Extracorporeal life support as a bridge to high‐urgency heart transplantation

Barth, Emeline; Durand, M.; Heylbroeck, Christophe; Rossi-Blancher, Marine; Boignard, Aude; Vanzetto, Gérald; Albaladéjo, Pierre; Chavanon, Olivier

doi:10.1111/j.1399-0012.2011.01525.x

Cited by 48 publications

(38 citation statements)

References 15 publications

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“…Its routine use for urgent heart transplant is not widely accepted in most transplant centers because of limited duration for this support. 6 In our country, a heart allocation system provides priority status granted to the sickest patients. This system is similar to some European countries and the United States.…”

Section: Discussionmentioning

confidence: 99%

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2016

Exp Clin Transplant

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Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. Among 31 patients who underwent heart transplant between January 2014 and June 2016, we present our experiences with 3 patients who received venoarterial extracorporeal support as a bridge to heart transplant. The first patient was a 51-year-old male with ischemic dilated cardiomyopathy. Transplant was performed after 6 days of extracorporeal support, and the patient was discharged and alive at follow-up. Patient 2 was a 12-yearold girl with dilated cardiomyopathy who presented with cardiac arrest. Extracorporeal support was initiated during cardiopulmonary resuscitation. She had full neurologic recovery and remained on the wait list. She received a transplant 22 days after resuscitation. She survived and was alive at day 220 posttransplant. The third patient was a 50-year-old male with ischemic dilated cardiomyopathy requiring venoarterial extracorporeal support. Percutaneous balloon atrial septostomy was performed for left ventricle venting. He underwent transplant on day 28 after intensive care unit admission. He died 29 days after release from the hospital. Regarding patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort.

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Section: Discussionmentioning

confidence: 99%

“…They also stated that femoral cannulation provided reliable access in emergency conditions. 6 The femoral route was used in our patients for VA-ECMO support at the bedside. Peripheral VA-ECMO support can be used as a bridge to urgent heart transplant.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

Exp Clin Transplant

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“…They reported on 8 of 242 patients (3.3%) who underwent urgent heart transplant and a mean duration of extracorporeal life support of 6.3 ± 4.6 days. 7 We performed 31 heart transplants during the study period, with 3 patients (9.7%) undergoing urgent heart transplant. The mean duration of VA-ECMO support was 13.3 ± 11.8 days in our preoperative group patients.…”

Section: Ender Gedik Et Al/experimental and Clinical Transplantation mentioning

confidence: 99%

“…Its routine use for urgent heart transplant is not widely accepted in most centers because of the limited duration for this support. 7 In some European countries including our country and the United States, a heart allocation system provides priority status granted to the sickest patients. 2,6 Patients in our preoperative group were admitted to the ICU for medical treatment of RCF.…”

Section: Ender Gedik Et Al/experimental and Clinical Transplantation mentioning

confidence: 99%

“…6,8 The use of emergent venoarterial extracorporeal life support using femoral veins for cannulation has been reported in a large patient series, with the authors stating that femoral cannulation provided reliable access in urgent conditions. 7 The femoral route was used in our patients for VA-ECMO support at the bedside in both the preoperative and most of the postoperative group patients. Barth and associates used peripheral VA-ECMO support as a bridge to urgent heart transplant.…”

Section: Ender Gedik Et Al/experimental and Clinical Transplantation mentioning

confidence: 99%

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Gedik

Atar²,

Özdemirkan³

et al. 2017

Exp Clin Transplant

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Objectives: Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. This technique may be used after heart transplant for conditions refractory to medical treatment like primary graft failure. Previously, we reported our experience with patients who received extracorporeal support as a bridge to emergency heart transplant. In this study, we present our perioperative experience with heart transplants in which extracorporeal support was used. Materials and Methods:We retrospectively screened the data of 31 patients who were seen at our center between January 2014 and June 2016. We screened for patients who were admitted to the intensive care unit before transplant and who required venoarterial extracorporeal membrane oxygenation for circulatory support and postoperative patients who required extracorporeal support. Patient demographics and characteristics, clinical data, and extracorporeal support data were collected from our electronic database and patient medical records. Results: There were 14 patients who required perioperative extracorporeal support. Preoperative support was performed in 3 patients before transplant, and postoperative support was performed in 11 patients after transplant. The mean age was 37.7 years in patients within the preoperative group and 29.7 years in patients within the postoperative group. One patient with preoperative support and 5 with postoperative support were pediatric patients. The main indication for transplant was dilated cardiomyopathy in both groups (100% and 63.7%). Overall mortality rates were 33% in the preoperative group and 63.7% in the postoperative group. Conclusions: For patients on heart transplant wait lists who are worsening despite optimal medical therapy, venoarterial extracorporeal membrane oxygenation support is a safe and viable last resort. In addition, extracorporeal support can be used during the posttransplant period as salvage therapy in heart recipients with hemodynamic deterioration. In our experience, preoperative extracorporeal support had lower mortality rates compared with postoperative support.

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