PMID- 34728522
OWN - NLM
STAT- MEDLINE
DCOM- 20211129
LR  - 20211129
IS  - 1488-2310 (Electronic)
IS  - 0008-428X (Print)
IS  - 0008-428X (Linking)
VI  - 64
IP  - 6
DP  - 2021 Nov-Dec
TI  - Use of extracorporeal membrane oxygenation for heart graft dysfunction in adults: 
      incidence, risk factors and outcomes in a multicentric study.
PG  - E567-E577
LID - 10.1503/cjs.021319 [doi]
AB  - BACKGROUND: The decision about whether to use venoarterial extracorporeal 
      membrane oxygenation (VA-ECMO) in patients with cardiac graft dysfunction (GD) is 
      usually made on a case-by-case basis and is guided by the team's experience. We 
      aimed to determine the incidence of VA-ECMO use after heart transplantation (HT), 
      to assess early- and long-term outcomes and to assess risk factors for the need 
      for VA-ECMO and early mortality in these patients. METHODS: We included adults 
      who underwent heart transplantation at 3 cardiac centres who met the most recent 
      International Society for Heart and Lung Transplantation definition of graft 
      dysfunction (GD) over a 10-year period. Pre-transplant, intraoperative and 
      posttransplant characteristics of the heart recipients as well as donor 
      characteristics were analyzed and compared among recipients with GD treated with 
      and without VA-ECMO. RESULTS: There were 135 patients with GD in this study, of 
      whom 66 were treated with VA-ECMO and 69 were not. The mean follow-up averaged 
      81.2 months (standard deviation 36 mo, range 0-184 mo); follow-up was complete in 
      100% of patients. The overall incidence of GD (30%) and of VA-ECMO use increased 
      over the study period. We did not identify any predictive pre-transplantation 
      factors for VA-ECMO use, but patients who required VA-ECMO had higher serum 
      lactate levels and higher inotropes doses after HT. The overall survival rates 
      were 83% and 42% at 1 year and 78% and 40% at 5 years among patients who received 
      only medical treatment and those who received VA-ECMO, respectively. Delayed 
      initiation of VA-ECMO and postoperative bleeding were strongly associated with 
      increased in-hospital mortality. CONCLUSION: The incidence of GD increased over 
      the study period, and the need for VA-ECMO among patients with GD remains 
      difficult to predict. In-hospital mortality decreased over time but remained high 
      among patients who required VA-ECMO, especially among patients with delayed 
      initiation of VA-ECMO.
CI  - (c) 2021 CMA Joule Inc. or its licensors.
FAU - Noly, Pierre-Emmanuel
AU  - Noly PE
FAU - Hebert, Melanie
AU  - Hebert M
FAU - Lamarche, Yoan
AU  - Lamarche Y
FAU - Cortes, Jorge Robles
AU  - Cortes JR
FAU - Mauduit, Marion
AU  - Mauduit M
FAU - Verhoye, Jean-Philippe
AU  - Verhoye JP
FAU - Voisine, Pierre
AU  - Voisine P
FAU - Flecher, Erwan
AU  - Flecher E
FAU - Carrier, Michel
AU  - Carrier M
AD  - From the Department of Cardiac Surgery, Montreal Heart Institute, Universite de 
      Montreal, Montreal, Que. (Noly, Hebert, Lamarche, Carrier); the Department of 
      Cardiac Surgery, Quebec Heart and Lung Institute, Universite Laval, Quebec, Que. 
      (Cortes, Voisine); and the Department of Thoracic and Cardiovascular Surgery, 
      Rennes Hospital, University of Rennes 1, Rennes, France (Mauduit, Verhoye, 
      Flecher).
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20211102
PL  - Canada
TA  - Can J Surg
JT  - Canadian journal of surgery. Journal canadien de chirurgie
JID - 0372715
RN  - 0 (Cardiotonic Agents)
RN  - 33X04XA5AT (Lactic Acid)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Cardiotonic Agents/administration & dosage
MH  - Extracorporeal Membrane Oxygenation/*statistics & numerical data
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Transplantation/adverse effects/*statistics & numerical data
MH  - Hospital Mortality
MH  - Humans
MH  - Incidence
MH  - Lactic Acid/blood
MH  - Male
MH  - Middle Aged
MH  - Outcome Assessment, Health Care/*statistics & numerical data
MH  - Postoperative Hemorrhage/epidemiology
MH  - Primary Graft Dysfunction/*epidemiology/*therapy
MH  - Retrospective Studies
MH  - Risk Factors
PMC - PMC8565882
COIS- Competing interests: None declared.
EDAT- 2021/11/04 06:00
MHDA- 2021/11/30 06:00
PMCR- 2021/11/02
CRDT- 2021/11/03 05:58
PHST- 2020/11/30 00:00 [accepted]
PHST- 2021/11/03 05:58 [entrez]
PHST- 2021/11/04 06:00 [pubmed]
PHST- 2021/11/30 06:00 [medline]
PHST- 2021/11/02 00:00 [pmc-release]
AID - 64/6/E567 [pii]
AID - 064E567 [pii]
AID - 10.1503/cjs.021319 [doi]
PST - epublish
SO  - Can J Surg. 2021 Nov 2;64(6):E567-E577. doi: 10.1503/cjs.021319. Print 2021 
      Nov-Dec.