A case series: the outcomes, support duration, and graft function recovery after VA-ECMO use in primary graft dysfunction after heart transplantation
AbstractPrimary graft dysfunction (PGD) is a rare complication associated with high mortality after heart transplantation, which may require veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) support. A standardized definition for PGD was developed by the International Society of Heart and Lung Transplantation in 2014. Due to limited reports using this definition, the detailed outcomes after VA-ECMO support remain unclear. Therefore, we retrospectively analyzed our single-center outcomes of PGD following VA-ECMO support. Between September 2014 and August 2018, 160 patients underwent heart transplantation in our single center. Nine PGD patients required VA-ECMO support, with an incidence of 5.6%. Pre-operative recipient/donor demographics, intra-operative variables, timing of VA-ECMO initiation and support duration, graft function recovery during 30 days after heart transplant, VA-ECMO complications, and survival were analyzed. The indication for VA-ECMO support was biventricular failure for all nine patients. Six patients had severe PGD requiring intra-operative VA-ECMO, while two patients had moderate PGD and one patient had mild PGD requir ing post-operative VA-ECMO. All cohorts were successfully decannulated in a median of 10 days. Survival to discharge rate was 88.9%. One-year survival rate was 85.7%. Left ventricular ejection fraction recovered to normal within 30 days in all PGD patients. Our study showed VA-ECMO support led to high survival an...
Peng DM, Koehl DA, Cantor RS, McMillan KN, Barnes AP, McConnell PI, Jordan J, Andersen ND, St Louis JD, Maeda K, Kirklin JK, Kindel SJ. Outcomes of children with congenital heart disease implanted with ventricular assist devices: An analysis of the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs). J Heart Lung Transplant 2019;38(4):420-30.
ConclusionsConcomitant AoV surgery in patients undergoing LVAD implantation is an independent predictor of mortality. Additional research is needed to determine the best AoV surgical strategy at the time of LVAD surgery.
Conditions: Rheumatic Heart Disease; Valvular Disease Interventions: Drug: Atorvastatin; Drug: Placebo Sponsors: University of Washington; Manmohan Cardiothoracic Vascular and Transplant Center; National Heart, Lung, and Blood Institute (NHLBI) Not yet recruiting
Abstract Although lung transplant remains the only option for patients with end-stage lung failure, short preservation times result in an inability to meet patient demand. Successful cryopreservation may ameliorate this problem; however, very little research has been performed on lung cryopreservation due to the inability to prevent ice nucleation or growth. Therefore, this research sought to characterize the efficacy of small-molecule ice recrystallization inhibitors (IRIs) for lung cryopreservation given their well-documented ability to control ice growth. Sprague-Dawley heart-lung blocks were perfused at room t...
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In an effort to address the increasing demand for heart transplantation within the United Kingdom (UK) we established a clinical programme of heart transplantation from donation after circulatory determined death (DCD) donors in 2015. Five years later we report the clinical early outcomes and impact of the programme.
Pulmonary hypertension (PH) is a common in patients with chronic heart failure (HF). For patients who progress to end stage HF and require orthotropic heart transplant (OHT), irreversible PH is a relative contraindication as it may lead to post-operative right HF. The International Society of Heart and Lung Transplant (ISHLT) recommends that transplantation be pursued in patients with a pulmonary vascular resistance (PVR)
Heart transplantation (HT) is the last resort for many patients with advanced heart failure. There is wide variation in access to transplant listing and in transplant outcomes across demographics.1,2,3 However, in recent years access to HT for minority and lower socioeconomic populations has increased.1 There has also been a concurrent rise in public (Medicare and Medicaid) payor for HT, which is approaching 50% share across the United States.4 This rise may relate to changing demographics and increasing transplants among Medicare patients who qualify due to disability.
Donor-recipient human leukocyte antigen (HLA)-DR locus matching may be protective against bronchiolitis obliterans syndrome (BOS) in lung transplant recipients. It is unknown whether this benefit is more significant among sensitized (CPRA>0%) and highly sensitized (CPRA ≥80%) recipients, who may be at higher risk for BOS.
The term idiopathic pulmonary arterial hypertension (IPAH) is used to categorize patients with pre-capillary pulmonary hypertension of unknown origin. There is considerable variability in the clinical presentation of these patients.Using data from the COMPERA registry, we performed a cluster analysis of 841 patients with IPAH based on age, sex, lung diffusion capacity for carbon monoxide (DLCO,