title: Management of acute severe perioperative failure of cardiac allografts: a single-centre experience with a review of the literature.
abstract: BACKGROUND
  Early graft failure is associated with high mortality and is the main cause of death within the first 30 days after transplantation. The purpose of the present study was to examine the investigators' experience of severe perioperative acute graft failure and to review the literature.
  
  
  METHODS
  Nine of 385 cardiac transplants (2.3%) performed from 1984 through 2005 developed severe perioperative acute graft failure either in the operating room or within 24 h after cardiac transplantation. Four patients had primary graft failure, two had right heart failure secondary to pulmonary hypertension, one had hyperacute rejection, one had accelerated acute rejection and one possibly sustained a particulate coronary embolus intraoperatively.
  
  
  RESULTS
  All except the two patients who had right heart failure secondary to pulmonary hypertension received mechanical circulatory support. Three patients were supported with total artificial hearts, two patients received a left ventricular assist device, one patient was supported with extracorporeal life support followed by a right ventricular assist device when the left ventricle recovered, and one patient was supported for several hours with cardiopulmonary bypass. Three patients were retransplanted after mechanical circulatory support, but only one survived. Only one of the nine patients (11%) survived; this patient was supported with a total artificial heart followed by retransplantation.
  
  
  CONCLUSIONS
  The outcome of severe perioperative acute graft failure is very poor. Mechanical circulatory support and retransplantation are not as successful as in other situations. Due to the shortage of donors and poor outcomes, retransplantation for hyperacute rejection is not advisable.
authors: Section of Cardiac Surgery, St. Boniface General Hospital, Winnipeg, Manitoba, Canada. mibrahim@sbgh.mb.ca
authors: Moheb
authors: M
authors: Ibrahim
authors: Paul
authors: P
authors: Hendry
authors: Roy
authors: R
authors: Masters
authors: Fraser
authors: F
authors: Rubens
authors: B-Khanh
authors: BK
authors: Lam
authors: Marc
authors: M
authors: Ruel
authors: Ross
authors: R
authors: Davies
authors: Haissam
authors: H
authors: Haddad
authors: John P
authors: JP
authors: Veinot
authors: Thierry
authors: T
authors: Mesana
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000628:therapy; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies; D014184:Transplantation, Homologous