Thoracic transplantationExtracorporeal Membrane Oxygenation for Primary Allograft 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)
- et al.
Peripheral extracorporeal membrane oxygenation (ECMO) in patients with posttransplant cardiac graft failure
Transplant Proc
(2005) - et al.
Extracorporeal membrane oxygenation for perioperative cardiac allograft failure
ASAIO J
(2006)
Cited by (29)
Is mechanically bridging patients with a failing cardiac graft to retransplantation an effective therapy? Analysis of the United Network of Organ Sharing database
2012, Journal of Heart and Lung TransplantationCitation Excerpt :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.
Mechanical circulatory support for cardiogenic shock
2012, Best Practice and Research: Clinical AnaesthesiologyCitation Excerpt :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
Changes in health-related quality of life across three post-heart transplantation stages: Preoperative extracorporeal membrane versus non-extracorporeal membrane group/Clinical Trial Plan group versus non-clinical trial plan group in Taiwan
2012, Transplantation ProceedingsCitation Excerpt :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.
Heart transplant recipients supported with extracorporeal membrane oxygenation: Outcomes from a single-center experience
2011, Journal of Heart and Lung Transplantation