Elsevier

Transplantation Proceedings

Volume 40, Issue 10, December 2008, Pages 3596-3597
Transplantation Proceedings

Thoracic transplantation
Extracorporeal Membrane Oxygenation for Primary Allograft Failure

https://doi.org/10.1016/j.transproceed.2008.06.079Get rights and content

Abstract

Objective

Herein we have reported our experience concerning the usefulness of extracorporeal membrane oxygenation (ECMO) in heart transplant patients.

Patients and Methods

Between July 2002 and March 2007, 11 heart transplant patients, namely, 8 men and 3 women of overall mean age of 49.4 ± 13.9 years (range, 19–62 years) with primary graft failure underwent ECMO implantation. Two patients had pulmonary hypertension; 3 had been transplanted with hearts from marginal donors. At the time of implantation, all were in severe cardiogenic shock despite maximal inotropic support. In 6 patients, the ECMO was implanted centrally in the operating room when there was failure of weaning of cardiopulmonary bypass. Among the 5 remaining patients, ECMO was implanted peripherally in the intensive care unit, during the first 60 hours, including 3 cases of hemodynamic instability and 1 of irreversible cardiac graft arrest. The last patient was implanted on day 30 after transplantation because of acute rejection.

Results

Mean pump outflow was 2.7 ± 0.4 L/min/m2. One patient died on circulatory support due to a cerebral hemorrhage. Ten patients were weaned from ECMO after a mean duration of 9.1 ± 6.9 days (range, 1–18 days). All of them were successfully discharged. No retransplantation occurred.

Conclusion

Rapid operating room or bedside placement of ECMO allowed stabilization of hemodynamics with potential myocardial recovery in patients with cardiac graft failure.

Section snippets

Patients and Methods

From July 2002 to March 2007, 188 patients underwent heart transplantation at our institution. Among them, the 11 who experienced early graft failure were resuscitated using ECMO. There were 8 men and 3 women of overall mean age of 49.4 ± 13.9 years (range, 19–62 years). Two patients displayed pulmonary artery hypertension with pulmonary vascular resistance (PVR) of 7 and 6.2 Wood units (WU). PVR remained high despite the use of dobutamine and nitric oxide in both patients (6 and 5 WU).

Results

In 6 patients, the ECMO system was implanted centrally in the operating room (OR) because cardiopulmonary bypass could not be weaned. The 5 other patients were implanted peripherally in the intensive care unit (ICU). Among them, 4 underwent implantation during the first 60 hours, including 3 cases of hemodynamic instability and 1 of irreversible cardiac graft arrest. The last patient was implanted on day 30 after heart transplantation because of acute rejection. The cannulation was performed

Discussion

Primary CGF is a severe condition often associated with high mortality and morbidity. Due to improved technology, the use of mechanical support in pretransplantation stabilization and postcardiotomy shock is well established; it is gradually being accepted as a proper choice for treatment of CGF.1, 2

We advocate the use of ECMO due to the advantages of easy application and feasibility. The system allows full circulatory support and, if central, biventricular unloading. It can be implanted

Acknowledgment

We thank Dr E. Potapov, Deutsches Herzzentrum Berlin, Germany, for several suggestions.

References (2)

Cited by (29)

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    A possible explanation may be that the population supported by ECMO is different than the population receiving VAD support. ECMO is thought to be the treatment of choice for patients requiring cardiopulmonary support.12,13 Patients who typically are supported by ECMO are younger, require emergency support, and are often in cardiac and pulmonary failure.

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    The earlier the mechanical support is initiated, the better the results.33 Arpesella et al. reported that 10 out of 11 patients with primary allograft failure after heart transplantation who received mechanical support with ECMO could be successfully weaned and discharged.34 CentriMag is being used increasingly to provide haemodynamic support during CS at several US institutions.35

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    It is argued that mental injuries were found in the 41% of the heart and lung failure victums who underwent ECMO therapy; however, no significant side effects were identified in 43% of the patients.10 And, about 33%–38% of adults using ECMO for heart failure were able to recover and be discharged from hospitals.8,11 Our study found that the major physical health problems within 3 months post-HT for the preop-ECMO group were physical weakness and being unable to walk or move.

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