Extracorporeal Membrane Oxygenation after Heart Transplantation: Impact of Type of Cannulation

Arash Mehdiani; Moritz Benjamin Immohr; Charlotte Boettger; Hannan Dalyanoglu; Daniel Scheiber; Ralf Westenfeld; Hug Aubin; Payam Akhyari; Diyar Saeed; Artur Lichtenberg; Udo Boeken

doi:10.1055/s-0039-3400472

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2021; 69(03): 263-270
DOI: 10.1055/s-0039-3400472

Original Cardiovascular

Extracorporeal Membrane Oxygenation after Heart Transplantation: Impact of Type of Cannulation

Authors

Arash Mehdiani‡^*

¹Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
Moritz Benjamin Immohr‡^*

¹Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
Charlotte Boettger

¹Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
Hannan Dalyanoglu

¹Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
Daniel Scheiber

²Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Medical School, Duesseldorf, Germany
Ralf Westenfeld

²Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Medical School, Duesseldorf, Germany
Hug Aubin

¹Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
Payam Akhyari

¹Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
Diyar Saeed

³Department of Cardiovascular Surgery, Leipzig Heart Center, Leipzig, Germany
Artur Lichtenberg

¹Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
Udo Boeken

¹Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany

Abstract

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Abstract

Background Primary graft dysfunction (PGD) is a common cause of early death after heart transplantation (htx). The use of extracorporeal life support (ECLS) after htx has increased during the last years. It is still discussed controversially whether peripheral cannulation is favorable compared to central cannulation. We aimed to compare both cannulation techniques.

Methods Ninety patients underwent htx in our department between 2010 and 2017. Twenty-five patients were treated with ECLS due to PGD (10 central extracorporeal membrane oxygenator [cECMO] and 15 peripheral extracorporeal membrane oxygenator [pECMO] cannulation). Pre- and intraoperative parameters were comparable between both groups.

Results Thirty-day mortality was comparable between the ECLS-groups (cECMO: 30%; pECMO: 40%, p = 0.691). Survival at 1 year (n = 18) was 40 and 30.8% for cECMO and pECMO, respectively. The incidence of postoperative renal failure, stroke, limb ischemia, and infection was comparable between both groups. We also did not find significant differences in duration of mechanical ventilation, intensive care unit stay, or in-hospital stay. The incidence of bleeding complications was also similar (cECMO: 60%; pECMO: 67%). Potential differences in support duration in pECMO group (10.4 ± 9.3 vs. 5.7 ± 4.7 days, p = 0.110) did not reach statistical significance.

Conclusions In patients supported for PGD, peripheral and central cannulation strategies are safe and feasible for prolonged venoarterial ECMO support. There was no increase in bleeding after central implantation. With regard to the potential complications of a pECMO, we think that aortic cannulation with tunneling of the cannula and closure of the chest could be a good option in patients with PGD after htx.

Keywords

transplantation - heart - extracorporeal membrane oxygenation - ECMO

Full Text

References

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