Thomas Schweiger

Medical University of Vienna | MedUni Vienna · Klinische Abteilung für Thoraxchirurgie

Idiopathic subglottic stenosis (ISGS) is a rare fibrotic disease of the upper trachea with an unknown pathomechanism. It typically affects adult Caucasian female patients, leading to severe airway constrictions caused by progressive scar formation and inflammation with clinical symptoms of dyspnoea, stridor and potential changes to the voice. Endos...

OBJECTIVES Treatment options for benign subglottic stenosis include endoscopic techniques or open surgery. Although endoscopic treatment is less invasive, a considerable proportion of patients develop recurrent stenosis. Endoscopic pretreatments do not exclude patients from a later surgical repair, however, the impact of previous endoscopic treatme...

Background Surgical treatment for airway stenosis necessitates personalized techniques based on the stenosis location and length, leading to favorable surgical outcomes. However, there is limited literature on functional outcomes following laryngotracheal surgery with an adequate number of patients. Material and Methods We conducted a retrospectiv...

Background In older patients, a limited physical reserve is considered a contraindication for lung transplantation (LTx). Herein, we aimed to establish a computed tomography (CT)-based quantification of physical reserve in older patients scheduled for transplantation. Methods This retrospective study included patients older than 60 years who receiv...

OBJECTIVES Dual-lumen cannulas for veno-venous (VV) extracorporeal membrane oxygenation (ECMO) support are typically inserted in the right internal jugular vein (RIJV); however, some scenarios can make this venous route inaccessible. This multicentre case series aims to evaluate if single-site cannulation using an alternative venous access is safe...

OBJECTIVES Compared to lung resections, airway procedures are relatively rare in thoracic surgery. Despite this, a growing number of dedicated airway centers has formed throughout Europe. These centers are characterized by a close interdisciplinary collaboration and they often act as supra-regional referring centers. To date, most evidence of airwa...

Idiopathic subglottic stenosis (ISGS) is a rare fibrotic disease of the upper trachea with an unknown pathomechanism. It typically affects adult Caucasian female patients, leading to severe airway constrictions caused by progressive scar formation and inflammation with clinical symptoms of dyspnoea, stridor and potential changes to the voice. Endos...

Background: Postoperative pain influences rehabilitation, postoperative complications and quality of life. Despite its impact, there are no uniform treatment guidelines. Different centers seem to use various strategies. This study aims to analyze pain management regimens used after anatomic VATS resections in Austrian thoracic surgery units, with a...

Background Cricotracheal resection (CTR) is considered the standard of care for patients suffering from idiopathic subglottic stenosis (iSGS). Although CTR results in permanent restoration of airway patency, it has a mild to moderate impact on voice quality. Here we propose modifications of the standard CTR technique to make it a voice-preserving p...

Background: Higher levels of inflammatory biomarkers are associated with an increased risk of perioperative atrial fibrillation and myocardial injury after non-cardiac surgery (MINS). Colchicine is an anti-inflammatory drug that might reduce the incidence of these complications. Methods: COP-AF was a randomised trial conducted at 45 sites in 11...

Background Management of mechanically ventilated patients can be improved with monitoring of key pulmonary function parameters that facilitate individualization and optimization. The VQm Pulmonary Health Monitor™ (PHM) (Rostrum Medical Innovations Inc., Vancouver, Canada) is a new monitor that continuously measures pulmonary blood flow (PBF), funct...

Zusammenfassung In der pädiatrischen Atemwegschirurgie sind zahlreiche anatomische Besonderheiten, spezifische Krankheitsbilder sowie spezielle Operationstechniken zu beachten. Auch an spezialisierten Zentren sind diese Eingriffe bei pädiatrischen Patienten eher selten. Ätiologisch handelt es sich meist um erworbene Stenosen als Folge von Frühgebur...

Background: The main causes of early respiratory failure after lung transplantation include primary graft dysfunction (PGD), acute rejection, and infection. This report describes a case of unclear early respiratory failure after bilateral lung transplantation for extensive COVID-19-induced acute respiratory distress syndrome (ARDS). Methods: We...

Background: Acute lung injury (ALI) occurs in 23% unilateral. Models of unilateral ALI were developed and used previously without clearly demonstrating the strictly unilateral nature and severity of lung injury by the key parameters characterizing ALI as defined by the American Thoracic Society (ATS). Thus, the use of unilateral ALI remained rare...

Objectives Organ donation after circulatory death (DCD) has become a standard in liver, kidney and lung transplantation (LTx). Based on recent innovations in ex-vivo heart preservation, heart transplant centers have started to accept DCD heart allografts. As the heart has very limited tolerance to warm ischemia, changes to the DCD organ procurement...

Background Acute lung injury (ALI) occurs in 23% unilateral. Models of unilateral ALI were developed and used previously without clearly demonstrating the strictly unilateral nature and severity of lung injury by the key parameters characterizing ALI as defined by the American Thoracic Society (ATS). Thus, the use of unilateral ALI remained rare de...

Objectives Traditionally, patients on bridge-to-transplant extracorporeal membrane oxygenation were kept sedated and intubated. However, awake bridging strategies have evolved during recent years. This study aims to elaborate differences in physical activity and postoperative outcomes after lung transplantation, depending on bridging strategy and d...

Alemtuzumab is a monoclonal antibody targeting CD52, used as induction therapy after lung transplantation (LTx). Its engagement produces a long-lasting immunodepletion; however, the mechanisms driving cell reconstitution are poorly defined. We hypothesized that miRNAs are involved in this process. The expression of a set of miRNAs, cytokines and co...

Purpose Approximately 50% of lung transplantation (LuTx) recipients develop de-novo DSA (dnDSAs) within the first year. In our institution, therapy is started only in case of clinical antibody-mediated rejection. The majority of dnDSAs disappears within 3-6 months; however, in some patients they persist. The aim of the study was to determine whethe...

PURPOSE Dual-lumen extracorporal membrane oxygenation (ECMO) cannulation is considered technically challenging and harbors the risk for potential life-threatening complications during cannulation. Dual-lumen cannula insertion is either performed under ultrasound or fluoroscopy guidance. Both techniques have significant disadvantages, such as examin...

Background Tracheobronchial injury is a rare but potentially life-threatening condition. Various surgical treatment options have been described for symptomatic patients with full-thickness injury. However, studies comprising a meaningful number of patients are sparse. Methods We retrospectively analyzed all patients, who received surgical repair o...

Zusammenfassung In der pädiatrischen Atemwegschirurgie sind zahlreiche anatomische Besonderheiten, spezifische Krankheitsbilder sowie spezielle Operationstechniken zu beachten. Auch an spezialisierten Zentren sind diese Eingriffe bei pädiatrischen Patienten eher selten. Ätiologisch handelt es sich meist um erworbene Stenosen als Folge von Frühgebur...

Alemtuzumab is a monoclonal antibody targeting CD52, increasingly used as induction therapy after transplantation. The aim of this study is to analyze the outcomes of alemtuzumab induction therapy followed by a low‐dose maintenance immunosuppression in a large single center cohort of lung transplant recipients. All patients, who received alemtuzuma...

Alemtuzumab is a monoclonal antibody targeting CD52, used as induction therapy after lung transplantation (LTx). Its engagement produces a long-lasting immunodepletion; however, the mechanisms driving cell reconstitution are poorly defined. We hypothesized that miRNAs are involved in this process. The expression of a set of miRNAs, cytokines and co...

Objectives In patients suffering from idiopathic pulmonary arterial hypertension (iPAH), cardiac function can be impaired in the early postoperative phase after lung transplantation as the chronically untrained left ventricle is prone to fail. Thus, restrictive fluid management is pivotal to unload the left heart. In our institution, continuous ren...

Purpose The evaluation of donor lungs heavily depends on the subjective judgment of the retrieval surgeon. As a consequence, acceptance rates vary significantly among transplant centers. We aimed to determine donor ventilation parameters in a prospective study and test if they could be used as objective quality criteria during organ retrieval. Met...

Purpose In patients suffering from idiopathic pulmonary arterial hypertension (iPAH), cardiac function can be impaired in the early postoperative phase after lung transplantation as the chronically untrained left ventricle is prone to fail. Thus, restrictive fluid management is pivotal to unload the left heart. In our institution, continuous renal...

OBJECTIVES A tension-free anastomosis is crucial to minimize the risk of airway complications after laryngotracheal surgery. The ‘guardian’ chin stitch is placed to prevent hyperextension of the neck in the early postoperative period. This manoeuvre was introduced early in tracheal surgery and is now routinely performed by many airway surgeons. How...

BACKGROUND The evaluation of donor lungs heavily depends on the subjective judgment of the retrieval surgeon. As a consequence, acceptance rates vary significantly among transplant centers. We aimed to determine donor ventilation parameters in a prospective study and test if they could be used as objective quality criteria during organ retrieval....

Objective Single-stage laryngotracheal reconstruction (SSLTR) provides a definite surgical treatment for patients with complex glotto-subglottic stenosis. To date, the impact of SSLTR on the functional outcome after surgery has not been analyzed. Methods A retrospective analysis of all patients receiving a SSLTR between 11/2012 and 10/2019 was per...

Background: For endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under general anaesthesia, both rigid bronchoscopy and laryngeal masks (LMAs) with superimposed high-frequency jet ventilation can be used. Despite the fact that in Europe rigid bronchoscopy for EBUS-TBNA is still widely used, an increasing number of centr...

Purpose The post-operative phase after LTx for iPAH can be challenging. A restrictive fluid management facilitates unloading of the untrained left ventricle and reduces the risk for reperfusion edema. In our center, hemofiltration (HF) is pre-emptively started when a patient cannot be balanced negatively despite maximal medicamentous effort. It rem...

Purpose The diagnosis and treatment of antibody-mediated rejection (AMR) after LTx has gained increasing recognition within the transplant community. Extracorporeal photopheresis (ECP) modulates various pathways of the immune system and is currently used to treat CLAD. In AMR, adding ECP to established AMR treatments could potentially prevent rebou...

Purpose ECLS is increasingly used to bridge deteriorating candidates to LTx. Most centers would only bridge patients previously approved for Tx and on the waiting list. Our center has accepted to transplant patients supported with ECLS device previously unknown to the transplant team. Methods Unscreened patients on ECLS for respiratory failure wer...

Background Airway management during repair of laryngotracheal stenosis is demanding and there is currently no accepted standard of care. Recently, an increasing number of airway centers have started to use a laryngeal mask until the airway is surgically exposed and cross-table ventilation can be initiated. However, detailed data on this approach ar...

Laryngotracheal resections have become a clinical routine in experienced airway centers and even extended glotto-subglottic resections and reconstructions can be performed with low complication rates and excellent long-term airway patency. However, reports on the functional outcome after laryngotracheal resections are sparse and there is no general...

Surgical treatment of benign subglottic stenoses can be challenging. It requires the close cooperation of an experienced team that includes various specialist disciplines. The treatment success will be evaluated with an extensive documentation of voice quality, lung function and swallowing function. The stenosis has to be analyzed in terms of its e...

Background Lung transplantation has evolved to a routinely performed surgical procedure in patients with end-stage pulmonary disease. Bronchial healing problems are rare but represent a potential life threatening complication. Herein, we aimed to define the incidence, classification and treatment of bronchial complications after lung transplantatio...

Objective: Intraoperative extracorporeal membrane oxygenation (ECMO) is usually reserved to support patients during complex lung transplantation. We hypothesized that a routine application of intraoperative ECMO in all patients improves primary graft function. Methods: Patients receiving a bilateral lung transplantation between November 2016 and...

Objectives: The current score for primary graft dysfunction after lung transplantation relies heavily on chest radiographs, and radiologic judgment can make the difference between the lowest (primary graft dysfunction 0) and the highest (primary graft dysfunction 3) grade. This study aimed to evaluate interobserver variability of the scoring of po...

Pulmonary metastasectomy (PM) with curative intent is a routinely performed surgical procedure in a variety of end-stage malignant diseases with secondary spreading to the lungs. Current selection criteria for PM are solely based on few clinical factors without regarding the biology and behavior of the underlying malignant disease. Hence, great var...

Purpose Acceptance rates of donor lungs differ substantially among transplant centers. This is mainly due to a lack of standardized functional parameters of the donor lungs, which can predict organ function after lung transplantation (LTx). Methods A prospective evaluation of lung donors were performed in three transplant centers between January 2...

Purpose Anastomotic healing problems are rare but confer significant morbidity after lung transplantation. Herein, we aimed to define the incidence, classification and treatment of bronchial complications as defined by the latest ISHLT guidelines, using a single running suture as a standard technique. Methods Patients receiving lung transplantatio...

Purpose: Preoperative assessment of benign subglottic stenosis is usually performed by endoscopy and a computed tomography scan. Both diagnostic modalities have relevant limitations and sometimes an accurate assessment of the extent of disease is challenging. Description: Based on computed tomography scans of benign glotto-subglottic stenosis an...

Objectives: Extracorporeal life support is increasingly used to bridge deteriorating candidates to lung transplantation. Nevertheless, only few systematic reports with a limited number of patients exist describing this practice and its changes over time. Methods: We retrospectively reviewed our institutional database and performed an era analysi...

Question addressed by the study The value of induction therapy in lung transplantation is controversial. According to the ISHLT, only about 50% of patients transplanted within the last 10 years received induction therapy. We reviewed our institutional experience to investigate the impact of induction therapy on short- and long-term outcomes. Mater...

Univariate analysis for LB risk. (DOCX)

Multivariable analysis for mortality risk and CLAD risk. (DOCX)

Univariate analysis for CLAD risk. (DOCX)

Multivariable analysis for ACR risk and LB risk. (DOCX)

Univariate analysis for ACR risk. (DOCX)

Univariate analysis for mortality risk. (DOCX)

Number of patient at each time point. (DOCX)

Background: Pulmonary metastasectomy is one of the cornerstones in the treatment of oligometastatic colorectal cancer (CRC). However, the selection of patients who benefit from a surgical resection is difficult. Mutational profiling has become an essential part of diagnosis and treatment of malignant disease. Despite this, comprehensive data on the...

Objectives: Bilateral vocal fold paralysis (VFP) is a severe complication after laryngotracheal (LT) surgery. The reduced glottic opening leads to significant respiratory distress immediately after the operation and requires the placement of a tracheostomy in most cases. Patients with a pre-existing unilateral VFP or expected recurrent nerve resec...

A 55-year-old woman was referred to our department with a bilateral stenosis of both main bronchi starting at the level of the carina and a blind-ended pouch originating from the carina. Differential diagnosis of diffuse narrowing of the intrathoracic central airways was excluded during the diagnostic workup. Recurrent infection of the blind-ended...

Objectives The value of intraoperative ECMO in lung transplantation remains controversial. In our department, ECMO has been used routinely for intraoperatively unstable patients since more than 15 years. Recently, we have extended its indication to a preemptive application in almost all cases. In addition, we prolong ECMO into the early postoperati...