Use of extracorporeal membrane oxygenation for treating acute cardiomyopathy after
            liver transplantation: a case report

Biondi, Rodrigo Santos; Barzilai, Vitor Salvatore; Watanabe, André Luís Conde; Ferreira, Gustavo de Sousa Arantes; Atik, Fernando Antibas

doi:10.5935/0103-507x.20180029

Cited by 11 publications

(7 citation statements)

References 9 publications

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Section: Discussionmentioning

confidence: 99%

“…Cases generally report favorable cardiac outcomes, with fully recovered EF within two weeks and preserved cardiac function throughout follow-up, which has varied in duration from 1 month to 2 years. 3,4 Solid organ transplant has been described as a specific risk factor for TTS, reported most frequently in liver transplant patients. Venoarterial extracorporeal membrane oxygenation has been increasingly used for liver transplant complications including cardiogenic shock, septic shock, and portopulmonary hypertension.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Stress-Induced (Takotsubo) Cardiomyopathy After Liver Transplant Rescued with Venoarterial Extracorporeal Membrane Oxygenation

Caturegli¹,

Crane²,

Etchill³

et al. 2021

ASAIO Journal

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Here, we report the case of a 55 year old male patient without significant preexisting cardiovascular disease who received a deceased donor liver transplant. Intraoperatively, the patient developed cardiogenic shock secondary to stress-induced cardiomyopathy or Takotsubo syndrome (TTS), which was refractory to high-dose vasoactive, inotropic medical therapy. The patient was successfully managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for 7 days, with complete recovery of cardiac function and maintenance of the hepatic graft. Given the anticipated need for only a short period of support and the expectation of full myocardial recovery, such patients may represent excellent candidates for the use of VA-ECMO.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stress-Induced (Takotsubo) Cardiomyopathy After Liver Transplant Rescued with Venoarterial Extracorporeal Membrane Oxygenation

Caturegli¹,

Crane²,

Etchill³

et al. 2021

ASAIO Journal

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“…There are only a few articles covering less than 50 LT recipients undergoing ECMO perioperatively. [ 9 – 13 ] It is worth noting that in most of the cases mentioned above, ECMO was utilized as a salvage measure for complications (pneumonia, acute respiratory distress syndrome, or septic shock) after LT. In 3 pediatric liver recipients, they developed graft failure and pulmonary failure after the first LT, supported by ECMO for a few days, and got retransplantation.…”

Section: Discussionmentioning

confidence: 99%

Utilization of extracorporeal membrane oxygenation for a severe cardiocirculatory dysfunction recipient in liver transplantation

et al. 2018

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Rationale:Severe cardiac dysfunction or severe pulmonary hypertension is a contraindication of liver transplantation (LT). Extracorporeal membrane oxygenation (ECMO) is an advanced therapy for severe lung and/or cardiocirculatory dysfunction or failure. The application of ECMO to patients during the LT perioperative period may help recipients with severe cardiac disease to maintain the heart function and alleviate the reperfusion syndrome.Patient concerns:A female liver recipient complained about weakness for 6 months.Diagnoses:The patient was diagnosed as hepatitis B virus (HBV)-related hepatic cirrhosis (MELD 24, Child–Pugh C) with severe mitral regurgitation, severe tricuspid regurgitation, left atrium and left ventricle enlargement, cardiac insufficiency, pulmonary arterial hypertension, and hypoxemia.Interventions:The patient underwent LT from a cardiac deceased donor. The surgery was completed by venoarterial ECMO. The femoral vessels cannulation was done after the dissection of the patient's liver and before the venous blocking. Venous cannula reached to the position below renal vein, while arterial cannula reached to common iliac artery. We regulated the ECMO index according to the patient's condition. The dosage of heparin was adjusted on the basis of the activated clotting time. Respiratory support, milrinone, furosemide, and mannitol were used to improve the circulation. The bleeding volume of surgery was 1200 mL. The cardiocirculatory function and other vital signs remained good in the perioperative period. In the first 24 hours after surgery, central venous pressure decreased from 17 to 7 cmH2O. Thirty hours after surgery, the ECMO was removed. Eighteen hours later, the recipient did not need respiratory support.Outcomes:No complications of transplantation or ECMO were found.Lessons:It is feasible to utilize ECMO as a cardiocirculatory function support in the LT. ECMO does not increase the risk of hemorrhage. ECMO can play an important role in ensuring the security of the liver recipients in the surgery and in the postoperative period.

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“…Thirteen case studies and series were identified comprising 31 individual cases of VA-ECMO (n = 23) or CPB use (n = 8) in adult LT patients (Table 3). 4,5,8,12,13,17,18,22,23,[26][27][28][29] In total, 17 of 31 patients survived to discharge (55%). Survival among patients requiring ECPR was 56% (10/18).…”

Section: Ecls For Cardiac Failurementioning

confidence: 99%

Applications and Outcomes of Extracorporeal Life Support Use in Adult Liver Transplantation: A Case Series and Review of Literature

et al. 2021

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The use of extracorporeal life support (ECLS) is increasingly reported in adult liver transplantation (LT). However, neither the role of ECLS in the perioperative setting for LT nor its outcomes has been well defined. We performed a retrospective chart review of all adult LT patients at our institution who received ECLS from 2004 to 2021. We also conducted a comprehensive literature search for adult LT cases that involved perioperative ECLS for respiratory or cardiac failure. Over the study period, 11 LT patients required ECLS at our institution, two for respiratory and nine for cardiac failure. Both patients with respiratory failure received ECLS as a bridge to LT and survived to discharge. Nine patients required ECLS for acute cardiac failure either intraoperatively or postoperatively, and two survived to discharge. In the literature, we identified 35 cases of respiratory failure in LT patients requiring perioperative ECLS. Applications included preoperative bridge to LT (n = 6) and postoperative rescue (n = 29), for which overall survival was 44%. We identified 31 cases of cardiac failure in LT patients requiring either ECLS or cardiopulmonary bypass for cardiac support or rescue for intraoperative or postoperative cardiac failure (n = 30). There is evidence for consideration of ECLS as a bridge to LT in patients with potentially reversible respiratory failure or as rescue therapy for respiratory failure in posttransplant patients. ECLS has a prohibitively high risk of futility in pretransplant patients with cardiac failure but may have a role in LT patients with a functioning graft and potentially reversible cardiac failure.

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Use of extracorporeal membrane oxygenation for treating acute cardiomyopathy after liver transplantation: a case report

Cited by 11 publications

References 9 publications

Stress-Induced (Takotsubo) Cardiomyopathy After Liver Transplant Rescued with Venoarterial Extracorporeal Membrane Oxygenation

Stress-Induced (Takotsubo) Cardiomyopathy After Liver Transplant Rescued with Venoarterial Extracorporeal Membrane Oxygenation

Utilization of extracorporeal membrane oxygenation for a severe cardiocirculatory dysfunction recipient in liver transplantation

Applications and Outcomes of Extracorporeal Life Support Use in Adult Liver Transplantation: A Case Series and Review of Literature

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