A multicenter study of primary graft failure after infant heart transplantation: Impact of extracorporeal membrane oxygenation on outcomes
- 7 November 2013
- journal article
- research article
- Published by Wiley in Pediatric Transplantation
- Vol. 18 (1), 72-78
- https://doi.org/10.1111/petr.12181
Abstract
Primary graft failure is the major cause of mortality in infant HTx. The aim of this study was to characterize the indication and outcomes of infants requiring ECMO support due to primary graft failure after HTx. We performed a retrospective review of all infants (<1 yr) who underwent Htx from three institutions. From 1999 to 2008, 92 infants (<1 yr) received Htx. Sixteen children (17%) required ECMO after Htx due to low cardiac output syndrome. Eleven (69%) infants were successfully weaned off ECMO, and 9 (56%) infants were discharged with a mean follow-up of 2.3 ± 2.5 yr. Mean duration of ECMO in survivors was 5.4 days (2-7 days) compared with eight days (2-10 days) in non-survivors (p = NS). The five-yr survival rate for all patients was 75%; however, the five-yr survival rate was 40% in the ECMO cohort vs. 80% in the non-ECMO cohort (p = 0.0001). Graft function within one month post-Htx was similar and normal between ECMO and non-ECMO groups (shortening fraction = 42 ± 3 vs. 40 ± 2, p = NS). For infants, ECMO support for primary graft failure had a lower short-term and long-term survival rate vs. non-ECMO patients. Duration of ECMO did not adversely impact graft function and is an acceptable therapy for infants after HTx for low cardiac output syndrome.Keywords
This publication has 15 references indexed in Scilit:
- Outcomes of ventricular assist device support in young patients with small body surface areaEuropean Journal of Cardio-Thoracic Surgery, 2011
- Mechanical bridging to orthotopic heart transplantation in children weighing less than 10kg: feasibility and limitationsEuropean Journal of Cardio-Thoracic Surgery, 2011
- Bridging children of all sizes to cardiac transplantation: The initial multicenter North American experience with the Berlin Heart EXCOR ventricular assist deviceThe Journal of Heart and Lung Transplantation, 2011
- Mechanical Assist Device as a Bridge to Heart Transplantation in Children Less Than 10 KilogramsThe Annals of Thoracic Surgery, 2010
- Outcome of Extracorporeal Membrane Oxygenation for Early Primary Graft Failure After Pediatric Heart TransplantationJournal of the American College of Cardiology, 2009
- Registry of the International Society for Heart and Lung Transplantation: Eleventh Official Pediatric Heart Transplantation Report—2008The Journal of Heart and Lung Transplantation, 2008
- Pre-existing Pulmonary Hypertension in Patients With End-stage Heart Failure: Impact on Clinical Outcome and Hemodynamic Follow-up After Orthotopic Heart TransplantationThe Journal of Heart and Lung Transplantation, 2007
- Extracorporeal membrane oxygenation in pediatric cardiac transplantationJournal of Pediatric Surgery, 2005
- Long-term survival after pediatric cardiac transplantation and postoperative ECMO supportThe Annals of Thoracic Surgery, 2003
- Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock in childrenThe Annals of Thoracic Surgery, 1989