Temporary Venoarterial Extracorporeal Membrane Oxygenation: Ten-Year Experience at a Cardiac Transplant Center

Tran, Bao; Cruz, Kim De La; Grant, Stuart W; Meltzer, Joseph; Benharash, Peyman; Dave, Ravi; Ardehali, A.; Shemin, Richard J.; DePasquale, E.C.; Nsair, Ali

doi:10.1177/0885066616654451

Cited by 24 publications

(14 citation statements)

References 25 publications

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“…Extracorporeal membrane oxygenation (ECMO) as treatment of graft failure after heart transplantation (HTx): a "simple" mechanical solution to a multifactorial problem HTx is a valuable option in eligible patients with end-stage heart failure, secondary to cardiomyopathy, failed palliation of congenital heart disease or acquired cardiac disease (1)(2)(3)(4). One of the most significant complications in the immediate post-operative period is early graft failure (EGF), with a mean incidence of 20-25% (1,(3)(4)(5).…”

Section: Perspectivementioning

confidence: 99%

Extracorporeal membrane oxygenation as treatment of graft failure after heart transplantation

Mastroianni¹,

Nenna²,

Lebreton³

et al. 2019

Ann. Cardiothorac. Surg.

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Heart transplantation (HTx) is a valuable option in eligible patients with end-stage heart failure. The most significant complication in the immediate post-operative period is early graft failure (EGF), with a mean incidence of 20-25%. EGF is a major risk factor for death and accounts for 40-50% of early mortality after HTx. Despite the use of inotropes, EGF may persist and require temporary mechanical circulatory support. Extracorporeal membrane oxygenation (ECMO) has been investigated over the years and has proved to be a reliable strategy in patients with EGF after HTx. This study aims to review the contemporary literature on this topic. Considering short-term outcomes, 45-80% of patients were discharged alive from hospital. Duration of support is variable, with a mean duration of 4-8 days. Cannulation strategy and device selection have no differences with respect to short-term outcomes. The main causes of death are multi-organ failure, bleeding, heart failure, stroke and sepsis. Considering long-term outcomes, ECMO survivors appear to have similar survival rates to HTx patients who did not experience EGF. Also, ECMO-treated EGF, among survivors, has no detrimental effect for graft function. In conclusion, ECMO is a reliable therapeutic option to support patients with severe graft failure after HTx, providing adequate support with either central or peripheral arteriovenous cannulation. Further studies will be needed to establish the correct threshold for ECMO support and to provide long-term results.

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Section: Perspectivementioning

confidence: 99%

Extracorporeal membrane oxygenation as treatment of graft failure after heart transplantation

Mastroianni¹,

Nenna²,

Lebreton³

et al. 2019

Ann. Cardiothorac. Surg.

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“…Survival with this double-bridge strategy has varied according to the patients selected, ranging from 30-80% survival after LVAD placement. Tran and colleagues at UCLA reported 45% survival in patients supported on ECMO prior to different VAD options (12). Shah and colleagues (9) observed 1-year survival of 57%, and more recently Marasco observed 1-to 2-year survival of 75% in patients supported on VA-ECMO for CS (8).…”

Section: Ecls Prior To Heart Transplantmentioning

confidence: 99%

Extracorporeal life support in preoperative and postoperative heart transplant management

Bermúdez

McMullan

2017

Annals of Translational Medicine

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Increased experience with extracorporeal life support (ECLS) as a mode of cardiac support has expanded its use to diverse patient populations including patients requiring a bridge to heart transplantation and patients requiring posttransplant support for primary graft dysfunction (PGD). The use of ECLS is associated with acceptable outcomes in well-selected patients. While outcomes with the use of extracorporeal membrane oxygenation (ECMO) as a bridge to heart transplant have been variable, several series have confirmed the safe use of ECLS to stabilize patients prior to left ventricular assist device (LVAD) implantation. These patients are then considered later, when in stable condition, for heart transplant.When ECLS is used prior to heart transplant, mortality is greatest during the first 6 months posttransplant.Patients who are alive 6 months after transplant appear to have similar survival rates as patients who were not supported with ECLS prior to transplant. ECLS support is a reliable therapeutic option for severe PGD and early graft failure after heart transplantation. In patients who require support for severe PGD, venoarterial-ECMO appears to result in better clinical outcomes than LVAD support. ECLS use for PGD after heart transplant continues to be the first line of support. Further studies are necessary to understand the optimal role of ECLS in heart transplantation.

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“…9,10 We have limited experience regarding extracorporeal support for bridge to urgent heart transplant. However, our patients were successfully transplanted after support with VA-ECMO.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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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. Among 31 patients who underwent heart transplant between January 2014 and June 2016, we present our experiences with 3 patients who received venoarterial extracorporeal support as a bridge to heart transplant. The first patient was a 51-year-old male with ischemic dilated cardiomyopathy. Transplant was performed after 6 days of extracorporeal support, and the patient was discharged and alive at follow-up. Patient 2 was a 12-yearold girl with dilated cardiomyopathy who presented with cardiac arrest. Extracorporeal support was initiated during cardiopulmonary resuscitation. She had full neurologic recovery and remained on the wait list. She received a transplant 22 days after resuscitation. She survived and was alive at day 220 posttransplant. The third patient was a 50-year-old male with ischemic dilated cardiomyopathy requiring venoarterial extracorporeal support. Percutaneous balloon atrial septostomy was performed for left ventricle venting. He underwent transplant on day 28 after intensive care unit admission. He died 29 days after release from the hospital. Regarding 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.

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Temporary Venoarterial Extracorporeal Membrane Oxygenation: Ten-Year Experience at a Cardiac Transplant Center

Cited by 24 publications

References 25 publications

Extracorporeal membrane oxygenation as treatment of graft failure after heart transplantation

Extracorporeal membrane oxygenation as treatment of graft failure after heart transplantation

Extracorporeal life support in preoperative and postoperative heart transplant management

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