Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practices
Extracorporeal life support (ECLS) serves as a bridge to lung transplantation (BTT) for patients with acute respiratory failure (ARF) or right ventricular (RV) dysfunction/failure (RVD/RVF). Proper assessment and management of RV function in BTT patients are crucial for successful outcomes. However,...
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Elsevier
2025-08-01
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| Series: | JHLT Open |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2950133425001119 |
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| author | Michaela Orlitová Bert Demeulenaere Dieter Van Beersel Dirk E. Van Raemdonck Robin Vos Laurens J. Ceulemans Steffen Rex Laurent Godinas Tom Verbelen Arne P. Neyrinck |
| author_facet | Michaela Orlitová Bert Demeulenaere Dieter Van Beersel Dirk E. Van Raemdonck Robin Vos Laurens J. Ceulemans Steffen Rex Laurent Godinas Tom Verbelen Arne P. Neyrinck |
| author_sort | Michaela Orlitová |
| collection | DOAJ |
| description | Extracorporeal life support (ECLS) serves as a bridge to lung transplantation (BTT) for patients with acute respiratory failure (ARF) or right ventricular (RV) dysfunction/failure (RVD/RVF). Proper assessment and management of RV function in BTT patients are crucial for successful outcomes. However, there is a lack of consensus on standardized RV assessment strategies or optimal ECLS configurations. We aim to synthesize current evidence on RVD/RVF assessment and management in BTT patients requiring ECLS, providing a foundation to aid development of standardized clinical algorithms.A scoping literature search across PubMed, Embase, Web of Science, Cochrane Library, and grey literature was performed. Inclusion criteria comprised human studies reporting on RV assessment and/or management in BTT patients. Data on patient characteristics, RV assessment methods, and ECLS strategies were extracted. A total of 280 patients were identified. Acute respiratory failure (ARF) was the most common BTT indication (40.4%), followed by RVF (33.2%) and RVD (17.9%). Echocardiography (52.5%) and right heart catheterization (43.2%) were the primary RV assessment tools. However, reporting of specific parameters of RV assessment was inconsistent. Furthermore, we report important variability of practice in ECLS strategies: VV-ECMO (38.8%) was the most common ECLS strategy, followed by VA-ECMO (31.1%), VAV-ECMO (8.2%), and OxyRVAD (13.2%). Based on our findings, bridging strategies currently lack guidance. As BTT is often confronted with dynamic changes over time, respiratory and circulatory ECLS indications may be overlapping. Therefore, a personalized patient approach is needed. We recommend implementing institutional guidelines and international standards to systematically capture this practice. |
| format | Article |
| id | doaj-art-ebf2302ec8f3409abc991c5e31d434ca |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHLT Open |
| spelling | doaj-art-ebf2302ec8f3409abc991c5e31d434ca2025-08-20T03:36:37ZengElsevierJHLT Open2950-13342025-08-01910031610.1016/j.jhlto.2025.100316Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practicesMichaela Orlitová0Bert Demeulenaere1Dieter Van Beersel2Dirk E. Van Raemdonck3Robin Vos4Laurens J. Ceulemans5Steffen Rex6Laurent Godinas7Tom Verbelen8Arne P. Neyrinck9Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Thoracic Surgery, University Hospitals Leuven, Leuven, BelgiumDepartment of Cardiovascular Sciences, KU Leuven, Leuven, BelgiumDepartment of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Anesthesiology, University Hospitals Leuven, Leuven, BelgiumDepartment of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, BelgiumDepartment of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, Leuven, BelgiumDepartment of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, BelgiumDepartment of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Anesthesiology, University Hospitals Leuven, Leuven, BelgiumDepartment of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium; Department of Respiratory Diseases, University Hospitals Leuven, Leuven, BelgiumDepartment of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiac Surgery, University Hospitals Leuven, Leuven, BelgiumDepartment of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium; Corresponding author: Arne P. Neyrinck, MD, PhD, Department of Anesthesiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. Telephone: +32 16 34 13 75.Extracorporeal life support (ECLS) serves as a bridge to lung transplantation (BTT) for patients with acute respiratory failure (ARF) or right ventricular (RV) dysfunction/failure (RVD/RVF). Proper assessment and management of RV function in BTT patients are crucial for successful outcomes. However, there is a lack of consensus on standardized RV assessment strategies or optimal ECLS configurations. We aim to synthesize current evidence on RVD/RVF assessment and management in BTT patients requiring ECLS, providing a foundation to aid development of standardized clinical algorithms.A scoping literature search across PubMed, Embase, Web of Science, Cochrane Library, and grey literature was performed. Inclusion criteria comprised human studies reporting on RV assessment and/or management in BTT patients. Data on patient characteristics, RV assessment methods, and ECLS strategies were extracted. A total of 280 patients were identified. Acute respiratory failure (ARF) was the most common BTT indication (40.4%), followed by RVF (33.2%) and RVD (17.9%). Echocardiography (52.5%) and right heart catheterization (43.2%) were the primary RV assessment tools. However, reporting of specific parameters of RV assessment was inconsistent. Furthermore, we report important variability of practice in ECLS strategies: VV-ECMO (38.8%) was the most common ECLS strategy, followed by VA-ECMO (31.1%), VAV-ECMO (8.2%), and OxyRVAD (13.2%). Based on our findings, bridging strategies currently lack guidance. As BTT is often confronted with dynamic changes over time, respiratory and circulatory ECLS indications may be overlapping. Therefore, a personalized patient approach is needed. We recommend implementing institutional guidelines and international standards to systematically capture this practice.http://www.sciencedirect.com/science/article/pii/S2950133425001119Right VentricleBridge to TransplantationMechanical Circulatory Support |
| spellingShingle | Michaela Orlitová Bert Demeulenaere Dieter Van Beersel Dirk E. Van Raemdonck Robin Vos Laurens J. Ceulemans Steffen Rex Laurent Godinas Tom Verbelen Arne P. Neyrinck Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practices JHLT Open Right Ventricle Bridge to Transplantation Mechanical Circulatory Support |
| title | Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practices |
| title_full | Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practices |
| title_fullStr | Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practices |
| title_full_unstemmed | Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practices |
| title_short | Right ventricular mechanical support as a bridge to lung transplantation: A literature review of current practices |
| title_sort | right ventricular mechanical support as a bridge to lung transplantation a literature review of current practices |
| topic | Right Ventricle Bridge to Transplantation Mechanical Circulatory Support |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425001119 |
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