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A case series: the outcomes, support duration, and graft function recovery after VA-ECMO use in primary graft dysfunction after heart transplantation

  • Masashi KawaboriEmail author
  • Michael A. MastroianniEmail author
  • Yong Zhan
  • Frederick Y. Chen
  • Hassan Rastegar
  • Kenneth G. Warner
  • John Adam Reich
  • Amanda Vest
  • David DeNofrio
  • Gregory S. Couper
Original Article Artificial Lung / ECMO
  • 51 Downloads

Abstract

Primary graft dysfunction (PGD) is a rare complication associated with high mortality after heart transplantation, which may require veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) support. A standardized definition for PGD was developed by the International Society of Heart and Lung Transplantation in 2014. Due to limited reports using this definition, the detailed outcomes after VA-ECMO support remain unclear. Therefore, we retrospectively analyzed our single-center outcomes of PGD following VA-ECMO support. Between September 2014 and August 2018, 160 patients underwent heart transplantation in our single center. Nine PGD patients required VA-ECMO support, with an incidence of 5.6%. Pre-operative recipient/donor demographics, intra-operative variables, timing of VA-ECMO initiation and support duration, graft function recovery during 30 days after heart transplant, VA-ECMO complications, and survival were analyzed. The indication for VA-ECMO support was biventricular failure for all nine patients. Six patients had severe PGD requiring intra-operative VA-ECMO, while two patients had moderate PGD and one patient had mild PGD requiring post-operative VA-ECMO. All cohorts were successfully decannulated in a median of 10 days. Survival to discharge rate was 88.9%. One-year survival rate was 85.7%. Left ventricular ejection fraction recovered to normal within 30 days in all PGD patients. Our study showed VA-ECMO support led to high survival and timely graft function recovery in all cohorts. Further larger research can clarify the detailed effects of VA-ECMO support which may lead to standardized indication of VA-ECMO support for PGD patients.

Keywords

Primary graft dysfunction PGD VA-ECMO Heart transplantation Artificial lung/ECMO 

Notes

Compliance with ethical standards

Conflict of interest

No funding was provided for this study. No authors have any conflicts of interest or any financial relationships with commercial entities to disclose.

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Copyright information

© The Japanese Society for Artificial Organs 2019

Authors and Affiliations

  • Masashi Kawabori
    • 1
    Email author
  • Michael A. Mastroianni
    • 1
    • 2
    Email author
  • Yong Zhan
    • 1
  • Frederick Y. Chen
    • 1
  • Hassan Rastegar
    • 1
  • Kenneth G. Warner
    • 1
  • John Adam Reich
    • 3
  • Amanda Vest
    • 4
  • David DeNofrio
    • 4
  • Gregory S. Couper
    • 1
  1. 1.1Cardiac Surgery, Cardiovascular CenterTufts Medical CenterBostonUSA
  2. 2.Tufts University School of MedicineBostonUSA
  3. 3.Anesthesiology, Critical Care MedicineTufts Medical CenterBostonUSA
  4. 4.Cardiology, Cardiovascular CenterTufts Medical CenterBostonUSA

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