Use of Extracorporeal Membrane Oxygenation for Primary Graft Dysfunction After Cardiac Transplantation: Results of an A Priori Ventless Approach.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
06 Oct 2023
06 Oct 2023
Historique:
medline:
5
10
2023
pubmed:
5
10
2023
entrez:
5
10
2023
Statut:
aheadofprint
Résumé
Primary graft dysfunction (PGD) after cardiac transplantation is a devastating complication with increasing frequency lately in the setting of donation after circulatory death (DCD). Severe PGD is commonly treated with extracorporeal membrane oxygenation (ECMO) using central or peripheral cannulation. We retrospectively reviewed the outcomes of PGD after cardiac transplantation requiring ECMO support at our center from 2015 to 2020, focused on our now preferential approach using peripheral cannulation without a priori venting. During the study period, 255 patients underwent heart transplantation at our center and 26 (10.2%) of them required ECMO for PGD. Of 24 patients cannulated peripherally 19 (79%) were alive at 30 days and 17 (71%) 1 year after transplant; two additional patients underwent central ECMO cannulation due to unfavorable size of femoral vessels and concern for limb ischemia. Successful decannulation with full graft function recovery occurred in 22 of 24 (92%) patients cannulated peripherally. Six of them had an indwelling intra-aortic balloon pump placed before the transplantation. None of the other 18 patients received a ventricular vent. In conclusion, the use of an a priori peripheral and ventless ECMO approach in patients with PGD after heart transplant is an effective strategy associated with high rates of graft recovery and survival.
Identifiants
pubmed: 37797341
doi: 10.1097/MAT.0000000000002051
pii: 00002480-990000000-00319
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © ASAIO 2023.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
Kobashigawa J, Zuckermann A, Macdonald P, et al.; Consensus Conference participants: Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant 33: 327–340, 2014.
Lima EB, Cunha CR, Barzilai VS, et al.: Experience of ECMO in primary graft dysfunction after orthotopic heart transplantation. Arq Bras Cardiol 105: 285–291, 2015.
Russo MJ, Iribarne A, Hong KN, et al.: Factors associated with primary graft failure after heart transplantation. Transplantation 90: 444–450, 2010.
Iyer A, Kumarasinghe G, Hicks M, et al.: Primary graft failure after heart transplantation. J Transplantat 2011: 175768, 2011.
DeRoo SC, Takayama H, Nemeth S, et al.: Extracorporeal membrane oxygenation for primary graft dysfunction after heart transplant. J Thorac Cardiovasc Surg 158: 1576–1584.e3, 2019.
Schroder JN, Shah A, Pretorius V, et al.: Expanding heart transplants from donors after circulatory death (DCD)—Results of the first randomized controlled trial using the organ care system (OCS™) Heart—(OCS DCD Heart Trial). J Heart Lung Transplant 41: S72, 2022.
Sun HY, Ko WJ, Tsai PR, et al.: Infections occurring during extracorporeal membrane oxygenation use in adult patients. J Thorac Cardiovasc Surg 140: 1125–32.e2, 2010.
Yau P, Xia Y, Shariff S, et al.: Factors associated with ipsilateral limb ischemia in patients undergoing femoral cannulation extracorporeal membrane oxygenation. Ann Vasc Surg 54: 60–65, 2019.
Ostermann M, Lumlertgul N, Lumlertgul N: Acute kidney injury in ECMO patients. Critical Care 25: 313, 2021.
Thomas J, Kostousov V, Teruya J: Bleeding and thrombotic complications in the use of extracorporeal membrane oxygenation. Semin Thromb Hemost 44: 20–29, 2018.
Alba AC, Foroutan F, Buchan TA, et al.: Mortality in patients with cardiogenic shock supported with VA ECMO: A systematic review and meta-analysis evaluating the impact of etiology on 29,289 patients. J Heart Lung Transplant 40: 260–268, 2021.
Stehlik J, Edwards LB, Rowe A, et al.: ISHLT international registry for heart and lung transplantation—three decades of scientific contributions. Transplantat Rev 27: 38–42, 2013.
Young JB, Hauptman PJ, Naftel DC, et al.: Determinants of early graft failure following cardiac transplantation, a 10-year, multi-institutional, multivariable analysis. J Heart Lung Transplant 20: 212, 2001.
Grandin EW, Nunez JI, Willar B, et al.: Mechanical left ventricular unloading in patients undergoing venoarterial extracorporeal membrane oxygenation. J Am Coll Cardiol 79: 1239–1250, 2022.
Saeed O, Jakobleff WA, Forest SJ, et al.: Hemolysis and nonhemorrhagic stroke during venoarterial extracorporeal membrane oxygenation. Ann Thorac Surg 108: 756–763, 2019.
Amarelli C, De Santo LS, Marra C, et al.: Early graft failure after heart transplant: Risk factors and implications for improved donor-recipient matching. Interact Cardiovasc Thorac Surg 15: 57–62, 2012.
John MM, Shih W, Estevez D, et al.: Interaction between ischemic time and donor age on adult heart transplant outcomes in the modern era. Ann Thorac Surg 108: 744–748, 2019.
Noly P-E, Hébert M, Lamarche Y, et al.: Use of extracorporeal membrane oxygenation for heart graft dysfunction in adults: Incidence, risk factors and outcomes in a multicentric study. Can J Surg 64: E567–E577, 2021.
Kavarana MN, Sinha P, Naka Y, Oz MC, Edwards NM: Mechanical support for the failing cardiac allograft: A single-center experience. J Heart Lung Transplant 22: 542–547, 2003.
Listijono DR, Watson A, Pye R, et al.: Usefulness of extracorporeal membrane oxygenation for early cardiac allograft dysfunction. J Heart Lung Transplant 30: 783–789, 2011.
Takeda K, Li B, Garan AR, et al.: Improved outcomes from extracorporeal membrane oxygenation versus ventricular assist device temporary support of primary graft dysfunction in heart transplant. J Heart Lung Transplant 36: 650–656, 2017.
Taghavi S, Ankersmit HJ, Wieselthaler G, et al.: Extracorporeal membrane oxygenation for graft failure after heart transplantation: Recent Vienna experience. J Thorac Cardiovasc Surg 122: 819–820, 2001.
Kaushal S, Matthews KL, Garcia X, et al.: A multicenter study of primary graft failure after infant heart transplantation: Impact of extracorporeal membrane oxygenation on outcomes. Pediatr Transplant 18: 72–78, 2014.
Marasco SF, Vale M, Pellegrino V, et al.: Extracorporeal membrane oxygenation in primary graft failure after heart transplantation. Ann Thorac Surg 90: 1541–1546, 2010.