Predictive risk factors for primary graft failure requiring temporary extra-corporeal membrane oxygenation support after cardiac transplantation in adults☆

D’Alessandro, Cosimo; Golmard, Jean‐Louis; Barreda, Eleodoro; Laali, Mojgan; Makris, Ralouka; Luyt, Charles‐Édouard; Leprince, Pascal; Pavie, Alain

doi:10.1016/j.ejcts.2011.01.064

Cited by 68 publications

(98 citation statements)

References 19 publications

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“…As previously mentioned, there has been a marked variation in the reported incidence of PGD among studies from individual centres, ranging from 2 % to 26 % [3][4][5]6•, 7-10, 11•], largely due to inconsistencies in the definition for PGD used by different authors. In a large retrospective study of the United Network of Organ Sharing (UNOS) database, Russo et al reported the incidence of PGF at 2.5 % [10]; however, the authors defined PGF as postoperative death or retransplantation within the first 90 days of transplant, indicating that only the most severe cases were included in the analysis.…”

Section: Incidencementioning

confidence: 91%

“…The reported incidence and outcomes of PGD have varied markedly among individual centres [3][4][5]6•, 7-10, 11•]. Some of this variability may reflect real differences (possibly reflecting different policies regarding donor and recipient acceptance criteria), but a more likely explanation for the inter-institutional variability is the use of different diagnostic criteria for PGD among centres.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Primary Graft Dysfunction After Heart Transplantation

et al. 2014

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Primary graft dysfunction (PGD) is a lifethreatening complication of heart transplantation that presents as left, right, or biventricular dysfunction occurring within the first 24 hours of transplant surgery for which there is no identifiable secondary cause. Myocardial injury caused by acute catecholamine toxicity and the release of multiple proinflammatory mediators in the donor, followed by ischaemiareperfusion injury sustained during retrieval, have been considered the predominant pathogenetic processes leading to PGD. Donor, recipient, and procedural factors contribute to the development and severity of the clinical syndrome. The changing donor and recipient characteristics over the last two decades, particularly the increasing donor and recipient age, have led to heightened risk of PGD. PGD is graded from mild to severe depending on the extent of circulatory support that is required to maintain haemodynamic stability and vital organ function. While advances in acute mechanical support devices have improved the outlook for patients with PGD, the rate of mortality remains high for those with severe PGD, reaching 40 %. Potential approaches to preventing or minimising the severity of PGD include optimising donor management, donor heart preservation, and donor/recipient matching.

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Section: Incidencementioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Primary Graft Dysfunction After Heart Transplantation

et al. 2014

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“…Within the first year, the early phase after transplantation is associated with the highest risk of death. In their article, D'Allesandro and colleagues have analyzed incidence, risk factors, and outcomes of primary graft failure after cardiac transplantation [1]. The authors have to be congratulated for writing an honest and very detailed analysis about their data.…”

Section: Introductionmentioning

confidence: 98%

Editorial comment

Zuckermann

Aliabadi

2011

European Journal of Cardio-Thoracic Surgery

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a recipient factor. Concerning the threshold for ECMO implantation, it was the result of an ongoing process. At the beginning of our experience, we were very reluctant to implant an ECMO because we were not aware of the late results. Nowadays we do not accept an inotropic support with epinephrine over 2 mg/h because of the high risk of a late refractory shock.Dr A. Almeida (Melbourne, Australia): How has this study impacted your practice at your hospital?Dr D'Alessandro: Honestly, we have not modified our practice very much yet. As with many other centers, we have a big problem with donor shortage and we discard very few donors. However, on the recipient side now we know that if we put an old patient with pulmonary hypertension on the waiting list, we cannot expect a good outcome.Dr Almeida:If I can answer that question from my point of view, I think the value of this paper is matching donors and recipients. You brought up several issues, and I think that should be a discussion point in your paper. Having an C. D'Alessandro et al. / European Journal of Cardio-thoracic Surgery 40 (2011) 962-970 969 Editorial comment Primary graft failure -the stepchild of cardiac transplantation

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“…From a consensus conference at the 33rd Annual International Society of Heart and Lung Transplant (ISHLT) meeting, PGD was defined as heart failure without secondary reasons developing within 24 h after HTx [3]. PGD is the major cause of early death after HTx, and there have been many reports about risk factors for the development of PGD, including donor age [4], recipient age [5], ischemic time of donor heart [6], female donor [7], donor-to-recipient weight mismatch [8], small donor heart [9], and so on. Therefore using marginal donors could be related to increased risk of PGD.…”

Section: Introductionmentioning

confidence: 99%