Outcome of primary graft dysfunction rescued by venoarterial extracorporeal membrane oxygenation after heart transplantation

Background. - Primary graft dysfunction remains the leading cause of 30-day mortality after heart transplantation. Few data have been published about the clinical outcome of severe primary graft dysfunction treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO).Aim. - To evaluate the prevalence and outcome of severe primary graft dysfunction requiring VA-ECMO, and to identify factors associated with hospital mortality.Methods. - We performed an observational analysis of our institutional database of VA-ECMO for primary graft dysfunction after heart transplantation. Patients with severe primary graft dysfunction, according to the International Society for Heart and Lung Transplantation classifi-cation, were included. The primary outcome was survival to hospital discharge. Risk factors for in-hospital mortality were searched with multiple logistic regression analysis using backward stepwise variable elimination.Results. - Of the 397 patients who had heart transplantation between January 2007 and Decem-ber 2018, 60 (15.1%) developed severe primary graft dysfunction requiring VA-ECMO. The median age was 52 (interquartile range 39-59) years, and 73.3% were male. Thirty-nine (65.0%) patients were weaned after a mean duration of VA-ECMO support of 7.2 +/- 6.0 days. Thirty-two (53.3%) patients were alive at hospital discharge. Inotropic support in the recipient before heart transplantation (odds ratio [OR] 3.88, 95% confidence interval [CI] 1.04-14.44; P = 0.04), total ischaemic time (OR 0.99, 95% CI 0.99-1.00; P = 0.01) and 48-hour total blood transfusion (OR 1.14, 95% CI 1.04-1.26; P = 0.01) were independent predictors of in-hospital mortality.Conclusions. - Severe primary graft dysfunction requiring VA-ECMO is frequent after heart transplantation. Survival to hospital discharge after VA-ECMO for severe primary graft dys-function is satisfactory in such a critically ill population.(c) 2022 Elsevier Masson SAS. All rights reserved.