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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

Arash Mehdiani‡   *
1   Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
,
Moritz Benjamin Immohr‡   *
1   Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
,
Charlotte Boettger
1   Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
,
Hannan Dalyanoglu
1   Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
,
Daniel Scheiber
2   Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Medical School, Duesseldorf, Germany
,
Ralf Westenfeld
2   Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Medical School, Duesseldorf, Germany
,
Hug Aubin 
1   Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
,
Payam Akhyari 
1   Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
,
Diyar Saeed
3   Department of Cardiovascular Surgery, Leipzig Heart Center, Leipzig, Germany
,
Artur Lichtenberg
1   Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
,
Udo Boeken 
1   Department of Cardiovascular Surgery, Heinrich-Heine-University Medical School, Duesseldorf, Germany
› Author Affiliations Funding None.
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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

* Both authors contributed equally to the study.




Publication History

Received: 24 June 2019

Accepted: 07 October 2019

Article published online:
08 February 2020

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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