Extracorporeal life support for primary graft dysfunction after heart transplantation

Pozzi, Mattéo; Bottin, Chiara; Armoiry, Xavier; Sebbag, Laurent; Boissonnat, P.; Hugon‐Vallet, Elisabeth; Koffel, Catherine; Flamens, C.; Paulus, S.; Fellahi, J.-L.; Obadia, Jean François

doi:10.1093/icvts/ivy157

Cited by 12 publications

(5 citation statements)

References 25 publications

(71 reference statements)

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“…In this study, the rate of ECMO support was 23.5%, which was within the wide range from 2.1% to 31.6% as reported in previous studies [12][13][14][15][16]. Our institution adopts an active, prompt protocol and initiates ECMO support for almost every recipient with signifcant graft dysfunction, which may contribute to the high ECMO rate.…”

Section: Discussionsupporting

confidence: 81%

Mildly Elevated Pulmonary Artery Systolic Pressure is Associated with Extracorporeal Membrane Oxygenation Support after Heart Transplantation

Cui

et al. 2023

Journal of Cardiac Surgery

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Background. Pulmonary hypertension is a well-known risk factor for hemodynamic instability after heart transplantation. However, it remains unclear whether a mild elevation of pulmonary artery systolic pressure (PASP) is associated with higher risks of graft dysfunction and resultant extracorporeal membrane oxygenation (ECMO) support. Methods. From 2016 to 2021, 102 adult recipients undergoing orthotopic heart transplantation at our institution were investigated (mean age, 48.5 ± 13.2 years; 22.5% female). This study cohort was stratified into 3 groups based on the PASP measured by right heart catheterization before surgery: >50 mmHg, 35–50 mmHg, and <35 mmHg. The primary end point was ECMO support after procedure. Results. ECMO was implemented in 24 (23.5%) patients due to difficult weaning from cardiopulmonary bypass or cardiac low output in the intensive care unit, which was likely to be associated with higher mortality ( P = 0.053 ). Age, gender, comorbidities, preoperative medications, and graft ischemia time were comparable across the 3 groups. The use of ECMO was significantly more common in patients with baseline PASP >50 mmHg (11/36, 30.6%) and 35–50 mmHg (12/38, 31.6%), while only 1 (3.6%) patient with baseline PASP <35 mmHg required ECMO support after transplant ( P = 0.007 ). Multivariate logistic models demonstrated that PASP (odds ratio = 2.34; P = 0.028 ) and cardiopulmonary bypass time (odds ratio = 1.01; P < 0.001 ) were independent risk factors for postoperative ECMO. Conclusions. A mild elevation of pretransplant PASP (e.g., 35–50 mmHg) is related to low cardiac output and subsequent ECMO after heart transplantation, for which prompt administration of vasodilators before transplant may be protective.

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Section: Discussionsupporting

confidence: 81%

Mildly Elevated Pulmonary Artery Systolic Pressure is Associated with Extracorporeal Membrane Oxygenation Support after Heart Transplantation

Cui

et al. 2023

Journal of Cardiac Surgery

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“…One of the covariates included in the propensity score was the potential for myocardial recovery based upon indications for VA-ECMO. Indeed, outcomes of patients undergoing VA-ECMO greatly differ regarding the reason for ECMO implantation [17][18][19][20][21][22][23][24][25][26]. Forty-two patients who received ECMO less than 48 h were excluded because we considered the probability to receive levosimendan was too low.…”

Section: Discussionmentioning

confidence: 99%

“…Secondary endpoints were mortality at day 28 and at 6 months after VA-ECMO implantation. Based on the available literature [17][18][19][20][21][22][23][24] and on the analysis of patient outcomes in our institutional database [25,26], we classified indications for VA-ECMO into three categories (high, intermediate, or low) according to the potential for myocardial recovery.…”

Section: Study Endpointsmentioning

confidence: 99%

Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis

et al. 2020

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Background: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used over the last decade in patients with refractory cardiogenic shock. ECMO weaning can, however, be challenging and lead to circulatory failure and death. Recent data suggest a potential benefit of levosimendan for ECMO weaning. We sought to further investigate whether the use of levosimendan could decrease the rate of ECMO weaning failure in adult patients with refractory cardiogenic shock. Methods: We performed an observational single-center cohort study. All patients undergoing VA-ECMO from January 2012 to December 2018 were eligible and divided into two groups: group levosimendan and group control (without levosimendan). The primary endpoint was VA-ECMO weaning failure defined as death during VA-ECMO treatment or within 24 h after VA-ECMO removal. Secondary outcomes were mortality at day 28 and at 6 months. The two groups were compared after propensity score matching. P < 0.05 was considered statistically significant. Results: Two hundred patients were analyzed (levosimendan group: n = 53 and control group: n = 147). No significant difference was found between groups on baseline characteristics except for ECMO duration, which was longer in the levosimendan group (10.6 ± 4.8 vs. 6.5 ± 4.7 days, p < 0.001). Levosimendan administration started 6.6 ± 5.4 days on average following ECMO implantation. After matching of 48 levosimendan patients to 78 control patients, the duration of ECMO was similar in both groups. The rate of weaning failure was 29.1% and 35.4% in levosimendan and control groups, respectively (OR: 0.69, 95%CI: 0.25-1.88). No significant difference was found between groups for all secondary outcomes. Conclusion: Levosimendan did not improve the rate of successful VA-ECMO weaning in patients with refractory cardiogenic shock. Trial registration: ClinicalTrials.gov, NCT04323709.

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“…The ECLS implantation technique and management were previously described 23 ously and titrated to achieve an anti-Xa factor activity between 0.30 and 0.35 IU/mL during ECLS support. The possibility to wean the patient from temporary mechanical support was evaluated with daily transesophageal echocardiography after stepwise reduction of ECLS flow.…”

Section: Ecls Implantation and Managementmentioning

confidence: 99%

“…The ECLS implantation technique and management were previously described 23 and the basic principles are summarized in the supplementary material. Briefly, ECLS implantation was accomplished through the femoral route or in an intrathoracic configuration.…”

Section: Ecls Implantation and Managementmentioning

confidence: 99%

Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock

et al. 2019

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Background and Aim of the Study Extracorporeal life support (ECLS) may be necessary in refractory postcardiotomy cardiogenic shock (PCS) unresponsive to optimal medical treatment. We sought to analyze the results and temporal outcomes of ECLS for PCS. Methods We performed an observational analysis of our prospective database. In order to analyze the temporal trends of ECLS for PCS, patients were divided into two groups according to the period of ECLS implantation: Group I from January 2007‐June 2012, Group II from July 2012‐December 2017. The primary endpoint was survival to hospital discharge. Results During the study period, 90 patients required ECLS for PCS (Group I n = 29, 32%; Group II n = 61, 68%). Mean age was 57.5 ± 15.0 years with 62% of males. Preoperative characteristics were comparable over the two periods. A high proportion of patients were in NYHA class III/IV (61%) or cardiogenic shock (22%). Group II showed a significantly higher proportion of miscellaneous cardiac surgery operations (23 vs 3%, P = 0.031). Crossclamp and cardiopulmonary bypass times were significantly shorter in Group II (85.4 vs 114.2 min, P = 0.023 and 135.2 vs 184.2 min, P = 0.022, respectively). The complication rate during ECLS support was comparable between both groups. Successful weaning from ECLS could be accomplished in 45 (50%) patients (Group I = 52% vs Group II = 49%, P = 0.822) after a mean support of 6.4 days. Thirty‐five (39%) patients survived to hospital discharge (Group I = 41% vs Group II = 38%, P = 0.738). Conclusions Outcomes following ECLS remained stable over an 11‐year period. ECLS may be limited in patients with severe preoperative cardiac dysfunction. Our data suggest that these patients may be better served with less invasive, percutaneous procedures.

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Extracorporeal life support for primary graft dysfunction after heart transplantation

Abstract: In case of severe PGD with various manifestations of ventricular failure refractory to conventional treatment, ECLS can be considered as a feasible option with satisfactory survival in this critically ill population.

Cited by 12 publications

References 25 publications

Mildly Elevated Pulmonary Artery Systolic Pressure is Associated with Extracorporeal Membrane Oxygenation Support after Heart Transplantation

Mildly Elevated Pulmonary Artery Systolic Pressure is Associated with Extracorporeal Membrane Oxygenation Support after Heart Transplantation

Can levosimendan reduce ECMO weaning failure in cardiogenic shock?: a cohort study with propensity score analysis

Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock

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