Extracorporeal Rescue for Early and Late Graft Failure after Cardiac Transplantation: Short Result and Long‐Term Followup

Abstract

Objectives. Graft failure after heart transplantation led to poor outcomes. We tried to analyze the outcomes of extracorporeal membrane oxygenation (ECMO) rescue in graft survival after transplantation. Methods. A retrospective review of 385 consecutive heart transplants revealed 46 patients of graft failure requiring ECMO rescue (48 episodes). The pretransplant and ECMO-related variables were evaluated. Results. The median age was 37.7 ± 18.8 years, and the median support time was 155 ± 145 hours. Success rate was 47.9% (23/48). Pretransplant ECMO use was 25% (12/48) and they had 58.3% mortality. The success rate in “early” graft failures was 51.4% (18/35) and 50% for “late” graft failure. The ischemic time with graft failure (178 ± 70 min) was significantly longer than that without graft failure. Preoperative status and the longer ischemic time may be the major factors for failure. Long-term 5-year survival demonstrated significant survival difference between graft failure and nongraft failure. No survival difference was shown between “early” and “late” graft failure. Conclusions. Graft failure still carried high mortality if advanced circulatory support was required. Early graft failure and late graft failure had similar outcomes. Further investigation of the risk factors shows that ECMO does play a role of rescue in catastrophic conditions.

Temporary Venoarterial Extracorporeal Membrane Oxygenation: Ten-Year Experience at a Cardiac Transplant Center

“…This is similar to the 52.1% mortality rate reported by Chou et al 12 We found no obvious evidence that the post-transplant patients were initiated on ECMO earlier than other patients from a hemodynamic standpoint. The lower mortality rate in this group may reflect the fact that acute decompensation following heart transplant is often a treatable process.…”

Extracorporeal life support for primary graft dysfunction after heart transplantation

“…It accounts for approximately 40% of deaths within 30 days of cardiac transplantation [20]. Moreover overall late survival is significantly lower in patients experiencing PGD [7,8,10,11,14,21]. The pathophysiology is multifactorial and several risk factors involving the donor, recipient and surgical procedure have been identified over time [3,14,21].…”

“…Although the definitions of PGD were heterogeneous making comparisons difficult to carry out, this incidence was consistent with previous reports. In papers providing detailed information the incidence of PGD supported with ECLS ranged between 7% and 23% [5,[7][8][9][10][11][12][13][14][15]21]. Interestingly, D'Alessandro et al found a temporal trend of PGD after HTx.…”

“…Finally the introduction of a grading system of PGD severity could guide the subsequent decision-making algorithm [3]. Medical management seems useful in mild or moderate PGD while extracorporeal life support (ECLS) could be suggested as a therapeutic option for those severe cases of PGD that are refractory to maximal conventional treatment including inotropes, vasodilators and nitric oxide [4][5][6][7][8][9][10][11][12][13][14][15].…”

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“…They concluded that ECMO does play a role in rescue in catastrophic conditions. 10 In our study, the overall mortality rate was 62.5% in our "early" and 66.6% in "late" graft failure patients. Our overall mortality rate was higher than that reported by the previous authors.…”