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Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts

Severe primary graft dysfunction (PGD) is the leading cause of early postoperative mortality following orthotopic heart transplantation (OHT). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used as salvage therapy. This study aimed to evaluate the outcomes in adult OHT recipien...

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Autores principales: Shudo, Yasuhiro, Alassar, Aiman, Wang, Hanjay, Lingala, Bharathi, He, Hao, Zhu, Yuanjia, Hiesinger, William, MacArthur, John W., Boyd, Jack H., Lee, Anson M., Currie, Maria, Woo, Y. Joseph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943911/
https://www.ncbi.nlm.nih.gov/pubmed/35340846
http://dx.doi.org/10.3389/ti.2022.10176
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author Shudo, Yasuhiro
Alassar, Aiman
Wang, Hanjay
Lingala, Bharathi
He, Hao
Zhu, Yuanjia
Hiesinger, William
MacArthur, John W.
Boyd, Jack H.
Lee, Anson M.
Currie, Maria
Woo, Y. Joseph
author_facet Shudo, Yasuhiro
Alassar, Aiman
Wang, Hanjay
Lingala, Bharathi
He, Hao
Zhu, Yuanjia
Hiesinger, William
MacArthur, John W.
Boyd, Jack H.
Lee, Anson M.
Currie, Maria
Woo, Y. Joseph
author_sort Shudo, Yasuhiro
collection PubMed
description Severe primary graft dysfunction (PGD) is the leading cause of early postoperative mortality following orthotopic heart transplantation (OHT). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used as salvage therapy. This study aimed to evaluate the outcomes in adult OHT recipients who underwent VA-ECMO for severe PGD. We retrospectively reviewed 899 adult (≥18 years) patients who underwent primary OHT at our institution between 1997 and 2017. Recipients treated with VA-ECMO (19, 2.1%) exhibited a higher incidence of previous cardiac surgery (p = .0220), chronic obstructive pulmonary disease (p = .0352), and treatment with a calcium channel blocker (p = .0018) and amiodarone (p = .0148). Cardiopulmonary bypass (p = .0410) and aortic cross-clamp times (p = .0477) were longer in the VA-ECMO cohort and they were more likely to have received postoperative transfusion (p = .0013); intra-aortic balloon pump (IABP, p < .0001), and reoperation for bleeding or tamponade (p < .0001). The 30-day, 1-year, and overall survival after transplantation of non-ECMO patients were 95.9, 88.8, and 67.4%, respectively, compared to 73.7, 57.9, and 47.4%, respectively in the ECMO cohort. Fourteen (73.7%) of the ECMO patients were weaned after a median of 7 days following OHT (range: 1–12 days). Following OHT, VA-ECMO may be a useful salvage therapy for severe PGD and can potentially support the usage of marginal donor hearts.
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spelling pubmed-89439112022-03-25 Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts Shudo, Yasuhiro Alassar, Aiman Wang, Hanjay Lingala, Bharathi He, Hao Zhu, Yuanjia Hiesinger, William MacArthur, John W. Boyd, Jack H. Lee, Anson M. Currie, Maria Woo, Y. Joseph Transpl Int Health Archive Severe primary graft dysfunction (PGD) is the leading cause of early postoperative mortality following orthotopic heart transplantation (OHT). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used as salvage therapy. This study aimed to evaluate the outcomes in adult OHT recipients who underwent VA-ECMO for severe PGD. We retrospectively reviewed 899 adult (≥18 years) patients who underwent primary OHT at our institution between 1997 and 2017. Recipients treated with VA-ECMO (19, 2.1%) exhibited a higher incidence of previous cardiac surgery (p = .0220), chronic obstructive pulmonary disease (p = .0352), and treatment with a calcium channel blocker (p = .0018) and amiodarone (p = .0148). Cardiopulmonary bypass (p = .0410) and aortic cross-clamp times (p = .0477) were longer in the VA-ECMO cohort and they were more likely to have received postoperative transfusion (p = .0013); intra-aortic balloon pump (IABP, p < .0001), and reoperation for bleeding or tamponade (p < .0001). The 30-day, 1-year, and overall survival after transplantation of non-ECMO patients were 95.9, 88.8, and 67.4%, respectively, compared to 73.7, 57.9, and 47.4%, respectively in the ECMO cohort. Fourteen (73.7%) of the ECMO patients were weaned after a median of 7 days following OHT (range: 1–12 days). Following OHT, VA-ECMO may be a useful salvage therapy for severe PGD and can potentially support the usage of marginal donor hearts. Frontiers Media S.A. 2022-03-10 /pmc/articles/PMC8943911/ /pubmed/35340846 http://dx.doi.org/10.3389/ti.2022.10176 Text en Copyright © 2022 Shudo, Alassar, Wang, Lingala, He, Zhu, Hiesinger, MacArthur, Boyd, Lee, Currie and Woo. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Health Archive
Shudo, Yasuhiro
Alassar, Aiman
Wang, Hanjay
Lingala, Bharathi
He, Hao
Zhu, Yuanjia
Hiesinger, William
MacArthur, John W.
Boyd, Jack H.
Lee, Anson M.
Currie, Maria
Woo, Y. Joseph
Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts
title Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts
title_full Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts
title_fullStr Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts
title_full_unstemmed Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts
title_short Post-Transplant Extracorporeal Membrane Oxygenation for Severe Primary Graft Dysfunction to Support the Use of Marginal Donor Hearts
title_sort post-transplant extracorporeal membrane oxygenation for severe primary graft dysfunction to support the use of marginal donor hearts
topic Health Archive
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943911/
https://www.ncbi.nlm.nih.gov/pubmed/35340846
http://dx.doi.org/10.3389/ti.2022.10176
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