PMID- 31895346
OWN - NLM
STAT- MEDLINE
DCOM- 20210208
LR  - 20210208
IS  - 1534-6080 (Electronic)
IS  - 0041-1337 (Linking)
VI  - 104
IP  - 10
DP  - 2020 Oct
TI  - Long-term Outcome in Severe Left Ventricular Primary Graft Dysfunction Post 
      Cardiac Transplantation Supported by Early Use of Extracorporeal Membrane 
      Oxygenation.
PG  - 2189-2195
LID - 10.1097/TP.0000000000003094 [doi]
AB  - BACKGROUND: Severe primary graft dysfunction (PGD) is the leading cause of early 
      death following cardiac transplantation. The early use of venoarterial 
      extracorporeal membrane oxygenation (VA-ECMO) may facilitate graft rescue. 
      However, the additional risks of its use are unknown. METHODS: We retrospectively 
      reviewed the medical records of all adult patients who underwent cardiac 
      transplantation from January 2009 to February 2016 at St Vincent's Hospital, 
      Sydney, to evaluate risk factors for the use of VA-ECMO and related morbidity and 
      long-term survival. RESULTS: One hundred ninety-two transplanted patients were 
      identified, 49 (25%) of whom developed left or biventricular PGD requiring 
      VA-ECMO. The total operation time (median 495 [interquartile range 139.8] versus 
      412.8 [132] min, P < 0.001), cardiopulmonary bypass time (220 [63] versus 176 
      [73] min, P < 0.001) and the presence of a previous sternotomy (29 [59%] versus 
      51 [36%], P = 0.019) were associated with the use of VA-ECMO. One-year survival 
      in the VA-ECMO cohort was 71%. After a median follow-up time of 696 days 
      (interquartile range 1201 d), survival was significantly higher in the non-ECMO 
      group (P = 0.004) but not when conditioned on hospital survival (P = 0.34). 
      Patients with shorter than median ECMO runtime (<108 h) had a similar long-term 
      survival to patients who did not require ECMO (P = 0.559). In the ECMO cohort, 
      multivariable logistic regression revealed baseline creatinine in micromol/L (odds 
      ratio 0.99 [95% confidence interval 0.99-1.00], P = 0.019) and duration of ECMO 
      support in days (odds ratio 0.65 [95% confidence interval 0.44-0.97], P = 0.034) 
      were inversely and independently associated with 1-year survival. CONCLUSIONS: 
      Short- and long-term survival of PGD supported with VA-ECMO was better than 
      previously described. Early recovery of PGD on VA-ECMO support negates its 
      negative impact on short- and long-term survival.
FAU - Connolly, Sophie
AU  - Connolly S
AD  - Department of Intensive Care Medicine, St Vincent's Hospital, Sydney, NSW, 
      Australia.
FAU - Granger, Emily
AU  - Granger E
AD  - Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, NSW, 
      Australia.
AD  - University of New South Wales, Sydney, NSW, Australia.
FAU - Hayward, Christopher
AU  - Hayward C
AD  - University of New South Wales, Sydney, NSW, Australia.
AD  - Department of Cardiology, St Vincent's Hospital, Sydney, NSW, Australia.
FAU - Huang, David
AU  - Huang D
AD  - University of New South Wales, Sydney, NSW, Australia.
FAU - Kerr, Stephen
AU  - Kerr S
AD  - The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
AD  - Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, 
      Bangkok, Thailand.
FAU - McCanny, Peter
AU  - McCanny P
AD  - Department of Intensive Care Medicine, St Vincent's Hospital, Sydney, NSW, 
      Australia.
AD  - Department of Intensive Care Medicine, Liverpool Hospital, Sydney, NSW, 
      Australia.
FAU - Buscher, Hergen
AU  - Buscher H
AD  - Department of Intensive Care Medicine, St Vincent's Hospital, Sydney, NSW, 
      Australia.
AD  - University of New South Wales, Sydney, NSW, Australia.
AD  - Centre of Applied Medical Research, St Vincent's Hospital, Sydney, NSW Australia.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Transplantation
JT  - Transplantation
JID - 0132144
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Extracorporeal Membrane Oxygenation/adverse effects/mortality
MH  - Female
MH  - Graft Survival
MH  - Heart Transplantation/*adverse effects/mortality
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Primary Graft Dysfunction/etiology/mortality/physiopathology/*therapy
MH  - Recovery of Function
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/etiology/mortality/physiopathology/*therapy
MH  - *Ventricular Function, Left
EDAT- 2020/01/03 06:00
MHDA- 2021/02/09 06:00
CRDT- 2020/01/03 06:00
PHST- 2020/01/03 06:00 [pubmed]
PHST- 2021/02/09 06:00 [medline]
PHST- 2020/01/03 06:00 [entrez]
AID - 00007890-202010000-00030 [pii]
AID - 10.1097/TP.0000000000003094 [doi]
PST - ppublish
SO  - Transplantation. 2020 Oct;104(10):2189-2195. doi: 10.1097/TP.0000000000003094.