Percutaneous extracorporeal membrane oxygenation for graft dysfunction after heart transplantation.
BACKGROUND
We evaluated the safety and efficacy of percutaneous extracorporeal membrane oxygenation (ECMO) in patients with primary graft dysfunction after heart transplantation.


METHODS
Of 65 patients (44 males and 21 females) who underwent heart transplantation from January 2006 to December 2012, 13 patients (group I) needed peripheral ECMO support due to difficulty in weaning from cardiopulmonary bypass (CPB) and 52 patients (group II) were weaned from CPB without mechanical support. The mean age of the patients at the time of operation was 54.4±13.6 years. There were no differences in the preoperative characteristics of the two groups. Multivariable analysis was performed to identify the risk factors for ECMO therapy.


RESULTS
All group I patients were successfully weaned from ECMO after 53±9 hours of circulatory support. Early mortality occurred in four patients (1 [7.7%] in group I and 3 [5.8%] in group II, p>0.999). There were no differences in the postoperative complications between the two groups, with the exception of reoperation for bleeding. A greater number of group I patients underwent reoperation for bleeding (5 [38.5%] in group I vs. 6 [11.5%] in group II, p=0.035). In multivariable analysis, preoperative mechanical support (ECMO and intra-aortic balloon pump) and longer CPB time were the risk factors of ECMO therapy for graft dysfunction (odds ratio, 6.377; 95% confidence interval, 1.519 to 26.77; p=0.011 and odds ratio, 1.010; 95% confidence interval, 1.001 to 1.019; p=0.033).


CONCLUSIONS
Percutaneous ECMO support could be a viable option for rescuing patients when graft dysfunction refractory to medical management develops after heart transplantation.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea.
Jae Hong
JH
Lim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea.
Ho Young
HY
Hwang
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea.
Sang Yoon
SY
Yeom
Division of Cardiology, Department of Internal Medicine, Cardiovascular Center and Cardiovascular Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Korea.
Hyun-Jai
HJ
Cho
Division of Cardiology, Department of Internal Medicine, Cardiovascular Center and Cardiovascular Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Korea.
Hae-Young
HY
Lee
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea.
Ki-Bong
KB
Kim
Extracorporeal circulation; Heart transplantation