Primary Graft Failure after Heart Transplantation. Successful Recovery with Pneumatic Biventricular Assistance

Abstract

A 41-year-old male underwent orthotopic heart transplantation complicated by intraoperative acute allograft failure. The patient required immediate placement of a pneumatic biventricular assist device which was kept for 49 days until graft recovery resulted in successful explantation of the device. The patient was discharged from hospital on postoperative day 112. Management of primary cardiac allograft failure with mechanical ventricular assistance is discussed.

Mechanical circulatory support after heart transplantation

“…Initial pharmacologic measures of support most commonly include a combination of inotropic agents (e.g., milrinone, dobutamine, and epinephrine) and pulmonary vasodilators (nitric oxide). Mechanical circulatory support (MCS) is indicated for patients whose graft function remains poor despite optimal medical therapy [4][5][6][7][8][9]. Commonly used forms of MCS include extracorporeal membrane oxygenation (ECMO) and right and biventricular assist devices.…”

Six years of continuous mechanical circulatory support following chronic graft failure

“…Long‐term use of LVAD after failed transplant has not been described in literature. We did; however, find some reports about its short‐term use 6–8 . Hulman et al studied the outcome of patients with primary graft failure who received mechanical circulatory support.…”

“…Ibrahim reported a series of nine patients who developed primary graft failure and required a mechanical circulatory support. Two of them received LVAD, and both patients died shortly after the operation 7 …”

“…We did; however, find some reports about its short-term use. [6][7][8] Hulman et al studied the outcome of patients with primary graft failure who received mechanical circulatory support. Among the 14 patients included in the study, 1 patient received an LVAD, and 1 patient was switched from ECMO to LVAD.…”

“…Two of them received LVAD, and both patients died shortly after the operation. 7 Takeda et al compared the outcome of ECMO and VAD support after primary graft failure. A total of 44 patients received either ECMO or LVAD.…”