Extracorporeal Membrane Oxygenation for Primary Allograft Failure

• Published in: Transplantation proceedings Vol. 40; no. 10; pp. 3596 - 3597
• Main Authors: Arpesella, G, Loforte, A, Mikus, E, Mikus, P.M
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Inc 01.12.2008; Elsevier
• Subjects: Adult; Biological and medical sciences; Equipment Design; Extracorporeal Membrane Oxygenation - instrumentation; Extracorporeal Membrane Oxygenation - methods; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Heart Transplantation - adverse effects; Heart Transplantation - physiology; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Resuscitation - methods; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Transplantation, Homologous - adverse effects; Treatment Failure; Young Adult; Medicine; Treatment; Surgery; Primary; Graft; Transplantation; Extracorporeal circuit; Graft failure
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.06.079

Abstract Objective Herein we have reported our experience concerning the usefulness of extracorporeal membrane oxygenation (ECMO) in heart transplant patients. Patients and Methods Between July 2002 and March 2007, 11 heart transplant patients, namely, 8 men and 3 women of overall mean age of 49.4 ± 13.9 years (range, 19–62 years) with primary graft failure underwent ECMO implantation. Two patients had pulmonary hypertension; 3 had been transplanted with hearts from marginal donors. At the time of implantation, all were in severe cardiogenic shock despite maximal inotropic support. In 6 patients, the ECMO was implanted centrally in the operating room when there was failure of weaning of cardiopulmonary bypass. Among the 5 remaining patients, ECMO was implanted peripherally in the intensive care unit, during the first 60 hours, including 3 cases of hemodynamic instability and 1 of irreversible cardiac graft arrest. The last patient was implanted on day 30 after transplantation because of acute rejection. Results Mean pump outflow was 2.7 ± 0.4 L/min/m2 . One patient died on circulatory support due to a cerebral hemorrhage. Ten patients were weaned from ECMO after a mean duration of 9.1 ± 6.9 days (range, 1–18 days). All of them were successfully discharged. No retransplantation occurred. Conclusion Rapid operating room or bedside placement of ECMO allowed stabilization of hemodynamics with potential myocardial recovery in patients with cardiac graft failure.