Elsevier

The Annals of Thoracic Surgery

Volume 90, Issue 5, November 2010, Pages 1541-1546
The Annals of Thoracic Surgery

Original article
Adult cardiac
Extracorporeal Membrane Oxygenation in Primary Graft Failure After Heart Transplantation

https://doi.org/10.1016/j.athoracsur.2010.05.066Get rights and content

Background

The aim of this review was to analyze our results with extracorporeal membrane oxygenation (ECMO) support for primary graft failure (PGF) in heart transplant recipients.

Methods

A retrospective review of 239 consecutive patients who underwent heart transplantation between January 2000 and August 2009 was performed. Orthotopic, heterotopic, and heart lung transplants were included in this analysis. Over that time period, 54 patients developed PGF, of whom 39 patients required ECMO support. These 39 patients form the basis of this review.

Results

Thirty-four patients (87%) were successfully weaned from ECMO and 29 (74.3%) survived to hospital discharge. There were no significant differences in wean rates or complications between central and peripheral ECMO. Comparison of survival in the 39 ECMO patients to the non-PGF patients (n = 185) showed a significantly worse survival in the ECMO group (p = 0.007). When those patients who died in the first 30 days were excluded, there was no difference in overall survival between groups (p = 0.73).

Conclusions

Extracorporeal membrane oxygenation provides excellent circulatory support for patients with PGF after heart transplantation with good wean and survival to discharge rates.

Section snippets

Patients and Methods

A retrospective review of prospectively collected data on 239 patients who underwent heart transplantation at our institution between January 2000 and August 2009 was performed. Orthotopic and heterotopic heart transplants, as well as heart-lung transplants, were included in this analysis. Over that time period, 54 patients developed PGF, of whom 39 patients required ECMO support. These 39 patients form the basis of this review. Institutional ethics approval was granted for this review and

Results

Two hundred thirty-nine patients underwent cardiac transplantation between January 2000 and August 2009, comprising 207 orthotopic heart transplants, 19 heterotopic heart transplants, and 13 heart lung transplants. Fifty-four patients developed PGF, of whom 39 required ECMO support (34 orthotopic heart transplants, two heterotopic heart transplants, and three heart lung transplants). In the three heart lung patients, ECMO was instituted primarily for cardiac support as per our algorithm. The

Comment

This series of heart transplant patients requiring ECMO in the immediate postoperative period for PGF represents one of the largest series published. The only published series larger is that by D'Alessandro and colleagues [7]. However, this series included patients other than those who sustained primary graft failure (personal communication); specifically it also included acute rejection patients. Our successful wean rate of 85% and survival to discharge rate of 74% also compares favorably with

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