A case series: the outcomes, support duration, and graft function recovery after VA-ECMO use in primary graft dysfunction after heart transplantation
| Autor: | Frederick Y. Chen, Y. Zhan, Amanda R. Vest, Hassan Rastegar, David DeNofrio, Kenneth G. Warner, Masashi Kawabori, John Adam Reich, Michael Mastroianni, Gregory S. Couper |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Biomedical Engineering Medicine (miscellaneous) Primary Graft Dysfunction Single Center Biomaterials Extracorporeal Membrane Oxygenation medicine Humans Lung transplantation Survival rate Aged Retrospective Studies Heart Failure Heart transplantation Ejection fraction business.industry Recovery of Function Middle Aged respiratory system Cardiac surgery Surgery Survival Rate surgical procedures operative Heart Transplantation lipids (amino acids peptides and proteins) Cardiology and Cardiovascular Medicine business Complication |
| Zdroj: | Journal of Artificial Organs. 23:140-146 |
| ISSN: | 1619-0904 1434-7229 |
| DOI: | 10.1007/s10047-019-01146-y |
| Popis: | Primary graft dysfunction (PGD) is a rare complication associated with high mortality after heart transplantation, which may require veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) support. A standardized definition for PGD was developed by the International Society of Heart and Lung Transplantation in 2014. Due to limited reports using this definition, the detailed outcomes after VA-ECMO support remain unclear. Therefore, we retrospectively analyzed our single-center outcomes of PGD following VA-ECMO support. Between September 2014 and August 2018, 160 patients underwent heart transplantation in our single center. Nine PGD patients required VA-ECMO support, with an incidence of 5.6%. Pre-operative recipient/donor demographics, intra-operative variables, timing of VA-ECMO initiation and support duration, graft function recovery during 30 days after heart transplant, VA-ECMO complications, and survival were analyzed. The indication for VA-ECMO support was biventricular failure for all nine patients. Six patients had severe PGD requiring intra-operative VA-ECMO, while two patients had moderate PGD and one patient had mild PGD requiring post-operative VA-ECMO. All cohorts were successfully decannulated in a median of 10 days. Survival to discharge rate was 88.9%. One-year survival rate was 85.7%. Left ventricular ejection fraction recovered to normal within 30 days in all PGD patients. Our study showed VA-ECMO support led to high survival and timely graft function recovery in all cohorts. Further larger research can clarify the detailed effects of VA-ECMO support which may lead to standardized indication of VA-ECMO support for PGD patients. |
| Databáze: | OpenAIRE |
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