title: Evaluation ECMO in adult cardiac transplantation: can outcomes of marginal donor hearts be improved?
abstract: OBJECTIVE
  This study documents our experience with the use of ECMO in adult cardiac transplantation. Furthermore, in an attempt to improve outcomes of donor hearts with long ischemic times (LITs) we evaluated the efficacy of a strategy based on intraoperative ECMO (i-ECMO) circuit extended into postoperative cardiopulmonary support.
  
  
  METHODS
  From February 2005 to September 2009, 11 patients (i-ECMO group) receiving allografts with LITs >7 hours underwent intraoperative ECMO circuit strategy with routine extension of ECMO into postoperative period. Eleven contemporary patients (s-CPB group) received ECMO support after standard CPB at the various intervals after the transplantation as a salvage therapy.
  
  
  RESULTS
  Overall weaning rate was 86.4%; overall 30-day and 1-year survival rates were 81.8% and 72.7%, respectively. There was no difference in mortality between the two groups. Length of stay in the intensive care unit, the requirement for packed red blood cells administration and the total in-hospital cost were significantly reduced in i-ECMO group patients (P<0.05).
  
  
  CONCLUSIONS
  The salvage of failing cardiac allograft with ECMO allows effective stabilization of the hemodynamic and leads toward myocardial recovery. Extending ECMO into postoperative period provides early, continues and effective support for donor hearts with LITs and maximizes the use of such marginal organs.
authors.affiliation: Anzhen Hospital of the Capital Medical University, Beijing, Republic of China. emin405@hotmail.com
authors.forename: E
authors.initials: E
authors.lastname: Gurbanov
authors.forename: X
authors.initials: X
authors.lastname: Meng
authors.forename: Y
authors.initials: Y
authors.lastname: Cui
authors.forename: Y
authors.initials: Y
authors.lastname: Jia
authors.forename: W
authors.initials: W
authors.lastname: Zeng
authors.forename: J
authors.initials: J
authors.lastname: Han
authors.forename: J
authors.initials: J
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D016009:Chi-Square Distribution; D002681:China; D050377:Cold Ischemia / Q000009:adverse effects*; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007362:Intensive Care Units; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome