Mechanical circulatory support after heart transplantation

Mihaljević, Tomislav; Jarrett, Craig M.; González-Stawinski, Gonzalo V.; Smedira, Nicholas G.; Nowicki, Edward R.; Thuita, Lucy; Mountis, Maria; Blackstone, Eugene H.

doi:10.1016/j.ejcts.2011.04.017

Cited by 22 publications

(29 citation statements)

References 23 publications

(35 reference statements)

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“…Among the patients with severe PGD, 19 (61%) received effective salvage therapy and recovered. Previous studies have reported various rates of PGD after heart transplant (range, 2%‐26%) and salvage rates that were lower than the rate in our study . Some previous studies included smaller sample sizes, rendering the discrepancies in the incidence of PGD statistically nonsignificant.…”

Section: Discussioncontrasting

confidence: 76%

“…The estimated incidence of moderate to severe PGD after heart transplant ranges from 2% to 26% . However, when PGD has been more strictly defined as the need for high‐dose inotropes or mechanical circulatory support in the immediate posttransplant period, most investigators have reported rates of 10%‐20% . This heterogeneity was addressed by the consensus statements of the International Society for Heart and Lung Transplantation (ISHLT) .…”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal membrane oxygenation as a salvage therapy for patients with severe primary graft dysfunction after heart transplant

Jacob

Lima

González-Stawinski

et al. 2019

Clinical Transplantation

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Background Severe primary graft dysfunction (PGD) is the leading cause of early death after heart transplant. Aim To examine the outcomes of heart transplant recipients who received venoarterial extracorporeal membrane oxygenation (VA‐ECMO) for severe PGD. Methods We reviewed electronic health records of adult patients who underwent heart transplant from November 2005 through June 2015. We defined severe PGD according to International Society for Heart and Lung Transplantation consensus statements. Results Of 1030 heart transplant patients, 31 (3%) had severe PGD and required VA‐ECMO. The mean (range) age was 59 (43‐69) years. Fifteen patients (48%) underwent prior sternotomy and 10 (32%) received a left ventricular assist device as a bridge to transplant. Severe PGD manifested as failure to wean from cardiopulmonary bypass in 20 patients (65%) and as severe hemodynamic instability in the immediate postoperative period in 10 (32%), including cardiac arrest in 3 (10%). Twenty‐five patients (81%) were successfully weaned from VA‐ECMO, and 19 (61%) were discharged; the other 12 (39%) died. Conclusions Although VA‐ECMO is a common method for providing mechanical circulatory support to patients with PGD, multicenter studies are needed to assess factors associated with successful outcomes and improved survival of these patients.

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Section: Discussioncontrasting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation as a salvage therapy for patients with severe primary graft dysfunction after heart transplant

Jacob

Lima

González-Stawinski

et al. 2019

Clinical Transplantation

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“…[226][227][228][229][230][231][232][233][234][235] The majority of published data describe the relatively successful use of extracorporeal membrane oxygenation (ECMO) in cases of primary graft failure. Although 30-day mortality is reduced in those who receive ECMO, in those who survive 30 days, long-term survival appears to be comparable to those who do not have primary graft failure.…”

Section: Mechanical Circulatory Support In Amr With Hemodynamic Comprmentioning

confidence: 99%

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

Colvin¹,

Cook²,

Chang³

et al. 2015

Circulation

283

251

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“…For heart recipients, graft failure has the potential to be life-threatening. Unlike kidney transplant recipients who are routinely treated with dialysis after graft failure, supporting a failing heart graft to successful retransplant is challenging (30)(31)(32)(33). While the use of extracorporeal membrane oxygenation and shortterm ventricular assist devices in acute graft failure have been described (31)(32)(33), the outcomes of patients with failing grafts supported with these technologies remain poor (30).…”

Section: Introductionmentioning

confidence: 99%

High Risk of Graft Failure in Emerging Adult Heart Transplant Recipients

Foster

Dahhou

Zhang

et al. 2015

American Journal of Transplantation

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Emerging adulthood (17-24 years) is a period of high risk for graft failure in kidney transplant. Whether a similar association exists in heart transplant recipients is unknown. We sought to estimate the relative hazards of graft failure at different current ages, compared with patients between 20 and 24 years old. We evaluated 11 473 patients recorded in the Scientific Registry of Transplant Recipients who received a first transplant at <40 years old and had at least 6 months of graft function. Timedependent Cox models were used to estimate the association between current age (time-dependent) and failure risk, adjusted for time since transplant and other potential confounders. Failure was defined as death following graft failure or retransplant; observation was censored at death with graft function. There were 2567 failures. Crude age-specific graft failure rates were highest in 21-24 year olds (4.2 per 100 person-years). Compared to individuals with the same time since transplant, 21-24 year olds had significantly higher failure rates than all other age periods except 17-20 years (HR 0.92 [95%CI 0.77, 1.09]) and 25-29 years (0.86 [0.73, 1.03]). Among young first heart transplant recipients, graft failure risks are highest in the period from 17 to 29 years of age.Abbreviations: HLA, human leukocyte antigen; HR, hazard ratio; IQR, interquartile range; SES, socioeconomic status; SRTR, Scientific Registry of Transplant Recipients

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Mechanical circulatory support after heart transplantation

Cited by 22 publications

References 23 publications

Extracorporeal membrane oxygenation as a salvage therapy for patients with severe primary graft dysfunction after heart transplant

Extracorporeal membrane oxygenation as a salvage therapy for patients with severe primary graft dysfunction after heart transplant

Antibody-Mediated Rejection in Cardiac Transplantation: Emerging Knowledge in Diagnosis and Management

High Risk of Graft Failure in Emerging Adult Heart Transplant Recipients

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