Extracorporeal membrane oxygenation for primary allograft failure

Abstract OBJECTIVE: Herein we have reported our experience concerning the usefulness of extracorporeal membrane oxygenation (ECMO) in heart transplant patients. PATIENTS AND METHODS: Between July 2002 and March 2007, 11 heart transplant patients, namely, 8 men and 3 women of overall mean age of 49.4 +/- 13.9 years (range, 19-62 years) with primary graft failure underwent ECMO implantation. Two patients had pulmonary hypertension; 3 had been transplanted with hearts from marginal donors. At the time of implantation, all were in severe cardiogenic shock despite maximal inotropic support. In 6 patients, the ECMO was implanted centrally in the operating room when there was failure of weaning of cardiopulmonary bypass. Among the 5 remaining patients, ECMO was implanted peripherally in the intensive care unit, during the first 60 hours, including 3 cases of hemodynamic instability and 1 of irreversible cardiac graft arrest. The last patient was implanted on day 30 after transplantation because of acute rejection. RESULTS: Mean pump outflow was 2.7 +/- 0.4 L/min/m(2). One patient died on circulatory support due to a cerebral hemorrhage. Ten patients were weaned from ECMO after a mean duration of 9.1 +/- 6.9 days (range, 1-18 days). All of them were successfully discharged. No retransplantation occurred. CONCLUSION: Rapid operating room or bedside placement of ECMO allowed stabilization of hemodynamics with potential myocardial recovery in patients with cardiac graft failure.