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Extracorporeal life support for primary graft dysfunction after heart transplantation
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Pozzi, Matteo, Bottin, Chiara, Armoiry, Xavier, Sebbag, Laurent, Boissonnat, Pascale, Hugon-Vallet, Elisabeth, Koffel, Catherine, Flamens, Claire, Paulus, Sylvie, Fellahi, Jean Luc and Obadia, Jean Francois (2018) Extracorporeal life support for primary graft dysfunction after heart transplantation. Interactive CardioVascular and Thoracic Surgery, 27 (5). pp. 778-784. doi:10.1093/icvts/ivy157
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WRAP-extracorporeal-life-support-for-primary-graft-dysfunction-after-heart-transplantation-Armoiry-2018.pdf - Accepted Version - Requires a PDF viewer. Download (540Kb) | Preview |
Official URL: https://doi.org/10.1093/icvts/ivy157
Abstract
OBJECTIVES
Survival after heart transplantation is steadily improving but primary graft dysfunction (PGD) is still a leading cause of death. Medical management seems useful in mild or moderate PGD, whereas extracorporeal life support (ECLS) could be suggested for severe PGD refractory to conventional treatment. Our aim is to present the results of ECLS for PGD after heart transplantation at a single-centre experience.
METHODS
We performed an observational analysis of our local database. According to the International Society for Heart and Lung Transplantation classification, patients were divided into a left and biventricular failure (PGD-LV) or isolated right ventricular failure (PGD-RV) group. The primary end point was survival to hospital discharge.
RESULTS
Between January 2010 and December 2016, 38 patients presented with PGD (PGD-LV n = 22, 58%; PGD-RV n = 16, 42%) requiring ECLS support. The mean age was 50.8 ± 12.4 years and 79% were males. Baseline characteristics were comparable between the 2 groups. PGD-LV patients displayed a significantly higher mortality rate on ECLS support as opposed to PGD-RV patients (46% vs 13%, P = 0.033). The rate of complications during ECLS support was comparable between the 2 groups. Twenty-three (61%) patients were successfully weaned from ECLS (PGD-LV = 50% vs PGD-RV = 75%, P = 0.111) after a mean support of 9.0 ± 6.4 days. Seventeen (45%) patients survived to hospital discharge (PGD-LV = 41% vs PGD-RV = 50%, P = 0.410).
CONCLUSIONS
In case of severe PGD with various manifestations of ventricular failure refractory to conventional treatment, ECLS can be considered as a feasible option with satisfactory survival in this critically ill population.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RD Surgery | ||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | ||||||||
| Library of Congress Subject Headings (LCSH): | Heart -- Transplantation, Heart -- Left ventricle -- Surgery, Transplantation of organs, tissues, etc., International Society for Heart and Lung Transplantation | ||||||||
| Journal or Publication Title: | Interactive CardioVascular and Thoracic Surgery | ||||||||
| Publisher: | Oxford University Press (OUP) | ||||||||
| ISSN: | 1569-9285 | ||||||||
| Official Date: | November 2018 | ||||||||
| Dates: |
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| Volume: | 27 | ||||||||
| Number: | 5 | ||||||||
| Page Range: | pp. 778-784 | ||||||||
| DOI: | 10.1093/icvts/ivy157 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Access rights to Published version: | Open Access | ||||||||
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