scholarly journals Venoarterial extracorporeal membrane oxygenation use in staged combined heart–kidney transplant

2020 ◽  
Vol 2020 (1) ◽  
Author(s):  
Tareq Al Saadi ◽  
Christopher Sciamanna ◽  
Ambar Andrade ◽  
Sunil Pauwaa ◽  
Gregory Macaluso ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplantation ◽  
Kidney Transplant ◽  
Solid Organ Transplantation ◽  
Orthotopic Heart Transplantation ◽  
Solid Organ ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo

Abstract Outside of heart and lung transplantation, only few cases have been reported describing venoarterial extracorporeal membrane oxygenation (VA-ECMO) use in solid organ transplantation. We present a case of a staged combined heart–kidney transplant in which VA-ECMO was utilized after a complicated orthotopic heart transplantation to successfully complete the subsequent renal transplantation.

scholarly journals Ten thousand kilometre transfer of cardiogenic shock patients on venoarterial extracorporeal membrane oxygenation for emergency heart transplantation: Cooperation between Reunion Island and Metropolitan France

2017 ◽  
Vol 7 (4) ◽  
pp. 371-378 ◽  
Author(s):  
Clément Charon ◽  
Jérôme Allyn ◽  
Bruno Bouchet ◽  
Fréderic Nativel ◽  
Eric Braunberger ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Heart Transplantation ◽  
Adult Patients ◽  
Long Term Results ◽  
Reunion Island ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Réunion Island ◽  
Va Ecmo

Background: There is no heart transplantation centre on the French overseas territory of Reunion Island (distance of 10,000 km). The aim of this study was to describe the characteristics of cardiogenic shock adult patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) who were transferred from Reunion Island to mainland France for emergency heart transplantation. Methods: This retrospective observational study was conducted between 2005 and 2015. The characteristics and outcome of cardiogenic shock patients on VA-ECMO were compared with those of cardiogenic shock patients not on VA-ECMO. Results: Thirty-three cardiogenic shock adult patients were transferred from Reunion Island to Paris for emergency heart transplantation. Among them, 19 (57.6%) needed mechanical circulatory support in the form of VA-ECMO. Median age was 51 (33–57) years and 46% of the patients had ischaemic heart disease. Patients on VA-ECMO presented higher Sequential Organ Failure Assessment score ( p = 0.03). No death occurred during the medical transfer by long flight, while severe complications occurred in 10 patients (30.3%). Incidence of thromboembolic events, severe infectious complications and major haemorrhages was higher in the group of patients on VA-ECMO than in the group of patients not on VA-ECMO ( p <0.01). Seven patients from the VA-ECMO group (36.8%) and six patients from the non-VA-ECMO group (42.9%, p=0.7) underwent heart transplantation after a median delay of 10 (4–29) days on the emergency waiting list. After heart transplantation, one-year survival rates were 85.7% for patients on VA-ECMO and 83.3% for patients not on VA-ECMO ( p=0.91). Conclusions: This study suggests the feasibility of very long-distance medical evacuation of cardiogenic shock patients on VA-ECMO for emergency heart transplantation, with acceptable long-term results.

scholarly journals SUCCESSFUL TREATMENT OF A RECIPIENT WITH MASSIVE THROMBOSIS OF HEART TRANSPLANT LEFT CHAMBERS DURING EXTRACORPOREAL MEMBRANE OXYGENATION

2016 ◽  
Vol 18 (2) ◽  
pp. 117-124
Author(s):  
V. N. Poptsov ◽  
V. M. Zakharevich ◽  
E. A. Spirina ◽  
A. M. Golts ◽  
S. G. Ukhrenkov ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Left Ventricular ◽  
Orthotopic Heart Transplantation ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Primary Graft Failure ◽  
Surgical Thrombectomy ◽  
Systemic Anticoagulation ◽  
Va Ecmo ◽  
Extracorporeal Support

We present a case report of a 16-year-old man with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for primary graft failure after orthotopic heart transplantation who developed left atrium and left ventricular thrombosis despite systemic anticoagulation. The surgical thrombectomy was performed and the patient was successfully weaned off the extracorporeal support on the first day thereafter.

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

2021 ◽  
Vol 8 ◽  
Author(s):  
Jun-yi Hou ◽  
Xin Li ◽  
Shou-guo Yang ◽  
Ji-li Zheng ◽  
Jie-fei Ma ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Heart Transplantation ◽  
Graft Function ◽  
Vena Cava ◽  
Ecmo Support ◽  
Circulatory Support ◽  
Orthotopic Heart Transplantation ◽  
Membrane Oxygenation ◽  
Va Ecmo

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.

scholarly journals What are the results of venoarterial extracorporeal membrane oxygenation bridging to heart transplantation?

2019 ◽  
Vol 29 (4) ◽  
pp. 632-634 ◽  
Author(s):  
Marian Urban ◽  
Aleem Siddique ◽  
HelenMari Merritt-Genore ◽  
John Um
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplantation ◽  
Elevated Serum ◽  
Serum Lactate ◽  
Organ Shortage ◽  
Post Transplantation ◽  
Poor Renal Function ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Va Ecmo

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether heart transplantation is a viable treatment option in patients in refractory cardiogenic shock who could not be weaned off venoarterial extracorporeal membrane oxygenation (VA ECMO). Altogether, 373 papers were found using the reported search, of which 7 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Evidence is derived from 3 papers based on registry analysis, 1 multi-institutional study and 3 single-institution reviews. Early post-transplant mortality of ECMO-bridged recipients ranges from 18.7% to 33.3% and 1-year survival from 44.6% to 72.0%. High acuity of recipient illness reflected by poor renal function, mechanical ventilation, advanced age, elevated serum lactate predict inferior outcome. We conclude that heart transplantation results in patients bridged with VA ECMO are inferior when compared to published outcome of non-bridged recipients. In the era of severe organ shortage and intense public and regulatory scrutiny of the results, the decision to transplant a patient directly of VA ECMO needs to be made on a case-by-case basis. Potential gain in decreasing the waiting list mortality of these critically ill patients needs to be weighed against poorer post-transplantation mortality rates and mid- and long-term outcomes.

scholarly journals Venoarterial extracorporeal membrane oxygenation with or without simultaneous intra-aortic balloon pump support as a direct bridge to heart transplantation: results from a nationwide Spanish registry

2019 ◽  
Vol 29 (5) ◽  
pp. 670-677 ◽  
Author(s):  
Gonzalo Barge-Caballero ◽  
María A Castel-Lavilla ◽  
Luis Almenar-Bonet ◽  
Iris P Garrido-Bravo ◽  
Juan F Delgado ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Extracorporeal Membrane Oxygenation ◽  
Heart Transplantation ◽  
Ecmo Support ◽  
Control Group ◽  
Intra Aortic Balloon Pump ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Iabp Support ◽  
Va Ecmo

Abstract OBJECTIVES To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). METHODS We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n = 73) were compared to a control group of patients without IABP support (n = 96). RESULTS There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P = 0.17), death during VA-ECMO support (20.6% vs 14.6%, P = 0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P = 0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P = 0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P = 0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02–4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P = 0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P = 0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56–1.58). CONCLUSIONS In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality.

scholarly journals Single-Kidney Transplant on VA-ECMO While Recovering from Post-Heart-Transplant Graft Failure

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Gabriel Prada ◽  
Anjali Agarwal ◽  
Jose L. Diaz-Gomez ◽  
Robert A. Ratzlaff
Keyword(s):  
Heart Transplantation ◽  
Organ Transplantation ◽  
Graft Failure ◽  
Solid Organ Transplantation ◽  
Deceased Donor ◽  
Ecmo Support ◽  
Orthotopic Heart Transplantation ◽  
Solid Organ ◽  
Va Ecmo ◽  
Single Kidney

Although no consensus exists on whether extracorporeal membrane oxygenation (ECMO) support is an indication for solid-organ transplantation other than heart and lung, this practice continues to be limited. We present a case of a 55-year-old man who was placed on venoarterial ECMO (VA-ECMO) during orthotopic heart transplantation (OHT) because of acute graft failure. Twenty-four hours later, the patient underwent deceased-donor renal transplantation (DDRT) while on VA-ECMO and had no complications. On post-DDRT day 2 (post-OHT day 3), the patient was successfully decannulated from VA-ECMO and ultimately discharged home. This case highlights the potential successful use of ECMO support during solid-organ transplantation other than heart and lung and the importance of trained providers and tailored anticoagulation. To the authors’ knowledge, this is the first report of perioperative ECMO use during kidney transplantation after recent heart transplantation.

scholarly journals Biventricular Unloading with Impella and Venoarterial Extracorporeal Membrane Oxygenation in Severe Refractory Cardiogenic Shock: Implications from the Combined Use of the Devices and Prognostic Risk Factors of Survival

2021 ◽  
Vol 10 (4) ◽  
pp. 747
Author(s):  
Georgios Chatzis ◽  
Styliani Syntila ◽  
Birgit Markus ◽  
Holger Ahrens ◽  
Nikolaos Patsalis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Extracorporeal Membrane Oxygenation ◽  
Cardiogenic Shock ◽  
Risk Scores ◽  
Circulatory Support ◽  
Membrane Oxygenation ◽  
Venoarterial Extracorporeal Membrane Oxygenation ◽  
Refractory Cardiogenic Shock ◽  
Lactate Levels ◽  
Va Ecmo

Since mechanical circulatory support (MCS) devices have become integral component in the therapy of refractory cardiogenic shock (RCS), we identified 67 patients in biventricular support with Impella and venoarterial Extracorporeal Membrane Oxygenation (VA-ECMO) for RCS between February 2013 and December 2019 and evaluated the risk factors of mortality in this setting. Mean age was 61.07 ± 10.7 and 54 (80.6%) patients were male. Main cause of RCS was acute myocardial infarction (AMI) (74.6%), while 44 (65.7%) were resuscitated prior to admission. The mean Simplified Acute Physiology Score II (SAPS II) and Sequential Organ Failure Assessment Score (SOFA) score on admission was 73.54 ± 16.03 and 12.25 ± 2.71, respectively, corresponding to an expected mortality of higher than 80%. Vasopressor doses and lactate levels were significantly decreased within 72 h on biventricular support (p < 0.05 for both). Overall, 17 (25.4%) patients were discharged to cardiac rehabilitation and 5 patients (7.5%) were bridged successfully to ventricular assist device implantation, leading to a total of 32.8% survival on hospital discharge. The 6-month survival was 31.3%. Lactate > 6 mmol/L, vasoactive score > 100 and pH < 7.26 on initiation of biventricular support, as well as Charlson comorbity index > 3 and prior resuscitation were independent predictors of survival. In conclusion, biventricular support with Impella and VA-ECMO in patients with RCS is feasible and efficient leading to a better survival than predicted through traditional risk scores, mainly via significant hemodynamic improvement and reduction in lactate levels.

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