Usefulness of extracorporeal membrane oxygenation for early cardiac allograft dysfunction

• Published in: The Journal of heart and lung transplantation Vol. 30; no. 7; pp. 783 - 789
• Main Authors: Listijono, Dave R, Watson, Alasdair, MBBS, Pye, Roger, FRACP, FJFICM, FANZCA, Keogh, Anne M., MD, FRACP, Kotlyar, Eugene, MD, FRACP, Spratt, Phillip, FRCS (Ed), FRACS, Granger, Emily, FRACS, Dhital, Kumud, PhD, FRCS, Jansz, Paul, MD, FRACS, Macdonald, Peter S., PhD, MD, FRACP, Hayward, Christopher S., MD, FRACP
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2011; Elsevier
• Subjects: Adult; Biological and medical sciences; Cardiology. Vascular system; Extracorporeal Membrane Oxygenation - methods; Extracorporeal Membrane Oxygenation - mortality; extracorporeal membrane support; graft dysfunction; heart transplantation; Heart Transplantation - adverse effects; Heart Transplantation - mortality; Hemodynamics; Humans; Length of Stay - statistics & numerical data; Medical sciences; Middle Aged; Postoperative Care - methods; Primary Graft Dysfunction - therapy; Retrospective Studies; Salvage Therapy - methods; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Time Factors; Transplantation, Homologous; Treatment Outcome; extracorporeal membrane support; graft dysfunction; heart transplantation; Heart; Transplantation; Homotransplantation; Phlebology; Treatment; Dysfunction; Surgery; Graft; Membrane; Early; Circulatory system; Cardiology; Oxygenation
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2011.01.728

Background Owing to persisting donor shortages, the use of “marginal hearts” has increased. Because patients who receive a marginal heart may require hemodynamic support in the early post-operative period, extracorporeal membrane oxygenation (ECMO) may be used until recovery of acute graft dysfunction. Methods A retrospective file review of 124 primary adult heart transplant patients from 2003 to 2008 was conducted. We compared 17 patients who received post-transplant ECMO support with 107 transplant recipients without ECMO. Donor and recipient pre-transplant, intra-operative, and post-transplant clinical variables to 6 months after transplant were compared. Results Pre-operative demographics of the 2 groups were similar. Eight (47%) of the patients in the ECMO group received marginal donor hearts, compared with 1 (1%) in the non-ECMO group ( p < 0.05). There were 3 early deaths in the ECMO group (2 of whom had received optimal donor hearts), resulting in lower Day 30 ECMO survival of 82.4% vs 100% for non-ECMO, respectively ( p < 0.001), and 6-month survival of 82.4% vs 95.6%, respectively ( p < 0.02). Most of the difference in survival was in patients who required salvage ECMO despite normal pre-transplant donor LV function. The rate of early dialysis was higher in the ECMO group, at 18% vs 6% at Day 3, but there was no difference between the 2 groups by Day 7. Pre-discharge ventricular function was normal in all discharged ECMO patients and all but 1 non-ECMO patient. ECMO patients had a longer intensive care unit stay (8.9 ± 3.4 vs 4.8 ± 5.4 days, p < 0.005), but there was a slightly shorter ward stay, resulting in a similar overall hospitalization length of stay (22.9 ± 8.3 vs 25.1 ± 25.2 days). Conclusions ECMO allows for salvage of acute graft dysfunction and may allow use of marginal donor hearts. Survival rates are lower in patients who require ECMO compared with optimal donors, but early cardiac dysfunction normalizes in most without long-term cardiac or renal sequelae. Despite longer ventilation times, overall hospitalization is not prolonged.