pressure-flow characteristics. Results were similar with LVAD set at 24,000, 26,000, or 28,000 rpm. At the highest LVAD and RVAD speeds, flow averaged 3.1 ± 0.7 liters/min, and pressures in the right atrium, pulmonary artery, left atrium, and aorta averaged 2.2 ± 3.7, 24.4 ± 6.5, 22.4 ± 5.5, and 56.6 ± 8.5 mm Hg, respectively.
BiVAD support with the 2 Synergy Micro-Pumps is feasible and able to provide full hemodynamic support in sheep. This approach holds promise for providing biventricular partial support in humans and, in particular, for full support in small adults and children.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 09/2012; 31(11):1223-9. · 3.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Patients' perceptions of immunosuppression-related symptom experience impact on quality of life and medication adherence. Using The Modified Transplant Symptom Occurrence and Symptom Distress Scale capturing items on symptom occurrence and symptom distress, 261 heart transplant recipients reported on their symptom experiences. Symptoms occurring with the highest prevalence were tiredness, lack of energy, and nervousness. Men showed erectile dysfunction causing the most distress. Women and younger patients reported significantly higher levels of symptom distress. Distress levels increased with time after transplant. Investigating responses to immunosuppression-related symptom experiences should help develop interventional methods to support long-term outcome.
Journal of Health Psychology 08/2012; · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: Newer generation left ventricular assist devices (LVADs) are established for long-term support. The aim of this multi-modal intervention was to improve the body weight, exercise tolerance and psychosocial status in outpatients on long-term LVAD support. METHODS: Seventy patients participated in this non-randomized intervention study [intervention group (IGr) n = 34; control group (CGr) n = 36] over 18 months (T1-T4); the baseline sample characteristics showed no differences between groups. Dietary counselling and weight management intervention was performed by a dietician based on a specific algorithm. Physical reconditioning followed a home ergometry protocol and was supplemented by psychosocial counselling. The outcomes were measured based on the body mass index (BMI), cardiopulmonary exercise testing and self-report [hospital anxiety and depression scale (HADS), SF-36]. RESULTS: The intervention showed a strong positive effect on nutrition and weight management [95% confidence interval (CI): -0.71-0.69; effect size (ES): 0.907; P = 0.02)], resulting in the normal BMI (kg/m(2)) values in the IGr (T1: 24.0 ± 0.6; T4: 24.5 ± 1.1; P = 0.35) compared with a significant BMI increase in the CGr (T1: 23.8 ± 0.6; T4: 29.7 ± 0.8; P = 0.05). Significant differences appeared regarding exercise tolerance (VO(2)max/% predicted) in favour of IGr patients (IGr: 69 ± 2.9; CGr 62 ± 3.7; P = 0.04). This increase was reflected by patients' self-reporting based on the SF-36 physical component score (IGr: P = 0.04; CGr: P = 0.54). SF-36 psychosocial component scores showed no changes for both groups. However, CGr showed a tendency for increased anxiety scores relative to their counterparts (IGr: 4.95 ± 0.4; CGr: 6.6 ± 0.9; P = 0.03). CONCLUSIONS: IGr patients showed a strong benefit from a multi-modal intervention, including dietary counselling, controlled exercise and psychosocial support. Dietary counselling holds potential to prevent obesity in this patient population.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 06/2012; · 2.40 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Lung transplantation (LTx) of patients on mechanical ventilation (MV) or extracorporeal support (ECS) is controversial because of impaired survival. Prognostic factors to predict survival should be identified.
A retrospective analysis was performed in a single centre of all ventilated LTx-candidates awarded an Eurotransplant (ET) high-urgency (HU) status between November 2004 and July 2009. Clinical data were collected on the first day of HU-status from intubated patients with an approved HU status. Single parameters as well as the lung allocation score (LAS), the Sequential Organ Failure Assessment score (SOFA) and the Simplified Acute Physiology Score (SAPS 2) were calculated. The association of these variables with survival was evaluated.
A total of 100 intubated patients (median age 38 years, 56 % female) fulfilled the inclusion criteria, of whom 60 also required ECS. The main indications were cystic fibrosis (25 %) and idiopathic pulmonary fibrosis (24 %). Median time with HU status was 12 days [interquartile range (IQR) 6-21 days]. Sixty patients were transplanted, five were weaned from mechanical ventilation and 38 died while on the wait list. One-year-survival rates were 57, 36 and 5 % for transplanted patients, all candidates and non-transplanted candidates, respectively (p < 0.001). A SAPS score >24 (median 30, IQR 27-35), a procalcitonin level of >0.5 µg/l (median 0.4, IQR 0.1-1.4 µg/l) and any escalation of bridging strategy were independently associated with mortality (p = 0.021, = 0.003, and < 0.001, respectively). The LAS (median 88, IQR 8-90) did not predict survival (p = 0.92).
High-urgency LTx improves survival in critically ill intubated candidates. Higher SAPS scores, escalating therapy and an abnormal procalcitonin level were associated with a poor outcome.
European Journal of Intensive Care Medicine 04/2012; 38(6):968-75. · 5.17 Impact Factor
-
Martin Strueber
[show abstract]
[hide abstract]
ABSTRACT: Bridging to lung transplantation remains a controversy. Individually, it may be a life-saving therapy to use ventilation and extracorporeal means for gas exchange to keep a patient alive until lung transplantation. Collectively, this may lead to a selection of patients with the worst outcome. New technologies have become available to minimize the adverse events of extracorporeal devices. This may have an impact on the indication and use of such devices and also on the outcome.
Literature of the last 3 years were reviewed for new aspects of extracorporeal gas exchange (extracorporeal membrane oxygenation, ECMO) in order to define the status quo of these therapeutic tools in bridging to lung transplantation. It was found that new oxygenator technologies as well as pump designs miniaturized ECMO systems. In addition, a variety of possibilities for specific indications were described. Recently, many programs work on concepts to use ECMO no longer in addition to mechanical ventilation, but to avoid or wean from ventilation. This situation represents a paradigm shift in the bridging strategies for lung transplantation.
Bridging to lung transplantation changes to concepts avoiding the sequels mechanical ventilation and thereby offers improvement of lung recipients prior to the transplant procedure.
Current opinion in organ transplantation 10/2011; 16(5):458-61. · 1.22 Impact Factor
-
The Journal of thoracic and cardiovascular surgery 09/2011; 143(2):511-3. · 3.41 Impact Factor
-
The Journal of thoracic and cardiovascular surgery 08/2011; 143(2):507-9. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine whether the hydroxy-3-methylglutaryl coenzyme A reductase inhibitor pravastatin has a graft-protective effect, we retrospectively analyzed 502 patients who had undergone lung transplantation in Hannover.
Propensity scores have been calculated for each patient and compared between two groups. Cox Hazard analyses were performed for different parameters (e.g., basic parameters of patients, underlying diagnoses, different operations, and important organ functions after lung transplantation). Lung function after transplantation was monitored using repeated measurement analyses. Additionally, conditional Kaplan-Meier survival analyses were used to explore the impact of different diagnoses, the severity of bronchiolitis obliterans, the type of transplantation, and different immunosuppressant regimes on patient survival.
The results indicate a strong association between the postoperative administration of statins and the improvement of survival, maintenance of graft (lung) function, and slowing of the onset of bronchiolitis obliterans.
These findings suggest a new postoperative therapeutic focus for maintaining graft function.
Transplantation 06/2011; 92(4):486-92. · 4.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to conduct an initial clinical evaluation of the new HeartWare Ventricular Assist System (HeartWare, Inc., Framingham, Massachusetts) in a multicenter, prospective, nonrandomized single-arm clinical trial.
Heart failure is a worldwide epidemic. The effectiveness of heart transplantation and medical therapy is limited, resulting in the emergence of mechanical circulatory support as a primary treatment for end-stage heart disease. Left ventricular assist devices that use rotary pumps are small and durable, which might reduce morbidity and mortality during support.
Fifty heart transplant candidates with New York Heart Association functional class IV symptoms were supported at 5 international centers by the HeartWare System for 180 days, until heart transplant, myocardial recovery and device explant, or death. Patients who continue to be supported have been followed for a minimum of 2 years.
Of the 50 patients, 20 (40%) received transplants, 4 (8%) had the pump explanted after myocardial recovery, and 17 (34%) continue support at 2 years. Nine (18%) patients died during support from sepsis (n = 3), multiple organ failure (n = 3), or hemorrhagic stroke (n = 3). The actual survival at 6, 12, and 24 months was 90%, 84%, and 79%, respectively. In the survivors, measures of quality of life showed a significant improvement over baseline values. Significant improvements were found for recognition memory at 3 months after implant (p = 0.006). The most frequent adverse events were infection and bleeding.
Patients with end-stage heart failure can be safely and effectively supported by the HeartWare Ventricular Assist System with improved quality of life and neurocognitive function.
Journal of the American College of Cardiology 03/2011; 57(12):1375-82. · 14.16 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of the study was to investigate the impact of the lung allocation score (LAS) on mortality among highly urgent (HU) and urgent (U) lung transplant (LTx) candidates in Eurotransplant (ET) and to identify useful additional parameters (LASplus).
All adult LTx candidates for whom a first request for HU or U status was made in 2008 in ET were included (N = 317). Patients were followed until LTx, death on the waiting list (WL), delisting, or closure date (i.e., January 10, 2010). The relationship between the LAS/LASplus and waiting list, post-transplant, and overall mortality was assessed with a multivariate regression model. The LAS and LASplus were decomposed into their basic waitlist and post-transplant components.
Waiting list mortality rate was 22% and 1-year post-transplant mortality rate was 34%. The waitlist component of the LASplus was significantly associated with waiting list mortality (hazard ratio [HR] 1.91, p = 0.021), whereas the LAS was not (p = 0.063). The post-transplant components of both scores were significantly associated with 1-year post-transplant mortality (LAS: HR 2.69, p = 0.005; LASplus: HR 2.55, p = 0.004). Both scores strongly predicted overall mortality (LAS: HR 1.65, p = 0.008; LASplus: HR 1.72, p = 0.005).
LAS accurately predicts overall mortality in critically ill transplant candidates and should therefore be considered as the basis for a new lung allocation policy in ET. An adjustment of the original LAS may be indicated to accurately predict waiting list mortality.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 01/2011; 30(1):22-8. · 3.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Rotary blood pumps used as left ventricular assist devices (LVADs) allow for long-term support and may become suitable alternatives to heart transplantation. Effects of this technology on the coagulation system are not completely understood, leading to controversial anticoagulation protocols. Thus, we investigated the primary hemostasis in patients with chronic LVAD therapy.
Twenty-six outpatients received axial flow LVAD (HeartMate II; Thoratec) for a median support time of 4.5 months. In a cross-sectional protocol, platelet aggregation in response to ADP and epinephrine, von Willebrand antigen (vWF:AG), and collagen-binding capacity (vWF:CB) were obtained. Von Willebrand factor (vWF) multimer analyses were performed, and patients were screened for bleeding events. This analysis was repeated after removal of the device for transplantation or recovery (n=12) and after a median of 15.5 months in ongoing patients (n=11). In all patients on devices, severe impairment of platelet aggregation as well as a loss of large vWF multimers were found. In 10 patients, a decreased vWF:CB/vWF:AG ratio was observed. Bleeding episodes occurred with an incidence of 0.17 per patient-year. After removal of the device, normal patterns of platelet aggregation, multimer analysis, and vWF:CB/vWF:AG ratio were recorded. In the second analysis of ongoing patients, impairment of platelet aggregation and loss of large vWF multimers were verified.
A diagnosis of von Willebrand syndrome type 2 was established in all patients after LVAD implantation, and bleeding events confirmed this finding. Reversibility of this condition was found after removal of the device.
Circulation Heart Failure 11/2010; 3(6):675-81. · 6.29 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Third-generation rotary blood pumps have magnetically levitated rotors that eliminate mechanical wear over the years. Together with their potential for miniaturization, these pumps seem suitable for long-term support of patients with a wide range of body surface areas (BSA). Recently, the novel HVAD pump (HeartWare Inc, Framingham, MA), a miniaturized centrifugal pump with a hydrodynamic, magnetically levitated rotor, became ready for clinical application.
In a multi-institutional trial in Europe and Australia, 23 patients (mean age, 47.9 ± 12 years) in end-stage heart failure were enrolled in 5 centers. The primary end point of the bridge-to-transplant study was survival to heart transplant or survival to 180 days on the device, whichever occurred first. Follow-up data at 1 year are presented. The small size of the device allows for intrapericardial placement of the pump.
Implant procedures were generally fast and uneventful. Mean duration of support was 167 ± 143 days (range, 13-425 days), and mean blood flow provided by the pump was 6.1 ± 1.1 liters/min. At the 180-day end point, 2 patients had undergone successful transplant at 157 and 175 days, 2 patients died while on the device, and 19 patients continued pump support for more than 180 days. Actuarial survival after 6 months was 91% and was 86% at the 1-year follow-up.
The design of the HVAD pump enables a quick and less invasive implantation. The results to date demonstrate satisfactory long-term survival with excellent quality of life in this cohort of 23 patients of the initial multi-institutional Conformité Européene (CE) mark trial.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 11/2010; 29(11):1218-25. · 3.54 Impact Factor
-
The Journal of thoracic and cardiovascular surgery 10/2010; 140(4):936-7. · 3.41 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate and compare health-related quality of life (HRQoL) and physical exercise tolerance in patients after heart transplantation (HTx) or implantation of a left ventricular assist device (LVAD).
A prospective, comparative design was used to characterize changes over time in HRQoL (SF-36) and exercise tolerance in patients after HTx (n = 54) and during LVAD support (n = 36). Nine LVAD patients were lost for follow-up. The majority of patients in both groups were male (97%); the LVAD cohort tended to be younger (p = 0.06).
HRQoL improved significantly in HTx patients in the SF-36 physical (p = 0.02), but not in the psychosocial (p = 0.27) component score during follow-up. In the LVAD group, HRQoL showed improvements for both the SF-36 physical and psychosocial component scores (both p = 0.04). Between-group comparisons revealed better HRQoL for the HTx cohort than the LVAD cohort for 2 of 8 SF-36 subscales. Age-, gender- and body mass index (BMI)-adjusted exercise tolerance (workload; VO(2max)) showed significant improvements for both HTx (p = 0.01) and LVAD (p = 0.01) patients. Adjusted maximum oxygen consumption was higher for HTx patients (p = 0.05) relative to LVAD patients at 8 ± 1 months after implant.
HRQoL and exercise capacity increased in both groups over the time-course of the study. After adjusting for relevant variables, HTx patients showed a higher exercise tolerance compared with the LVAD group during follow-up. Thus, future large-scale intervention studies should emphasize the specific needs of these patient cohorts.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 10/2010; 30(2):204-10. · 3.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Patient satisfaction with left ventricular assist device (LVAD) external equipment has not yet been reported. We aimed to evaluate the quality of two different systems based on patients' perspective and its interrelationship with quality of life. Differential assessment of the HeartMate II axial flow pump (n = 17; Thoratec, Pleasanton, CA, USA) and the HVAD centrifugal pump (n = 10; HeartWare, Inc., Miramar, FL, USA) was obtained from 27 outpatients by a questionnaire 2 months to 2.9 years after device implantation. In addition, a health-related quality of life questionnaire (Short Form-36 [SF-36]) was completed. Overall patients' satisfaction was high. Severe limitations were attributed to the loudness of the power base unit in HeartMate II patients (P = 0.00), and HVAD patients were dissatisfied by the length of the driveline (P = 0.02). Between HVAD and HeartMate II patients, no significant differences in the quality of life (assessed by SF-36) were reported. While the overall satisfaction of outpatients on LVAD support was high, differences between the systems were found. Patients' perspectives may have an important impact on future modification of external components. Ultimately, this may also contribute to an improvement in the quality of life of chronic LVAD patients.
Artificial Organs 09/2010; 34(9):721-5. · 2.00 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Owing to the improved long-term outcome after cardiac transplantation, cardiac allograft vasculopathy or valvular disease is developing late after heart transplantation in a growing number of patients. In this study, we evaluated our results of nonretransplant cardiac surgery in these patients and compared them with those after retransplantation.
Since 1983, a total of 867 heart transplantations have been performed at our institution. Among them, 44 patients underwent nonretransplant cardiac surgery, 4 of them repeatedly. The procedures included 19 coronary artery revascularizations, 20 tricuspid valve procedures, 4 other valvular procedures, 4 aortic operations, and 1 right atrial thrombectomy. Long-term results of these patients were compared with those of 20 patients after late cardiac retransplantation.
Indications for nonretransplant surgery included cardiac allograft vasculopathy, tricuspid regurgitation, aortic and mitral valve insufficiency, as well as acute aortic dissection type A. Mean interval between heart transplantation and reoperation was 8.4 years. Mean follow-up was 5.8 years. Early mortality was 4.5% (2/44). The early deaths were caused by intracerebral bleeding and acute rejection. Actuarial survivals at 1, 5, and 7 years were 84%, 64%, and 58%, respectively. In comparison, early mortality in the retransplant group was 20% (4/20) and survivals at the same time points were 70%, 70%, and 47%, respectively.
According to these results, we consider nonretransplant surgical options for cardiac allograft vasculopathy and valvular disease a safe and effective therapeutic approach with low early mortality and acceptable long-term results.
The Journal of thoracic and cardiovascular surgery 04/2010; 140(2):433-9. · 3.41 Impact Factor
-
Martin Strueber
[show abstract]
[hide abstract]
ABSTRACT: Allocation of grafts for lung transplantation has been directed in many countries to patients in life-threatening conditions. Advances in technology for extracorporeal devices led to new concepts and increased use for bridging to lung transplantation. Taking these two developments into account, it seems that bridging technologies are used more frequently around the world.
The durability of extracorporeal devices for some weeks was described in many institutional and case reports. The change in technology seems to open a new era of possibilities. Use of this new technology not only in bridge to transplant but also as a bridge to recovery in acute respiratory distress syndrome patients was published most recently. Current and future use of extracorporeal gas exchange as an alternative to mechanical ventilation appears in the literature. Use of low resistance membranes in patients with pulmonary hypertension was described as a new therapeutical option.
Bridge to lung transplantation is of increasing importance with new allocation systems and the increasing demand. New extracorporeal technologies address this demand with reliable function for some weeks. But these developments also raise ethical questions of how to use these new tools wisely individually and also collectively for the field of lung transplantation.
Current opinion in critical care 11/2009; 16(1):69-73. · 2.67 Impact Factor
