Extracorporeal Membrane Oxygenation for Graft Failure after Heart Transplantation: A Multidisciplinary Approach to Maximize Weaning Rate

Santise, Gianluca; Panarello, Giovanna; Ruperto, Cettina; Turrisi, Marco; Pilato, Gerlando; Giunta, Andrea; Sciacca, Sergio; Pilato, Michele

doi:10.5301/ijao.5000353

Cited by 38 publications

(39 citation statements)

References 23 publications

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“…The incidence of EGF has increased slightly in recent years, probably due to the shortage of organs and the consequent extensive use of marginal donors with high α‐agonist or inotropic dosages . Reported rates of EGF after Htx range from 2.3 to 28.2%, with mortality rates ranging from 20 to 66% , which is in line with our data.…”

Section: Discussionsupporting

confidence: 89%

Role of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure After Cardiac Transplantation

Loforte¹,

Murana²,

Cefarelli³

et al. 2016

Artificial Organs

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Early graft failure (EGF) is a major risk factor for death after heart transplantation (Htx). We investigated the predictive risk factors for moderate-to-severe EGF requiring an intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO) circulatory support as treatment after Htx. Between January 2000 and December 2014, 412 consecutive adult patients underwent isolated Htx at our institution. Moderate and severe EGF were defined as the need for IABP and ECMO support, respectively, within 24 h after Htx. All available recipient and donor variables were analyzed to assess the risk of EGF occurrence. Overall, moderate-to-severe EGF occurred in 46 (11.1%) patients. Twenty-nine (63.04%) patients required peripheral or central ECMO support in the treatment of severe EGF and 17 (36.9%) patients required IABP support for the treatment of moderate EGF. The predictive risk factors for moderate-to-severe EGF in recipients, as assessed by logistic regression analysis, were a preoperative transpulmonary gradient > 12 mm Hg (odds ratio [OR] 5.2; P = 0.023), a preoperative inotropic score > 10 (OR 8.5; P = 0.0001), and preoperative ECMO support (OR 4.2; P = 0.012). For donors, the predictive risk factor was a donor score ≥ 17 (OR 8.3; P = 0.006). The absence of EGF was correlated with improved long-term survival: 94% at 1 year and 81% at 5 years without EGF versus 76% and 36% at 1 year (P < 0.001), and 70% and 28% at 5 years (P < 0.001) with EGF requiring IABP and ECMO support, respectively. In-hospital weaned and survived patients after IABP or ECMO treatment for moderate-to-severe EGF had a similar 5-year conditional survival rate as transplant patients who had not suffered EGF: 88% without EGF versus 84% with EGF treated with mechanical circulatory support devices (P = 0.08). The occurrence of EGF is a multifactorial deleterious event that depends on donor and recipient profiles. IABP and ECMO support are reliable treatment strategies, depending on the grade of EGF. Furthermore, surviving patients treated with IABP or ECMO have the same long-term conditional survival rate as patients who have not suffered EGF.

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Section: Discussionsupporting

confidence: 89%

Role of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure After Cardiac Transplantation

Loforte¹,

Murana²,

Cefarelli³

et al. 2016

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“…Существуют различные методики меха-нической поддержки трансплантированного сердца (ВАБК, одно-или двухжелудочковый обход сердца, ВА ЭКМО, катетерные осевые насосы (Impella Recover, Impella RP™ (Right Percutaneous) System) и т. п. ВА ЭКМО является одним из наиболее часто применяемых методов вспомогательного кровооб-ращения при выраженной ранней или отдаленной дисфункции сердечного трансплантата независимо от варианта расстройств центральной гемодинами-ки (бивентрикулярный, преимущественно право-или левожелудочковый) [5]. У реципиентов с ран-ней дисфункцией сердечного трансплантата для ВА ЭКМО применяют как центральную, так перифери-ческую методику канюляции [6].…”

Section: Discussionunclassified

Successful Treatment of a Recipient With Massive Thrombosis of Heart Transplant Left Chambers During Extracorporeal Membrane Oxygenation

Попцов

Захаревич

Спирина

et al. 2016

RJTAO

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1 ФГБУ «ФНЦ трансплантологии и искусственных органов им. акад. В.И. Шумакова» Минздрава России, Москва, Российская Федерация 2 Кафедра трансплантологии и искусственных органов ГБОУ ВПО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России, Москва, Российская Федерация Представлен клинический случай успешного лечения реципиента сердца с тотальным тромбозом левого предсердия и левого желудочка, развившимся в ранние сроки после трансплантации на фоне применения периферической ВА ЭКМО как метода механической поддержки кровообращения при острой право-желудочковой недостаточности пересаженного сердца. Пациенту успешно выполнили хирургическую тромбэктомию, и ВА ЭКМО прекращена на первые сутки после операции.Ключевые слова: трансплантация сердца, экстракорпоральная мембранная оксигенация, тромбоз левого желудочка, активированное время свертывания. We present a case report of a 16-year-old man with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for primary graft failure after orthotopic heart transplantation who developed left atrium and left ventricular thrombosis despite systemic anticoagulation. The surgical thrombectomy was performed and the patient was successfully weaned off the extracorporeal support on the fi rst day thereafter. SUCCESSFUL TREATMENT OF A RECIPIENT WITH MASSIVE THROMBOSIS OF HEART TRANSPLANT LEFT CHAMBERS DURING EXTRACORPOREAL MEMBRANE OXYGENATION

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“…The authors concluded that a multidisciplinary (intensivists, cardiologists, and surgeons) evaluation of ECMO patients is important for high success rates. 5 The mean duration of support was 8.1 ± 6.5 days in patients within the postoperative group. In our center, we also use a multidisciplinary approach over 24-hour periods for heart transplant patients.…”

Section: Ender Gedik Et Al/experimental and Clinical Transplantation mentioning

confidence: 99%

“…6 The use of VA-ECMO during both the early and late postoperative periods for severe PGD in heart transplant recipients is a widely accepted multidisciplinary treatment. 5,11 However, we used postoperative extracorporeal support in our patients. We have limited experience regarding VA-ECMO support for PGD in heart transplant recipients.…”

Section: Ender Gedik Et Al/experimental and Clinical Transplantation mentioning

confidence: 99%

“…4 Venoarterial extracorporeal membrane oxygenation may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. 5 Previously, we reported our experience with patients who received VA-ECMO as a bridge to emergency heart transplant in the intensive care unit (ICU). 6 In this study, we present our perioperative experience with heart transplant recipients in which VA-ECMO was performed in our ICU.…”

Section: Introductionmentioning

confidence: 99%

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Gedik

Atar²,

Özdemirkan³

et al. 2017

Exp Clin Transplant

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Objectives: Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. This technique may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. Previously, we reported our experience with patients who received extracorporeal support as a bridge to emergency heart transplant. In this study, we present our perioperative experience with heart transplants in which extracorporeal support was used. Materials and Methods:We retrospectively screened the data of 31 patients who were seen at our center between January 2014 and June 2016. We screened for patients who were admitted to the intensive care unit before transplant and who required venoarterial extracorporeal membrane oxygenation for circulatory support and postoperative patients who required extracorporeal support. Patient demographics and characteristics, clinical data, and extracorporeal support data were collected from our electronic database and patient medical records. Results: There were 14 patients who required perioperative extracorporeal support. Preoperative support was performed in 3 patients before transplant, and postoperative support was performed in 11 patients after transplant. The mean age was 37.7 years in patients within the preoperative group and 29.7 years in patients within the postoperative group. One patient with preoperative support and 5 with postoperative support were pediatric patients. The main indication for transplant was dilated cardiomyopathy in both groups (100% and 63.7%). Overall mortality rates were 33% in the preoperative group and 63.7% in the postoperative group. Conclusions: For patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort. In addition, extracorporeal support can be used during the posttransplant period as salvage therapy in heart recipients with hemodynamic deterioration. In our experience, preoperative extracorporeal support had lower mortality rates compared with postoperative support.

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Extracorporeal Membrane Oxygenation for Graft Failure after Heart Transplantation: A Multidisciplinary Approach to Maximize Weaning Rate

Cited by 38 publications

References 23 publications

Role of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure After Cardiac Transplantation

Role of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure After Cardiac Transplantation

Successful Treatment of a Recipient With Massive Thrombosis of Heart Transplant Left Chambers During Extracorporeal Membrane Oxygenation

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