Patients with pulmonary arterial hypertension (PAH) become candidates for lung or lung and heart transplantation when the maximum specific therapy is no longer effective. The most difficult challenge is choosing one of the above options in the event of symptoms of right ventricular failure. Here, we present two female patients with PAH: (1) a 21-year-old patient with Eisenmenger syndrome, caused by a congenital defect—patent ductus arteriosus (PDA); and (2) a 39-year-old patient with idiopathic PAH and coexistent PDA. Their common denominator is PDA and the hybrid surgery performed: double lung transplantation with simultaneous PDA closure. The operation was performed after pharmacological bridging (conditioning) to transplantation that lasted for 33 and 70 days, respectively. In both cases, PDA closure effectiveness was 100%. Both patients survived the operation (100%); however, patient no. 1 died on the 2nd postoperative day due to multi-organ failure; while patient no. 2 was discharged home in full health. The authors did not find a similar description of the operation in the available literature and PubMed database. Hence, we propose this new treatment method for its effectiveness and applicability proven in our practice.

Pulmonary complications of systemic scleroderma (SSc), such as interstitial lung disease and pulmonary hypertension (PH), are responsible for up to 60% of deaths among patients. For many years, most centers considered SSc a contraindication to lung transplantation (LTx); however, recent publications show that appropriately selected SSc candidates for LTx give results comparable to patients with idiopathic PH or idiopathic pulmonary fibrosis. This paper presents the cases of a 60-year-old male patient (patient 1) and a 42-year-old female patient (patient 2) diagnosed with SSc in 2019 and 2013, respectively. In both patients, interstitial-fibrotic changes in the lungs leading to respiratory failure were confirmed by high-resolution computed tomography as well as pulmonary hypertension (WHO group 3), which was also diagnosed during right heart catheterization. In both cases, despite pharmacotherapy, pulmonary fibrosis progressed, leading to severe respiratory failure. The patients were referred for LTx qualification. LTx was possible to consider in patients due to the lack of significant changes in other internal organs. Double LTx was successfully performed in both patients (patient 1-July 19, 2022; patient 2-September 14, 2022). They were discharged from the hospital in good condition on the 22nd and 20th postoperative day, respectively. LTx is a last-chance therapy that saves lives among patients with extreme respiratory failure in the course of SSc. It prolongs and improves the quality of life. The selection of appropriate patients is key to the success of the procedure.

Objectives: This study aims to describe the experience of using ECMO on various patients who require ECMO support during the entire perioperative period of lung transplantation. ECMO has several roles: it can bridge patients to transplantation, improve lung graft function in case of primary graft dysfunction after transplantation, improve left ventricle function after transplantation in patients with primary pulmonary hypertension, and manage COVID-19 patients who are awaiting LuTx or undergoing LTx. Methods: We present 6-year results from a high-volume lung transplant center (219 cases/6 years, >50 cases/2022). We used ECMO in 56 cases (25.6%) of all lung transplants between 2018 and 2023. Results: The one-year survival rate of patients transplanted on ECMO was 85.7%. We applied all advanced ECMO techniques, such as bridging to transplantation on ECMO (n = 15, early survival 66.7%) and left ventricular conditioning after LuTx with VA-ECMO (n = 12, 60-day and one-year survival 85.1% and 53%, respectively). We also bridged patients with COVID-19 to transplantation and transplanted them from ECMO (n = 9, early survival 55%). Conclusions: This article shows possible applications of ECMO therapy for various indications in lung transplant patients and, along with data from other publications, it demonstrates that ECMO can improve survival and outcomes for patients with respiratory failure, primary pulmonary hypertension, and COVID-19. The COVID-19 pandemic highlighted new utilization of ECMO, demonstrating its usefulness and importance in critical care medicine. Further research into capabilities of the ECMO system may expand the knowledge about its role in lung transplantation and future treatments.

Ojectives: This article explores the use of ECMO therapy in patients with end-stage respiratory failure who need lung transplantation (LTx). ECMO has several roles: it can bridge patients to transplantation, condition the lung graft in case of primary graft dysfunction after transplantation, condition the the left ventricle after transplantation in patients with primary pulmonary hypertension, and manage COVID-19 patients who are awating LTx or undergoing LTx. Methods: We present 6-year results from high volume lung transplant center (219 cases/6years, >50 cases/2022). We used ECMO in 56 cases (25.6%) of all lung transplants be- tween 2018 and 2023. Results: The one-year survival rate of patients transplanted on ECMO was 85.7% (95%CI: 77.0-95.4%). We applied all advanced ECMO techniques, such as bridging to transplantation on ECMO (n=15, early survival 66.7%), left ventricular conditioning after LTX with VA-ECMO protocol (n=12, 60-day and one-year survival 85.1% and 53% respectively) and the most advanced variant of ECMO such as Sport-ECMO (n=7). We also bridged to transplantation patients with COVID-19 and were among the first in Europe to transplant them from ECMO (n=9, early survival 55%). Conclusions: This article shows possible applications of ECMO therapy for various indications in lung transplant patients and along with data from other publications it demonstrates that ECMO can improve survival and outcomes in patients with end-stage respiratory failure, primary pulmonary hypertension, and COVID-19. The COVID-19 pan- demic highlighted new utilization of ECMO,demonstrating its usefulness and importance in critical care medicine. Further research into the capabilities of the ECMO system may expand knowledge about its role in lung transplantation and future treatments.