title: Long-term survival after pediatric cardiac transplantation and postoperative ECMO support.
abstract: BACKGROUND
  Graft failure after cardiac transplantation in children can be managed acutely with mechanical support, most commonly extracorporeal membrane oxygenation (ECMO). The purpose of this study was to evaluation the long-term outcome of ECMO support early and late after pediatric cardiac transplantation.
  
  
  METHODS
  From February 1982 through October 2002, 168 patients underwent isolated cardiac transplantation. Twenty patients (11.9%) required mechanical support early or late after transplantation. Inpatient and outpatient records of these were reviewed.
  
  
  RESULTS
  Indication for transplantation was complex congenital heart disease in 12, cardiomyopathy in 7, and graft failure (retransplant) in 1. One patient was also on ECMO preoperatively. Fifteen patients required circulatory support immediately or shortly (less than 6 weeks) after transplantation. The remaining 5 patients were placed on ECMO for ventricular dysfunction late (3 months to 7 years) after transplantation. In the perioperative ECMO group, 8 (53%) were successfully decannulated and subsequently discharged. Three of 5 (60%) patients placed on ECMO late were successfully decannulated, 1 of whom died in hospital 10 days later and 2 of whom are still alive.
  
  
  CONCLUSIONS
  Mechanical circulatory support using ECMO can be a useful strategy is the management of graft dysfunction after pediatric cardiac transplantation both early and late postoperatively. The mortality rate is acceptable in this very high risk group of patients and long-term outcome is good.
authors.affiliation: Children's Hospital, Omaha, Nebraska 68114, USA. kfenton@chsomaha.org
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Fenton
authors.forename: Steven A
authors.initials: SA
authors.lastname: Webber
authors.forename: David A
authors.initials: DA
authors.lastname: Danford
authors.forename: Sanjiv K
authors.initials: SK
authors.lastname: Gandhi
authors.forename: Jayson
authors.initials: J
authors.lastname: Periera
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011182:Postoperative Care; D015996:Survival Rate; D013997:Time Factors