Veno-Arterial Extracorporeal Membrane Oxygenation for Patients Undergoing Heart Transplantation: A 7-Year Experience

Jun-Yi Hou; Xin Li; Shou-Guo Yang; Ji-Li Zheng; Jie-Fei Ma; Ying Su; Yi-Jie Zhang; Ke-Fang Guo; Guo-Wei Tu; Zhe Luo

doi:10.3389/fmed.2021.774644

Veno-Arterial Extracorporeal Membrane Oxygenation for Patients Undergoing Heart Transplantation: A 7-Year Experience

Front Med (Lausanne). 2021 Dec 16:8:774644. doi: 10.3389/fmed.2021.774644. eCollection 2021.

Authors

Jun-Yi Hou¹, Xin Li², Shou-Guo Yang², Ji-Li Zheng³, Jie-Fei Ma⁴, Ying Su¹, Yi-Jie Zhang¹, Ke-Fang Guo⁵, Guo-Wei Tu¹, Zhe Luo^{1

4

6}

Affiliations

¹ Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
² Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
³ Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.
⁴ Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
⁵ Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China.
⁶ Shanghai Key Lab of Pulmonary Inflammation and Injury, Fudan University, Shanghai, China.

Abstract

Objective: Primary graft dysfunction (PGD) is the leading cause of early death after heart transplantation. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide temporary mechanical circulatory support and time for functional recovery of the transplanted heart. The purpose of this study was to analyze the timing and prognoses of VA-ECMO in patients with severe PGD after heart transplantation. Methods: A total of 130 patients underwent heart transplantation at the Zhongshan Hospital Affiliated with Fudan University between January 2014 and December 2020. All patients received basiliximab immunoinduction and a classic double vena cava anastomosis orthotopic heart transplantation. Among them, 29 patients (22.3%) developed severe PGD in the early postoperative period. VA-ECMO was performed in patients with difficulty weaning from cardiopulmonary bypass (CPB) or postoperative refractory cardiogenic shock. Patients were divided into two groups according to whether or not they were successfully weaned from VA-ECMO (patients who survived for 48 h after weaning and did not need VA-ECMO assistance again). The perioperative clinical data were recorded, and all patients were followed up until discharge. Early outcomes were compared between groups. Results: A total of 29 patients with VA-ECMO support after heart transplantation were included in this study. The proportion of patients receiving VA-ECMO was 22.3% (29/130). Nineteen patients (65.5%) needed VA-ECMO due to difficulty with weaning from CPB, and 10 patients required VA-ECMO for postoperative cardiogenic shock. Nineteen patients (65.5%) were successfully weaned from VA-ECMO. Overall, in-hospital mortality of VA-ECMO support patients was 55.2%. The main causes of death were ventricular fibrillation (four cases), major bleeding (three cases), infection (four cases), and graft failure (five cases). Conclusion: Despite advances in heart transplantation, severe PGD remains a lethal complication after heart transplantation. At present, the treatment for severe PGD after heart transplantation is a challenge. VA-ECMO provides an effective treatment for severe PGD after heart transplantation, which can promote graft function recovery.

Keywords: cardiogenic shock; heart failure; heart transplantation; primary graft dysfunction; veno-arterial extracorporeal membrane oxygenation.