title: Improved outcomes from extracorporeal membrane oxygenation versus ventricular assist device temporary support of primary graft dysfunction in heart transplant.
abstract: BACKGROUND
  Primary graft dysfunction (PGD) is one of the most common causes of early death after orthotopic heart transplantation. Mechanical circulatory support devices are required for severe forms of PGD. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) and temporary ventricular assist device (VAD) support have both been reported to be useful for severe PGD.
  
  
  METHODS
  Between January 2007 and December 2015, 597 patients received a heart transplant at our center. Of those, severe PGD developed in 44 patients (7.4%), and they received a continuous-flow external VAD (n = 17) or VA-ECMO (n = 27) support within 24 hours after transplant. We compared early and late outcomes between groups.
  
  
  RESULTS
  Baseline characteristics were similar between groups. Implantation of the temporary VAD required longer cardiopulmonary bypass time compared with VA-ECMO (323 ± 86 minutes vs 216 ± 65 minutes, p < 0.0001). Patients who received a VAD were more likely to have longer support time (14 ± 17 days vs 5.2 ± 3.9 days, p = 0.011), a higher incidence of major bleeding requiring chest reexploration (77% vs 30%, p = 0.0047), and a higher incidence of renal failure requiring renal replacement therapy (53% vs 11%, p = 0.0045) after surgery. Overall hospital mortality was 27%. In-hospital mortality for VAD and VA-ECMO patients were 41% and 19%, respectively (p = 0.16). Ten patients (59%) were weaned from VAD support, and 24 (89%) were weaned from VA-ECMO support after adequate graft function recovery (p = 0.03). The 3-year post-transplant survival was 41% in the VAD group and 66% in the VA-ECMO group (p = 0.13).
  
  
  CONCLUSIONS
  For severe PGD, support with VA-ECMO appears to result in better clinical outcomes compared with VAD.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, New York, New York. Electronic address: kt2485@cumc.columbia.edu.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, New York, New York.
authors.forename: Boyangzi
authors.initials: B
authors.lastname: Li
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Garan
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Veli K
authors.initials: VK
authors.lastname: Topkara
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, New York, New York.
authors.forename: Jiho
authors.initials: J
authors.lastname: Han
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Maryjane A
authors.initials: MA
authors.lastname: Farr
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
mesh_terms: D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011182:Postoperative Care / Q000379:methods*; D055031:Primary Graft Dysfunction / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: extracorporeal membrane oxygenation; heart transplantation; mechanical circulatory support; primary graft dysfunction; ventricular assist device