Mechanical circulatory support in severe primary graft dysfunction: Peripheral cannulation but not earlier implantation improves survival in heart transplantation

Olivella, A.; Almenar‐Bonet, Luis; González-Vílchez, Francisco; Díez‐López, Carles; Díaz‐Molina, Beatriz; Blázquez-Bermejo, Zorba; Sobrino-Márquez, José Manuel; Gómez‐Bueno, Manuel; Garrido-Bravo, Iris P.; Barge‐Caballero, Eduardo; Farrero, Marta; García‐Cosio, María Dolores; Blasco‐Peiró, Teresa; Pomares-Varó, Antonia; Muñiz, Javier; González-Costello, José

doi:10.1016/j.healun.2023.03.008

Cited by 9 publications

(2 citation statements)

References 23 publications

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“…Rescue treatment by use of VA ECMO support maintains perfusion and oxygenation while the graft recovery occurs. Peripheral cannulation support in PGD was associated with better survival then central [20].…”

Section: Rescue From Primary Graft Dysfunction (Pgd)mentioning

confidence: 91%

Extracorporeal Membrane Oxygenation (ECMO) Use in Heart Transplantation

Peter Echieh,

Hooker

2024

Cardiology and Cardiovascular Medicine

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Extracorporeal membrane oxygenation (ECMO) use in patients both pre and post heart transplantation has become a life-saving tool in the armamentarium for physicians. Early developments in perfusion were hindered by the challenges of coagulation. Technological advances leading to contemporary management of ECMO began with the oxygenation of blood circulating through an artificial cistern. VA ECMO provides mechanical circulatory support (MCS) to patients not responding to medical treatment with primary cardiac dysfunction or combined respiratory and cardiac dysfunction failure. Management of the patient on ECMO is complex and involves multidisciplinary daily input from cardiology, cardiac surgery, and intensivist with ECMO specialization. Indications for ECMO use in heart transplantation include bridge to decision, bridge to transplant, rescue from PGD, and management of vasoplegia. The use of ECMO pre transplant has increased in the United States since the heart allocation changes implemented in 2018. Outcomes utilizing ECMO in pre and post heart transplant patients appear to be improving worldwide.

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Section: Rescue From Primary Graft Dysfunction (Pgd)mentioning

confidence: 91%

Extracorporeal Membrane Oxygenation (ECMO) Use in Heart Transplantation

Peter Echieh,

Hooker

2024

Cardiology and Cardiovascular Medicine

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“…Olivella et al reported that early initiation of ECMO did not benefit the HTx recipient compared to a more delayed ECMO initiation. However, they did notice a survival benefit in peripheral ECMO compared to central ECMO [38]. Moreover, another recent study suggested some slight benefits in the use of axillary instead of femoral cannulation in post-Tx ECMO [39].…”

Section: Treatment and Management Of Pgdmentioning

confidence: 95%

Primary graft dysfunction in heart transplantation: the challenge to survival

Sicim,

Tam,

Tang

2024

J Cardiothorac Surg

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Primary graft dysfunction (PGD) is a life-threatening clinical condition with a high mortality rate, presenting as left, right, or biventricular dysfunction within the initial 24 h following heart transplantation, in the absence of a discernible secondary cause. Given its intricate nature, definitive definition and diagnosis of PGD continues to pose a challenge. The pathophysiology of PGD encompasses numerous underlying mechanisms, some of which remain to be elucidated, including factors like myocardial damage, the release of proinflammatory mediators, and the occurrence of ischemia-reperfusion injury. The dynamic characteristics of both donors and recipients, coupled with the inclination towards marginal lists containing more risk factors, together contribute to the increased incidence of PGD. The augmentation of therapeutic strategies involving mechanical circulatory support accelerates myocardial recovery, thereby significantly contributing to survival. Nonetheless, a universally accepted treatment algorithm for the swift management of this clinical condition, which necessitates immediate intervention upon diagnosis, remains absent. This paper aims to review the existing literature and shed light on how diagnosis, pathophysiology, risk factors, treatment, and perioperative management affect the outcome of PGD.

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