Korean J Thorac Cardiovasc Surg.  2014 Apr;47(2):100-105.

Percutaneous Extracorporeal Membrane Oxygenation for Graft Dysfunction after Heart Transplantation

• Lim JH
• Hwang HY
• Yeom SY
• Cho HJ
• Lee HY
• Kim KB

Abstract

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).
CONCLUSION
Percutaneous ECMO support could be a viable option for rescuing patients when graft dysfunction refractory to medical management develops after heart transplantation.

Keyword

Heart transplantation; Extracorporeal circulation

MeSH Terms

Cardiopulmonary Bypass
Extracorporeal Circulation
Extracorporeal Membrane Oxygenation*
Heart Transplantation*
Heart*
Hemorrhage
Humans
Male
Mortality
Odds Ratio
Postoperative Complications
Primary Graft Dysfunction
Reoperation
Risk Factors
Transplants*
Weaning