Experience of ECMO in Primary Graft Dysfunction after Orthotopic Heart Transplantation

Lima, Elson Borges; Cunha, Claúdio Ribeiro da; Barzilai, Vitor Salvatore; Ulhoa, Marcelo Botelho; Barros, Maria Regina; Moraes, Camila Scatolin; Fortaleza, Letycia Chagas; Vieira, Nubia W.; Atik, Fernando Antibas

doi:10.5935/abc.20150082

Cited by 24 publications

(27 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ECMO is a critical treatment which is potentially harmful but also life‐saving. Despite this, perhaps we should be more liberal with ECMO treatment post‐HT even at a low grade of PGD, which also seem to be an upcoming trend 16,25,26 …”

Section: Discussionmentioning

confidence: 99%

The influence of ischemia and reperfusion time on outcome in heart transplantation

Jernryd

Metzsch

Andersson

et al. 2020

Clinical Transplantation

View full text Add to dashboard Cite

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractIschemia/reperfusion may lead to graft dysfunction in heart transplantation (HT).The purpose of this study was to evaluate the influence of ischemic and reperfusion time on acute cellular rejection (ACR) within the first-year post-HT and on long-term outcomes. Data were collected from 331 patients (mean age 49 ± 12 y, 28% females) who underwent HT 1988-2016. Endomyocardial biopsies obtained within the first year after HT were graded according to the 2004-ISHLT-WF. We classified the patients by ischemic time 4 hours, and of these, 31 (55%) patients had reperfusion with CPB ≥90 minutes. Ischemia >4 hours had an increased risk of ACR ≥ 2R during the first year (adjusted OR = 3.1, P = .016); however, an extended reperfusion ≥90 minutes reduced the risk (adjusted OR = 0.25, P = .024). The conditional probability of surviving 10 years post-transplant, given that the patients already survived first year, was inferior for recipients with ischemia ≥ 4 hours and reperfusion <90 minutes, 59%, compared with the other groups 83%, P = .016. Prolonged reperfusion appears to reduce the risk for ACR ≥ 2R and improve long-term survival. K E Y W O R D Sacute cellular rejection, heart transplantation, ischemic time, reperfusion

show abstract

Section: Discussionmentioning

confidence: 99%

The influence of ischemia and reperfusion time on outcome in heart transplantation

Jernryd

Metzsch

Andersson

et al. 2020

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…In our experience, the causes of PGD were not associated with severe rejection, as documented by routine endomyocardial biopsy in the first week, with only one patient presenting cellular rejection greater than 2R. Donors were predominantly male (n = 7; 63.6%) and had an average age of 26 In this group of patients, the use of ECMO met the desired goals, promoting cardiac recovery in most cases, with acceptable complication rates, considering the severity of the clinical condition of patients [71]. We were successful in removing the ECMO, with cardiac recovery in 81.8% of the patients after an average of 76 h. The main postoperative problems that we found were acute renal failure, stroke, and requirement for surgical revision of hemostasis.…”

Section: Personal Experiencementioning

confidence: 81%

“…Between January 2007 and December 2013, a total of 71 heart transplantations were performed in patients with advanced heart failure and 11 (15.5%) of these patients presented PGD [71].…”

Section: Personal Experiencementioning

confidence: 99%

Mechanical Circulatory Support (MCS) for Primary Graft Dysfunction (PGD)

Canêo¹,

Barzilai²

2019

Advances in Extra-Corporeal Perfusion Therapies

View full text Add to dashboard Cite

Primary graft dysfunction is the main cause of early mortality after heart transplantation (HT). Preventive strategies to avoid primary graft dysfunction (PGD) have been focused on better donor choice and maintenance, heart preservation methods in long-distance retrievals with prolonged ischemia time, and better myocardial protection during implantation, among others. Hemodynamic deterioration, caused by cardiogenic shock due to pump failure unresponsive to inotropes, has a catastrophic progression if not corrected in time. Severe PGD without response to inotropes and heart rhythm control in the absence of cardiac tamponade should be treated promptly with mechanical circulatory support. Extracorporeal life support (ECLS) should be installed early, before the occurrence of multiorgan dysfunction or prior to cardiac arrest, as highlighted in the literature.The aim of this chapter is to discuss the use of mechanical circulatory support (MCS) and its impact on the success to survival for patients with PGD.

show abstract

“…As the duration of ECMO support increases, this may prompt consideration of other support strategies including placement of a VAD. While ECMO support has traditionally been used in the early post‐HTx period and has demonstrated improved outcomes compared to VAD support in the setting of primary graft dysfunction, VADs facilitate a longer duration of support and may be appropriate as a bridge to recovery, a bridge to re‐transplantation, or a bridge to decision …”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation use in the first 24 hours following pediatric heart transplantation: Incidence, risk factors, and outcomes

Godown

Bearl

Thurm

et al. 2019

Pediatric Transplantation

View full text Add to dashboard Cite

Primary graft dysfunction following HTx is associated with significant morbidity and mortality. This study aimed to assess the incidence of, risk factors for, and outcomes of children requiring ECMO within 24 hours of HTx. This study utilized a linked PHIS/SRTR database of pediatric HTx recipients (2002‐2016). Post‐HTx ECMO was identified using inpatient billing data. Logistic regression assessed risk factors for post‐HTx ECMO. Kaplan‐Meier analyses assessed in‐hospital mortality and post‐discharge survival. A total of 2820 patients were included with 224 (7.9%) requiring ECMO. Independent risk factors for post‐HTx ECMO include age <1 year (aOR: 2.2, 95% CI: 1.3‐3.7, P = 0.006) or 1‐5 years (aOR: 2.1, 95% CI: 1.3‐3.4, P = 0.002), and ECMO support at HTx (aOR: 27.4, 95% CI: 15.2‐49.6, P < 0.001). Survival to discharge decreased with increasing duration of post‐HTx ECMO support; 89% for 1‐3 days, 79.1% for 4‐6 days, 63.2% for 7‐9 days, and 18.8% for ≥10 days. There was no difference in long‐term survival for patients requiring post‐HTx ECMO who survived to hospital discharge (P = 0.434). There are identifiable risk factors associated with the need for ECMO in the post‐HTx period. Length of time on ECMO post‐HTx is strongly associated with the risk of in‐hospital mortality. Patients who require ECMO early post‐HTx and survive to discharge have comparable outcomes to patients who did not require ECMO.

show abstract

Experience of ECMO in Primary Graft Dysfunction after Orthotopic Heart Transplantation

Cited by 24 publications

References 17 publications

The influence of ischemia and reperfusion time on outcome in heart transplantation

The influence of ischemia and reperfusion time on outcome in heart transplantation

Mechanical Circulatory Support (MCS) for Primary Graft Dysfunction (PGD)

Extracorporeal membrane oxygenation use in the first 24 hours following pediatric heart transplantation: Incidence, risk factors, and outcomes

Contact Info

Product

Resources

About