Extracorporeal membrane oxygenation: experience in acute graft failure after heart transplantation.
BACKGROUND
Acute graft failure is the leading cause of early mortality after heart transplantation (HTx). Extracorporeal membrane oxygenation (ECMO) is an efficient therapeutic option to treat various pathologies, unburden the left and right ventricle, and allow for functional recovery of the transplanted heart. We reviewed our ECMO experience and outcomes in HTx patients.


METHODS
Retrospectively, we analyzed all patients who received an orthotopic HTx (n = 298) in our department over a 15-yr period (1997 through 2011) to assess the incidence of post-HTx ECMO implantation, perioperative complications, early and one-yr mortality as well as causes of death.


RESULTS
ECMO therapy was utilized to treat graft failure in 28 patients (10.6%) with a mean duration of ECMO support of 4.2 d (six h to 9.4 d). Multivariate analysis revealed as independent predictors for mortality low cardiac output (p = 0.028; odds ratio (OR) = 11.3) and stroke (p = 0.008; OR = 19.7). Cumulative survival rates were 46.4 ± 9.4% within 30 d and 25.0 ± 8.2% at one yr. Causes of death were multiorgan failure (n = 9), sepsis (n = 9), lung failure (n = 2), and intracerebral bleeding (n = 2). ECMO was implanted due to primary graft failure (PGF, n = 16), sepsis (n = 4), and right heart failure (n = 6).


CONCLUSIONS
Temporary ECMO support for postoperative output failure is an acceptable option as a last resort for otherwise doomed patients with fatal graft failure after HTx. The small fraction of patients surviving appear to have a decent long-term prognosis.
Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
Sven
S
Lehmann
Madlen
M
Uhlemann
Christian D
CD
Etz
Jens
J
Garbade
Thomas
T
Schroeter
Michael
M
Borger
Martin
M
Misfeld
Hartmuth B
HB
Bittner
Friedrich Wilhelm
FW
Mohr
D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006333:Heart Failure / Q000150:complications* / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
extracorporeal membrane oxygenation therapy; heart transplantation; long-term follow up; multivariate analysis; survival rate