title: Right-left atrium by-pass as salvage treatment for graft failure after heart transplantation.
abstract: Chronic functional pulmonary hypertension (FPH) secondary to end-stage cardiomyopathy constitutes a risk factor for graft right ventricular failure (RVF) after orthotopic heart transplantation (HTx). A novel form of mechanical assist circuit, the extracorporeal right to left atrium bypass (ECRLAB), has been proposed. Since 1998, at our institution, a total of six patients with FPH who experienced graft RVF after HTx, as ischemic end-stage cardiomyopathy, during the effort to wean from cardiopulmonary bypass, underwent ECRLAB support. There were five men and one woman with a mean age of 55+/-3.5 years (49-59 years). The Jostra Rota Flow pump was used in five patients and the Bio-Medicus in one. Mean duration of support was 94.3+/-17.5 h (75-126 h). All (100%) patients were successfully weaned from ECRLAB support. Hemodynamic parameters improved in all patients. Two patients died from cerebral haemorrhage. Four (66.6%) patients were successfully discharged home. ECRLAB could be proposed during HTx in patients with increased preoperative transpulmonary gradient to promote the functional adaptation of the graft and avoid graft RVF, until the decline of pulmonary resistances.
authors: Heart and Lung Transplantation Program, Policlinico S.Orsola-Malpighi, Bologna University, Via Massarenti 9, 40138 Bologna, Italy.
authors: Giorgio
authors: G
authors: Arpesella
authors: Elisa
authors: E
authors: Mikus
authors: Antonino
authors: A
authors: Loforte
authors: Piero Maria
authors: PM
authors: Mikus
mesh_terms: D009202:Cardiomyopathies / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000601:surgery*; D006325:Heart Atria / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D008297:Male; D008875:Middle Aged; D016879:Salvage Therapy / Q000379:methods*; D016896:Treatment Outcome