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Extra-corporeal membrane oxygenation support in cardiac transplantation

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Author(s): H. B. Bittner

Journal: Applied Cardiopulmonary Pathophysiology
ISSN 0920-5268

Volume: 15;
Issue: 4;
Start page: 272;
Date: 2011;
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Keywords: ECMO | heart transplantation | thoracic transplantation | primary graft failure | cardiac surgery | weaning

ABSTRACT
Objective: Extra-corporeal membrane oxygenation (ECMO) provides temporary cardiopulmonary-circulatory support with minimal surgical trauma in patients with therapy refractory cardiogenic shock and early graft failure following thoracic organ transplantation. The frequent use of echocardiography allows objectively the assessment of the biventricular myocardium and cardiac recovery potential, which may lead to ECMO weaning and discontinuation of circulatory support in the majority of patients with significantly improved myocardial function. Methods and results: Between January 1997 and December 2009, 221 patients underwent orthotopic heart transplantation at our institution. Twenty-three patients (10 %) were treated for low cardiac output with ECMO support with a mean duration of 4 days (4 hours to 21 days). Peripheral access procedures for ECMO support were performed in all patients. Aorto-right atrial cannulation was always avoided, which would prevent sternal closure. Intra-aortic balloon counterpulsation was used in the majority of patients (18 of 23 patients). The early and one-year mortality rate of the ECMO supported patients were 61% and 74%, respectively. Primary graft failure (PGF) was a major indication for early ECMO support in 14 patients. Other indications were right heart failure and sepsis. Among the 14 patients supported with ECMO for PGF, 9 patients were weaned from the assisting device. The one-year survival rate for ECMO-supported PGF patients was 43%.Conclusions: ECMO support is a reliable therapeutic option in severe PGF after cardiac transplantation. Although the 1-year survival is reduced, the use of ECMO is a valuable bridge to recovery strategy in heart transplant patients with graft failure related low cardiac output. Furthermore, our experience suggests that ECMO use is a feasible and cost-effective mechanical support technique to overcome severe cardiac allograft dysfunction.
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