Incidence and Effect of VA-ECMO Use in Primary Graft Failure Patients after Heart Transplantation

Abstract

Purpose Primary graft dysfunction (PGD) is a complication associated with high mortality after heart transplant, which may require veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) support. However, the outcomes of VA-ECMO use for heart transplant recipients remains unclear in limited studies. Methods Between September 2014 and August 2018, 169 patients underwent heart transplantation in our single center. 10 patients who required VA-ECMO support were analyzed retrospectively. Incidence, pre-operative recipient and donor demographics, intraoperative variables, VA-ECMO support duration, short and long-term survival were analyzed. The outcomes were stratified by PGD severity. Results Of 10 patients, the incidence of severe PGD requiring immediate VA-ECMO support from primary heart transplant was 70.0% (n = 7). The incidence of non-severe PGD requiring non-immediate VA-ECMO support was 30.0% (n = 3). Median ischemic time and interquartile range (IQR) was 189 [158-212] minutes. The survival to discharge rate was 71.4% and 100% for severe and non-severe PGD patients, respectively (Figure 1). Median survival days and IQR was 580 [80-877] for severe PGD patients and 366 [64-381] for non-severe PGD patients. 30-day survival rate was 85.7% and 100% for severe and non-severe PGD patients. 1-year survival rate was 66.7% for severe PGD and 100% for non-severe PGD patients, respectively (Table 1). Conclusion VA-ECMO support following heart transplant led to acceptable results in PGD patients. However, further stratified research with larger cohorts is needed to evaluate the effects of VA-ECMO and to improve outcomes.