PMID- 35430222
OWN - NLM
STAT- MEDLINE
DCOM- 20230224
LR  - 20231127
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 115
IP  - 3
DP  - 2023 Mar
TI  - Improvements in Extracorporeal Membrane Oxygenation for Primary Graft Failure 
      After Heart Transplant.
PG  - 751-757
LID - S0003-4975(22)00516-1 [pii]
LID - 10.1016/j.athoracsur.2022.03.065 [doi]
AB  - BACKGROUND: Severe primary graft failure is a life-threatening complication of 
      heart transplantation that may require venoarterial extracorporeal membrane 
      oxygenation (VA-ECMO) support. Surgical practices and management strategies 
      regarding VA-ECMO vary between and within centers. METHODS: We performed a 
      single-center retrospective cohort study on adult patients who received VA-ECMO 
      for primary graft failure between 2013 and 2020. Clinical data were obtained from 
      chart review and national databases. Patients were stratified by transplantation 
      before or after 2017, when our center adopted additional objective criteria for 
      VA-ECMO, adopted partial-flow support, and changed from central cannulation to 
      chimney graft arterial cannulation of brachiocephalic, axillary, or aorta. The 
      primary outcome was survival to device weaning. Secondary outcomes were survival 
      to discharge, survival to 1 year, complications on support, and time to sedation 
      weaning and extubation. RESULTS: From 276 heart transplant recipients, 39 severe 
      primary graft failure patients requiring VA-ECMO were identified. Incidence of 
      graft failure was 13% (n = 18 of 135) pre-2017 and 15% (n = 21 of 141) post-2017. 
      Survival at all time points improved significantly after 2017, with greatest 
      difference in survival to device weaning (61% pre-2017 vs 100% post-2017). After 
      controlling for other factors in multivariable Cox regression modeling, 
      transplantation after 2017 was a predictor of reduced mortality (hazard ratio, 
      0.209; 95% CI, 0.06-0.71; P = .01). Significant differences were not observed in 
      other secondary outcomes of recovery. CONCLUSIONS: The new VA-ECMO strategy 
      displayed reasonable survival and a remarkable improvement from the prior system.
CI  - Copyright (c) 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Guo, Aaron
AU  - Guo A
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine in St Louis, St Louis, Missouri.
FAU - Kotkar, Kunal
AU  - Kotkar K
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine in St Louis, St Louis, Missouri.
FAU - Schilling, Joel
AU  - Schilling J
AD  - Division of Cardiology, Department of Medicine, Washington University School of 
      Medicine in St Louis, St Louis, Missouri.
FAU - Jocher, Brandon
AU  - Jocher B
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine in St Louis, St Louis, Missouri.
FAU - Fischer, Irene
AU  - Fischer I
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine in St Louis, St Louis, Missouri.
FAU - Masood, Muhammad F
AU  - Masood MF
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine in St Louis, St Louis, Missouri.
FAU - Itoh, Akinobu
AU  - Itoh A
AD  - Division of Cardiothoracic Surgery, Department of Surgery, Washington University 
      School of Medicine in St Louis, St Louis, Missouri. Electronic address: 
      akitoh@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20220414
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
CIN - Ann Thorac Surg. 2023 Mar;115(3):758. PMID: 35513052
CIN - Ann Thorac Surg. 2023 Dec;116(6):1353-1354. PMID: 37414381
MH  - Adult
MH  - Humans
MH  - *Extracorporeal Membrane Oxygenation
MH  - Retrospective Studies
MH  - *Heart Transplantation
MH  - Arteries
MH  - Catheterization
EDAT- 2022/04/18 06:00
MHDA- 2023/02/25 06:00
CRDT- 2022/04/17 20:17
PHST- 2021/08/01 00:00 [received]
PHST- 2022/02/21 00:00 [revised]
PHST- 2022/03/28 00:00 [accepted]
PHST- 2022/04/18 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2022/04/17 20:17 [entrez]
AID - S0003-4975(22)00516-1 [pii]
AID - 10.1016/j.athoracsur.2022.03.065 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2023 Mar;115(3):751-757. doi: 10.1016/j.athoracsur.2022.03.065. 
      Epub 2022 Apr 14.