Naslov
Management of primary graft dysfunction after heart transplantation
(Management of primary graft dysfunction after heart transplantation)

Autori
Bradić, Nikola ; Rudež, Igor ; Neuberg, Marijana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Perfusion-uk, 36 (2021), 1S / - , 2021, 15-15

Skup
EuroELSO virtual congress

Mjesto i datum
Online, 05.05.2021. - 07.05.2021

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
primary graft dysfunction ; heart transplantation

Sažetak
Objective: In 4-15% heart transplants (HTx), recipients don’t survive initial months. Leading cause of early mortality is primary graft dysfunction (PGD). Between 2013 to 2018, we performed 77 HTxs’, and in 3 of them (3.89%), PGD were developed. All of them we treated with VA ECMO combined with levosimendan in continuous infusion. Methods: Retrospective data analysis. Results: Male patient, 53 years old, with previous valve replacement and CABG surgery, became hemodynamically unstable soon after ICU admission despite of inotropic support. TEE has shown dilated right atrium and akinetic right ventricle. VA ECMO/levosimendan (0.1 mcg/kg/min - 24 hours) established immediately. Levosimendan discontinued, and ECMO discontinued 5th day. TEE has shown improvement of heart function and reduced heart dimensions and patient transferred on ward. Second, 39 years old male, could not be weaned from CPB and ECMO/levosimendan established in operating room (ECMO 72 hours/levosimendan 0.1 mcg/kg/min 32 hours). He stabilized hemodynamically, but postoperatively was complicated with bleeding and multiple revisions. TEE at 5th day showed normal diastolic diameter of LV, but akinetic right ventricle (EFRV 15%) and the patient died. Third, 47 years old male, could not be weaned from CPB. TEE has shown dilated both ventricles with global hypocontractility. ECMO/levosimendan was established (levosimendan 0.1mcg/kg/min - 24 hours, ECMO 72 hours). TEE has shown improvement of contractility with EFLV 60%, and 6th day, patient discharged to the ward. Conclusions: In case of PGD after HTx, combination of ECMO and levosimendan gave positive effect of heart function recovery. ISHLT consensus suggested that ECMO may reduce the amount and doses of inotropic medications and improves the overall outcome. As our results, results of other centers have shown advantage of ECMO usage over the other mechanical devices and in combination with levosimendan may shorten the time of ECMO and improve survival and should become standard treatment for PGD.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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