Impact of temporary mechanical circulatory support for early graft failure on post–heart transplantation outcomes. Issue 11 (29th August 2020)

• Record Type: Journal Article
• Authors: Urban, Marian; Lundgren, Scott W.; Siddique, Aleem; Ryan, Timothy R.; Lowes, Brian D.; Stoller, Douglas A.; Um, John Y.
• Is Part Of: Clinical transplantation. Volume 34:Issue 11(2020)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-08-29
• Subjects: extracorporeal membrane oxygenation -- fatal outcome -- heart transplantation -- primary graft dysfunction -- ventricular assist device; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ctr.14060
• Languages: English
• ISSNs: 0902-0063

Abstract

Abstract: Although temporary mechanical circulatory support (tMCS) for hemodynamic failure following heart transplantation is associated with increased early morbidity and mortality, the impact of etiology of graft dysfunction and long‐term clinical implications are less well known. The objective of our study was to evaluate outcomes in patients who required venoarterial extracorporeal membrane oxygenation (VA ECMO) or temporary right ventricular assist device (RVAD) support for either primary or secondary early graft dysfunction. Hospital mortality in 27 patients who required tMCS following heart transplantation at our institution between 2007 and 2017 was 56%, 30% in patients with right ventricular dysfunction secondary to increased afterload, 60% in patients with primary graft dysfunction, and 100% in patients with graft failure secondary to coagulopathy with intraoperative bleeding or overwhelming sepsis. Conditional 1‐year and 5‐year survival was comparable between patients with, and without, the need for post‐transplantation support with tMCS (98% and 89%; 92% and 65% at 1 and 5 years, P = .21). Etiology of early graft failure plays an important part in determining the short‐term post–heart transplantation outcome. Although complications associated with tMCS use, such as renal dysfunction and infection, extend beyond index transplant hospitalization, long‐term conditional survival is not compromised.