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Extracorporeal membrane oxygenation: experience in acute graft failure after heart transplantation
Author(s) -
Lehmann Sven,
Uhlemann Madlen,
Etz Christian D.,
Garbade Jens,
Schroeter Thomas,
Borger Michael,
Misfeld Martin,
Bittner Hartmuth B.,
Mohr Friedrich Wilhelm
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12380
Subject(s) - medicine , extracorporeal membrane oxygenation , heart failure , heart transplantation , perioperative , transplantation , sepsis , odds ratio , surgery , cardiology
Acute graft failure is the leading cause of early mortality after heart transplantation ( HTx ). Extracorporeal membrane oxygenation ( ECMO ) is an efficient therapeutic option to treat various pathologies, unburden the left and right ventricle, and allow for functional recovery of the transplanted heart. We reviewed our ECMO experience and outcomes in HTx patients. Methods Retrospectively, we analyzed all patients who received an orthotopic HT x (n = 298) in our department over a 15‐yr period (1997 through 2011) to assess the incidence of post‐ HT x ECMO implantation, perioperative complications, early and one‐yr mortality as well as causes of death. Results ECMO therapy was utilized to treat graft failure in 28 patients (10.6%) with a mean duration of ECMO support of 4.2 d (six h to 9.4 d). Multivariate analysis revealed as independent predictors for mortality low cardiac output (p = 0.028; odds ratio ( OR ) = 11.3) and stroke (p = 0.008; OR = 19.7). Cumulative survival rates were 46.4 ± 9.4% within 30 d and 25.0 ± 8.2% at one yr. Causes of death were multiorgan failure (n = 9), sepsis (n = 9), lung failure (n = 2), and intracerebral bleeding (n = 2). ECMO was implanted due to primary graft failure ( PGF , n = 16), sepsis (n = 4), and right heart failure (n = 6). Conclusion Temporary ECMO support for postoperative output failure is an acceptable option as a last resort for otherwise doomed patients with fatal graft failure after HT x. The small fraction of patients surviving appear to have a decent long‐term prognosis.