title: Perioperative Venoarterial Extracorporeal Membrane Oxygenation Support During Heart Transplant.
abstract: OBJECTIVE
  Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. This technique may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. Previously, we reported our experience with patients who received extracorporeal support as a bridge to emergency heart transplant. In this study, we present our perioperative experience with heart transplants in which extracorporeal support was used.
  
  
  METHODS
  We retrospectively screened the data of 31 patients who were seen at our center between January 2014 and June 2016. We screened for patients who were admitted tothe intensive care unit before transplant and who required venoarterial extracorporeal membrane oxygenation for circulatory support and postoperative patients who required extracorporeal support. Patient demographics and characteristics, clinical data, and extracorporeal support data were collected from our electronic database and patient medical records.
  
  
  RESULTS
  There were 14 patients who required perioperative extracorporeal support. Preoperative support was performed in 3 patients before transplant, and postoperative support was performed in 11 patients after transplant. The mean age was 37.7 years in patients within the preoperative group and 29.7 years in patients within the postoperative group. One patient with preoperative support and 5 with postoperative support were pediatric patients. The main indication for transplant was dilated cardiomyopathy in both groups (100% and 63.7%). Overall mortality rates were 33% in the preoperative group and 63.7% in the postoperative group.
  
  
  CONCLUSIONS
  For patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort. In addition, extracorporeal support can be used during the posttransplant period as salvage therapy in heart recipients with hemodynamic deterioration. In our experience, preoperative extracorporeal support had lower mortality rates compared with postoperative support.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Baskent University, Ankara, Turkey.
authors.forename: Ender
authors.initials: E
authors.lastname: Gedik
authors.forename: Funda
authors.initials: F
authors.lastname: Atar
authors.forename: Aycan
authors.initials: A
authors.lastname: Ozdemirkan
authors.forename: Aynur
authors.initials: A
authors.lastname: Camkiran Firat
authors.forename: Pinar
authors.initials: P
authors.lastname: Zeyneloglu
authors.forename: Atilla
authors.initials: A
authors.lastname: Sezgin
authors.forename: Arash
authors.initials: A
authors.lastname: Pirat
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016208:Databases, Factual; D057286:Electronic Health Records; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult