AUTHOR=Shudo Yasuhiro , Alassar Aiman , Wang Hanjay , Lingala Bharathi , He Hao , Zhu Yuanjia , Hiesinger William , MacArthur John W. , Boyd Jack H. , Lee Anson M. , Currie Maria , Woo Y. Joseph 

TITLE=Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10176

DOI=10.3389/ti.2022.10176

ISSN=1432-2277

ABSTRACT=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=0.0220), chronic obstructive pulmonary disease (p=0.0352), and treatment with a calcium channel blocker (p=0.0018) and amiodarone (p=0.0148). Cardiopulmonary bypass (p=0.0410) and aortic cross-clamp times (p=0.0477) were longer in the VA-ECMO cohort and they were more likely to have received postoperative transfusion (p=0.0013); intra-aortic balloon pump (IABP), p<0.0001; and reoperation for bleeding or tamponade (p<0.0001). 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).
VA-ECMO can be a useful salvage therapy for adult OHT recipients with previous cardiac surgery and slightly less optimal selection.