engleski

ECMO for graft failure after heart transplantation

Extracorporeal membrane oxygenation (ECMO) is using in the many life-saving situations. This paper showed the case of patient who had graft failure after heart transplantation and in which veno-arterial (V-A) ECMO was established within several hours after transplantation. Case: Male patient, 51 years old, scheduled for heart transplantation after pre-transplantation processing. In 2002, patient underwent mitral valve replacement and threefold coronary revascularization. Between that surgery and heart transplantation, its condition has complicated with paravalvular leak on mitral artificial valve, atrial fibrillation and frequent decompensations. In the end of 2013, patient underwent on heart transplantation. Surgery passed without complications, but on the admission in ICU, patient became hemodynamically unstable with continuous infusions of milrinone (0.5 mcg/kg/min), norepinephrine (>2.0 mcg/kg/min and isoproterenol (0.1 mcg/kg/min). Emergency transesophageal echocardiography (TEE) has shown dilated right atrium with akinetic right ventricle, septal bulging in left and highly increased lactate values >8.0 mmol/L and decreased arterial oxygen saturation despite to mechanical ventilation. Two hours later, in patient V-A ECMO was established. During next several hours, improvement of all findings was reached and doses of all medications decreased. Second day after ECMO implementation, patient developed additional hemodynamic instability, and another one right ventricular dilatation. Then, levosimendan in doses of 0.1 mcg/kg/min introduced in therapy for the further two days. After that, levosimendan discontinued, and V-A ECMO was continuing for the next five days. In that period, control TEE performed and has been showing improvement in right heart functioning, decreasing of right chambers (both atrial and ventricular) dimensions and improvement in left-heart functioning. Tenth day ECMO was removed from patient and after next several days patient transferred to the hospital ward. Conclusion: In the literature, there is little number of cases, which shown ECMO uses in treatment of graft failure after heart transplantation. Our case has been showing, in combination with medication, that V-A ECMO can be one of the opportunities in threatening of acute graft failure after heart transplantation. Positive effect of ECMO uses in this situation is the result of heart relief during accommodation on the new hemodynamic conditions.

ECMO; graft failure; heart transplantation

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