Mechanical Circulatory Support for Primary Graft Dysfunction Following Heart Transplantation: Risk Factors and Clinical Outcome

2014 ◽  
Vol 33 (4) ◽  
pp. S279
Author(s):  
A.A. Ali ◽  
K. Southerland ◽  
L. Harling ◽  
M. Schechter ◽  
A. Saeed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Heart Transplantation ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction

scholarly journals The first experience of extracorporal membrane oxygenation application in severe primary graft failure following heart transplantation

2020 ◽  
Vol 12 (4) ◽  
pp. 301-310
Author(s):  
I. V. Abdulyanov ◽  
I. M. Rakhimullin ◽  
M. R. Gaysin ◽  
R. R. Khamzin
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplantation ◽  
Postoperative Period ◽  
Mechanical Circulatory Support ◽  
Circulatory Support ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Extracorporal Membrane Oxygenation

Introduction. The number of surgically treated cases of heart failure by means of orthotopic heart transplantation is increasing every year. At the same time, there is a shortage of optimal donors for heart transplantation, being a factor that leads to a primary graft dysfunction in the intra- and immediate postoperative period. In order to reduce the risk of complications and increase patient survival rates in primary heart graft dysfunction, a number of transplant centers resort to the choice of the treatment by means of mechanical circulatory support, such as extracorporeal membrane oxygenation. Clinical case. In the early postoperative period after heart transplantation, the patient was diagnosed with developing primary graft dysfunction. The clinical response to medication support of hemodynamics was unsatisfactory. Venoarterial extracorporeal membrane oxygenation was performed. On the 4th day, the regional contractility of the left ventricle restored, the ejection fraction of both ventricles increased, their systolic function improved. The patient was discharged on the 21st day in a satisfactory condition. Conclusion. Mechanical circulatory support modalities, such as venoarterial extracorporeal membrane oxygenation, can compensate for the emerging primary myocardial dysfunction in recipients. The efficiency of the extracorporeal membrane oxygenation is achieved not only by knowledge of current clinical recommendations, but also depends on the implementation of other clinics' experience as well as technical readiness of the center and medical personnel' qualification.

scholarly journals Primary graft dysfunction after heart transplantation: Incidence, trends, and associated risk factors

2017 ◽  
Vol 18 (6) ◽  
pp. 1461-1470 ◽  
Author(s):  
Alina Nicoara ◽  
David Ruffin ◽  
Mary Cooter ◽  
Chetan B. Patel ◽  
Annemarie Thompson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Transplantation ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Incidence Trends ◽  
Associated Risk Factors

scholarly journals Multimodal Temporary Mechanically Circulatory Assistance for Primary Graft Dysfunction after Heart Transplantation—A Case Report

2021 ◽  
Author(s):  
Moritz B Immohr ◽  
Artur Lichtenberg ◽  
Payam Akhyari ◽  
Udo Boeken
Keyword(s):  
Heart Transplantation ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Therapeutic Option ◽  
Bleeding Complications ◽  
Circulatory Support ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Biventricular Failure ◽  
Va Ecmo

Abstract Background Primary graft dysfunction (PGD) remains a serious complication after heart transplantation (HTx). Although there is no therapy available, veno-arterial extracorporeal life support (va-ECMO), may be a bailout strategy in selected cases. Especially in patients with severe biventricular failure, chances of survival remain poor. Case Summary Here we report a case of a 56-year old patient suffering from severe PGD after HTx with biventricular failure (ejection fraction < 20%) who was successfully bridged to recovery of the donor graft by temporary multimodal mechanically circulatory assistance by combining both, va-ECMO and a microaxial pump (Impella®, Abiomed, Inc., Danvers, MA, USA), a concept also referred as ECMELLA. During ECMELLA support, the patient experienced multiple severe thoracic bleeding complications with need for four re-thoracotomies and temporary open chest situation. Nevertheless, ventricular function recovered and the patient could be weaned from mechanical circulatory support after twelve days. During follow-up, the patient recovered and was successfully discharged. After the following rehabilitation, the patient now shows no persistent signs of heart failure with normal biventricular function of the cardiac graft. Discussion ECMELLA may offer a therapeutic option for patients with severe PGD after HTx. Special awareness and further studies addressing targeted anticoagulation strategies for patients on dual-mechanical support are needed to diminish the incidence of bleeding complications.

Sign in / Sign up

Export Citation Format

Share Document