Mechanical Circulatory Support (MCS) for Primary Graft Dysfunction (PGD)

Abstract

Primary graft dysfunction is the main cause of early mortality after heart transplantation (HT). Preventive strategies to avoid primary graft dysfunction (PGD) have been focused on better donor choice and maintenance, heart preservation methods in long-distance retrievals with prolonged ischemia time, and better myocardial protection during implantation, among others. Hemodynamic deterioration, caused by cardiogenic shock due to pump failure unresponsive to inotropes, has a catastrophic progression if not corrected in time. Severe PGD without response to inotropes and heart rhythm control in the absence of cardiac tamponade should be treated promptly with mechanical circulatory support. Extracorporeal life support (ECLS) should be installed early, before the occurrence of multiorgan dysfunction or prior to cardiac arrest, as highlighted in the literature.The aim of this chapter is to discuss the use of mechanical circulatory support (MCS) and its impact on the success to survival for patients with PGD.

Mechanical circulatory support in pre and postheart transplant period

“…That being said, the consensus is that the support should be considered sooner rather than later and VA-ECMO is usually the support of choice, which is often deployed in the operating room or emergently at bedside without the need for fluoroscopy. Central ECMO cannulation results in LV offloading compared to peripheral ECMO thus giving the struggling transplanted heart the chance to recover [15]. The use of VA-ECMO or RVAD for the management of early graft dysfunction is associated with significant posttransplantation morbidity and mortality.…”