Extracorporeal membrane oxygenation is superior to right ventricular assist device for acute right ventricular failure after heart transplantation.
BACKGROUND
Acute right ventricular failure after heart transplantation is a life-threatening condition, and sometimes the use of mechanical circulatory support is inevitable. The aim of this retrospective study was to investigate the effectiveness of two different mechanical circulatory support systems for this indication.


METHODS
From 1984 to 2003, 28 heart transplant recipients exhibited right ventricular failure resistant to drug therapy. Right ventricular assist device (n = 15) or extracorporeal membrane oxygenation (n = 13) was implanted to support the failing heart.


RESULTS
Overall in-hospital survival was 43%. In the right ventricular assist device group, only 2 patients (13%) could be weaned from mechanical circulatory support compared with 10 patients (77%) in the extracorporeal membrane oxygenation group (p = 0.001). Retransplantation was necessary in 6 patients in the right ventricular assist device group and in 1 patient in the extracorporeal membrane oxygenation group (p = 0.049). There was no difference in patient survival between groups, but graft survival was significantly better in the extracorporeal membrane oxygenation group (p = 0.005).


CONCLUSIONS
In view of these results, extracorporeal membrane oxygenation seems to be the better option as mechanical circulatory support for right ventricular failure in heart transplantation.
Taghavi
Shahrokh
S
Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria. taghavis@hotmail.com
Zuckermann
Andreas
A
Ankersmit
Jan
J
Wieselthaler
Georg
G
Rajek
Angela
A
Laufer
Günther
G
Wolner
Ernst
E
Grimm
Michael
M
D000368:Aged; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000401:mortality / Q000628:therapy*