TY - JOUR
T1 - Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts
AU - Shudo, Yasuhiro
AU - Alassar, Aiman
AU - Wang, Hanjay
AU - Lingala, Bharathi
AU - He, Hao
AU - Zhu, Yuanjia
AU - Hiesinger, William
AU - MacArthur, John W.
AU - Boyd, Jack H.
AU - Lee, Anson M.
AU - Currie, Maria
AU - Woo, Y. Joseph
N1 - Publisher Copyright:
Copyright © 2022 Shudo, Alassar, Wang, Lingala, He, Zhu, Hiesinger, MacArthur, Boyd, Lee, Currie and Woo.
PY - 2022/3/10
Y1 - 2022/3/10
N2 - Severe primary graft dysfunction (PGD) is the leading cause of early postoperative mortality following orthotopic heart transplantation (OHT). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used as salvage therapy. This study aimed to evaluate the outcomes in adult OHT recipients who underwent VA-ECMO for severe PGD. We retrospectively reviewed 899 adult (≥18 years) patients who underwent primary OHT at our institution between 1997 and 2017. Recipients treated with VA-ECMO (19, 2.1%) exhibited a higher incidence of previous cardiac surgery (p =.0220), chronic obstructive pulmonary disease (p =.0352), and treatment with a calcium channel blocker (p =.0018) and amiodarone (p =.0148). Cardiopulmonary bypass (p =.0410) and aortic cross-clamp times (p =.0477) were longer in the VA-ECMO cohort and they were more likely to have received postoperative transfusion (p =.0013); intra-aortic balloon pump (IABP, p <.0001), and reoperation for bleeding or tamponade (p <.0001). The 30-day, 1-year, and overall survival after transplantation of non-ECMO patients were 95.9, 88.8, and 67.4%, respectively, compared to 73.7, 57.9, and 47.4%, respectively in the ECMO cohort. Fourteen (73.7%) of the ECMO patients were weaned after a median of 7 days following OHT (range: 1–12 days). Following OHT, VA-ECMO may be a useful salvage therapy for severe PGD and can potentially support the usage of marginal donor hearts.
AB - Severe primary graft dysfunction (PGD) is the leading cause of early postoperative mortality following orthotopic heart transplantation (OHT). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used as salvage therapy. This study aimed to evaluate the outcomes in adult OHT recipients who underwent VA-ECMO for severe PGD. We retrospectively reviewed 899 adult (≥18 years) patients who underwent primary OHT at our institution between 1997 and 2017. Recipients treated with VA-ECMO (19, 2.1%) exhibited a higher incidence of previous cardiac surgery (p =.0220), chronic obstructive pulmonary disease (p =.0352), and treatment with a calcium channel blocker (p =.0018) and amiodarone (p =.0148). Cardiopulmonary bypass (p =.0410) and aortic cross-clamp times (p =.0477) were longer in the VA-ECMO cohort and they were more likely to have received postoperative transfusion (p =.0013); intra-aortic balloon pump (IABP, p <.0001), and reoperation for bleeding or tamponade (p <.0001). The 30-day, 1-year, and overall survival after transplantation of non-ECMO patients were 95.9, 88.8, and 67.4%, respectively, compared to 73.7, 57.9, and 47.4%, respectively in the ECMO cohort. Fourteen (73.7%) of the ECMO patients were weaned after a median of 7 days following OHT (range: 1–12 days). Following OHT, VA-ECMO may be a useful salvage therapy for severe PGD and can potentially support the usage of marginal donor hearts.
KW - ECMO
KW - heart transplantation
KW - marginal donor heart
KW - outcomes
KW - primary graft dysfunction
UR - http://www.scopus.com/inward/record.url?scp=85127291478&partnerID=8YFLogxK
U2 - 10.3389/ti.2022.10176
DO - 10.3389/ti.2022.10176
M3 - Article
C2 - 35340846
AN - SCOPUS:85127291478
SN - 0934-0874
VL - 35
JO - Transplant International
JF - Transplant International
M1 - 10176
ER -