Extra-corporeal membrane oxygenation temporary support for early graft failure after cardiac transplantation.
OBJECTIVE
Early graft failure (EGF) is a major risk for death after heart transplantation. We studied the impact of an extra-corporeal membrane oxygenation (ECMO) temporary support on the operative mortality and the mean-term survival after EGF.


METHODS
Between January 2000 and December 2006, 394 patients underwent orthotopic heart transplantation at our institution. EGF was observed in 90 (23%) patients. Fifty-four patients (14%) were treated with ECMO support, eight (2%) with other assisting devices, and 28 (7%) received maximal inotropic drug support only.


RESULTS
The overall mortality was 21% (83 patients). EGF was a major risk for death: 13% (35 patients) without EGF versus 58% (49 patients) with EGF, p<0001. Among patients supported with ECMO, 36 (67%) were weaned from the assisting device and 27 (50%) were discharged from the hospital. Overall survival was 73% at 1 year and 66% at 5 years. Absence of EGF improved long-term survival: 78% at 1 year and 70% at 5 years without EGF versus 37% at 1 year and 35% at 5 years with EGF. Patients treated with ECMO have the same 1-year conditional survival as patients not having suffered EGF: 94% at 3 years.


CONCLUSIONS
ECMO support is a reliable therapeutic option in severe EGF after cardiac transplantation; furthermore, patients treated with ECMO have the same 1-year conditional survival as patients not having suffered EGF.
D'Alessandro
Cosimo
C
Université Pierre et Marie Curie, Paris VI, APHP, Groupe hospitalier Pitié-Salpétrière, Institute of Cardiology, Division of Thoracic and Cardiovascular Surgery, F-75013 Paris, France. cosimodalessandro@wanadoo.fr
Aubert
Stéphane
S
Golmard
Jean Louis
JL
Praschker
Beltran Levy
BL
Luyt
Charles Edouard
CE
Pavie
Alain
A
Gandjbakhch
Iradj
I
Leprince
Pascal
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002648:Child; D004334:Drug Administration Schedule; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult
D002316:Cardiotonic Agents