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Ghoneim M, Knierim J, Hedwig F, Kurz SD. Six years of continuous mechanical circulatory support following chronic graft failure. Artif Organs 2023; 47:214-216. [PMID: 36254560 DOI: 10.1111/aor.14422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 08/20/2022] [Accepted: 10/04/2022] [Indexed: 01/04/2023]
Abstract
Re-transplantation is the preferred treatment for patients with chronic heart transplant failure. If re-transplantation is not a viable option due to the patient's comorbidities, left ventricle assist device can be used as the destination treatment. An interdisciplinary approach with thorough follow-up can help in the early detection and treatment of complications associated with LVAD.
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Affiliation(s)
- Mohamed Ghoneim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Berlin Institute of Health, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany
| | - Jan Knierim
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Berlin Institute of Health, Berlin, Germany
| | - Felix Hedwig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Berlin Institute of Health, Berlin, Germany
| | - Stephan D Kurz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Berlin Institute of Health, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
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Hulman M, Artemiou P, Ondrusek M, Hudec V, Gasparovic I, Bena M, Glonek I. Short-term mechanical circulatory support for severe primary graft dysfunction following orthotopic heart transplant. Interact Cardiovasc Thorac Surg 2019. [PMID: 29514222 DOI: 10.1093/icvts/ivy050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Primary graft dysfunction (PGD) is a devastating complication and the most common cause of early death following a heart transplant. The goal of this study was to report our experience of using mechanical circulatory support to manage severe PGD. METHODS Following 208 heart transplants performed between January 2007 and May 2017, 14 (6.7%) patients presented with severe PGD. We provided haemodynamic support using the following approaches: a venoarterial extracorporeal membrane oxygenation device, left ventricular assist device, right ventricular assist device and biventricular assist device. Primary complications included severe PGD, which resulted in hospital deaths and late survival. The mean follow-up was 3.7 ± 2.7 years. RESULTS Fourteen (6.7%) heart transplant recipients presented with severe PGD. Seven patients received a venoarterial extracorporeal membrane oxygenation device; 1 patient received a left ventricular assist device; 4 patients received a right ventricular assist device; and 2 patients received a biventricular assist device. Mean device support and explantation times were 4.7 ± 2 and 6.3 ± 2 days, respectively. Weaning with cardiac recovery was successful in 57.1% of the patients. The hospital mortality rate was 50%. Postoperative causes of morbidity included renal failure that necessitated dialysis in 28.5%, surgical re-exploration due to postoperative bleeding in 57.1%, pneumonia in 28.5%, sepsis in 14.2%, sternal wound infection in 14.2% and mediastinitis in 7.1% of the patients, respectively. There were no deaths following hospital discharge or later follow-up appointments. CONCLUSIONS Mechanical support devices such as venoarterial extracorporeal membrane oxygenation specifically offer a reliable therapeutic approach. Recognizing the relatively high number of deaths in-hospital, patients who have cardiac recovery and a successful hospital discharge can expect a favourable late outcome.
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Affiliation(s)
- Michal Hulman
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Matej Ondrusek
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Vladan Hudec
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Ivo Gasparovic
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Martin Bena
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Ivan Glonek
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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Tenderich G, Koerner M, Stuettgen B, Minami K, El-Banayosy A, Arusoglu L, Mirow N, Wlost S, Gromzik H, Kleesiek K, Meyer H, Koerfer R. Mechanical Circulatory Support after Orthotopic Heart Transplantation. Int J Artif Organs 2018. [DOI: 10.1177/039139889802100712] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Frequently the only therapy for primary graft- and right heart failure, as well as low output syndrome from acute of chronic rejection, is implantation of a mechanical circulatory support system, until recompensation or retransplantation. At our institution, mechanical assist devices were implanted in 25 heart recipients for a cute rejection (n=9), primary graft failure (n=7), acute right heart failure (n=7), and chronic rejection with low output syndrome (n=2). Patients (pts) with primary graft failure (n=3) received an intraaortic balloon pump (IABP), one pt an IABP plus Abiomed®-System for left ventricular support, one pt the Thoratec®-System for biventricular support. Patients with right heart failure (RHF) received the Biomedicus® centrifugal pump for right ventricular support. Nine pts suffered from acute rejection. Six pts received an IABP, one the Biomedicus® as femoro-femoral bypass, one the Abiomed®-System for biventricular support, two the Thoratec®-System for biventricular support and two within this group switched from the Biomedicus® pump to the Thoratec®-System for biventricular support. Patients with chronic graft failure (n=2) received the Novacor®-System (LVAD) for left ventricular support, one received a Tojobo®-System and an oxygenator for biventricular support post coronary artery bypass surgery. Support time ranged from 0.5-h to 73 days. Five pts were weaned. Two (8%) of 25 pts were retransplanted, 18 (72%) died in spite of mechanical support from multiple organ failure. The use of a mechanical assist device after heart transplantation is encouraging only in the case of early right heart failure, as well as primary and chronic graft failure. In view of the poor results, the use of mechanical assist devices should not be recommended in the case of heart failure caused by acute rejection.
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Affiliation(s)
- G. Tenderich
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - M.M. Koerner
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - B. Stuettgen
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - K. Minami
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - A. El-Banayosy
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - L. Arusoglu
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - N. Mirow
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - S. Wlost
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - H. Gromzik
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - K. Kleesiek
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - H. Meyer
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
| | - R. Koerfer
- Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen - Germany
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Chen JW, Chen YS, Chi NH, Huang SC, Yu HY, Chou NK, Wang CH, Wang SS. Risk Factors and Prognosis of Patients With Primary Graft Failure After Heart Transplantation: An Asian Center Experience. Transplant Proc 2014; 46:914-9. [DOI: 10.1016/j.transproceed.2013.11.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/15/2013] [Indexed: 12/21/2022]
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Mihaljevic T, Jarrett CM, Gonzalez-Stawinski G, Smedira NG, Nowicki ER, Thuita L, Mountis M, Blackstone EH. Mechanical circulatory support after heart transplantation. Eur J Cardiothorac Surg 2012; 41:200-6; discussion 206. [PMID: 21640601 DOI: 10.1016/j.ejcts.2011.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Mechanical circulatory support (MCS) may be used for severe graft failure after heart transplantation, but the degree to which it is lifesaving is uncertain. METHODS Between June 1990 and December 2009, 53 patients after 1417 heart transplants (3.7%) required post-transplant MCS for acute rejection (n=17), biventricular failure (n=16), right ventricular failure (n=16), left ventricular failure (n=1), or respiratory failure (n=3). Although support was occasionally instituted remotely post-transplant (5>1 year), in 39 (73%) instances it was required within 1 week. Initial mode of support was extracorporeal membrane oxygenation in 43 patients (81%), biventricular assist device in 4 (7.5%), and right ventricular assist device in 6 (11%). RESULTS Risk of requiring respiratory support was highest in those with restrictive cardiomyopathy as indication for transplant, women, and those with elevated pulmonary pressure or renal failure. Complications of support, which increased progressively with its duration, included stroke in two patients (3.8%), infection in two (3.8%), and reoperation for bleeding (seven instances) in four (7.0%). Nineteen patients (36%) recovered and were removed from support, five (9.4%) underwent retransplantation (four after biventricular failure and one after acute rejection), and 29 died while on support (55%). Overall survival after initiating support was 94%, 83%, 66%, and 43% at 1, 3, 7, and 30 days, respectively. Patients requiring support for biventricular failure had better survival than those having acute rejection or other indications (P=0.03). Survival after retransplantation or removal from support following recovery was 88% at 1 year and 61% at 10 years. CONCLUSION Severe refractory heart failure after transplantation is a rare catastrophic event for which MCS offers the possibility of recovery or bridge to retransplantation, particularly for patients with biventricular failure in the absence of rejection. Early retransplantation should be considered in patients who show no evidence of graft recovery on MCS.
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Affiliation(s)
- Tomislav Mihaljevic
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
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Hauer D, Beiras-Fernandez A, Kur F, Weis M, Schmoeckel M, Weis FC. The Management of Severe Primary Graft Failure After Cardiac Transplantation. J Cardiothorac Vasc Anesth 2009; 23:203-5. [DOI: 10.1053/j.jvca.2007.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Indexed: 11/11/2022]
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Ibrahim M, Hendry P, Masters R, Rubens F, Lam BK, Ruel M, Davies R, Haddad H, Veinot JP, Mesana T. Management of acute severe perioperative failure of cardiac allografts: a single-centre experience with a review of the literature. Can J Cardiol 2007; 23:363-7. [PMID: 17440641 PMCID: PMC2649186 DOI: 10.1016/s0828-282x(07)70769-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Early graft failure is associated with high mortality and is the main cause of death within the first 30 days after transplantation. The purpose of the present study was to examine the investigators' experience of severe perioperative acute graft failure and to review the literature. METHODS Nine of 385 cardiac transplants (2.3%) performed from 1984 through 2005 developed severe perioperative acute graft failure either in the operating room or within 24 h after cardiac transplantation. Four patients had primary graft failure, two had right heart failure secondary to pulmonary hypertension, one had hyperacute rejection, one had accelerated acute rejection and one possibly sustained a particulate coronary embolus intraoperatively. RESULTS All except the two patients who had right heart failure secondary to pulmonary hypertension received mechanical circulatory support. Three patients were supported with total artificial hearts, two patients received a left ventricular assist device, one patient was supported with extracorporeal life support followed by a right ventricular assist device when the left ventricle recovered, and one patient was supported for several hours with cardiopulmonary bypass. Three patients were retransplanted after mechanical circulatory support, but only one survived. Only one of the nine patients (11%) survived; this patient was supported with a total artificial heart followed by retransplantation. CONCLUSION The outcome of severe perioperative acute graft failure is very poor. Mechanical circulatory support and retransplantation are not as successful as in other situations. Due to the shortage of donors and poor outcomes, retransplantation for hyperacute rejection is not advisable.
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Affiliation(s)
- Moheb Ibrahim
- Section of Cardiac Surgery, St. Boniface General Hospital, Winnipeg, Manitoba, Canada.
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Arribas JM, Pascual DA, Gutiérrez F, Ray V, García-Puente J, Valdés M, Arcas R. Successful biventricular assistance after heart transplantation. Ann Thorac Surg 2004; 77:720-1. [PMID: 14759475 DOI: 10.1016/j.athoracsur.2003.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2003] [Indexed: 11/29/2022]
Abstract
We present a successful use of biventricular pneumatic assistance during seven days allowing the recovery from a severe primary graft failure that occurred in the operating room. Suboptimal donors are associated with higher rates of immediate graft failure; however proper use of mechanical assistance can help to recover graft function.
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Affiliation(s)
- Jose M Arribas
- Department of Cardiovascular Surgery, University Hospital Virgen de la Arrixaca, Murcia, Spain.
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Fernández AL, Martínez A. Successful recovery of allograft failure with biventricular support. Ann Thorac Surg 2001; 71:1753-4. [PMID: 11383856 DOI: 10.1016/s0003-4975(01)02403-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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