Usefulness of extracorporeal membrane oxygenation for early cardiac allograft dysfunction

Background Owing to persisting donor shortages, the use of "marginal hearts" has increased. Because patients who receive a marginal heart may require hemodynamic support in the early post-operative period, extracorporeal membrane oxygenation (ECMO) may be used until recovery of acute graft dysfunction. Methods A retrospective file review of 124 primary adult heart transplant patients from 2003 to 2008 was conducted. We compared 17 patients who received post-transplant ECMO support with 107 transplant recipients without ECMO. Donor and recipient pre-transplant, intra-operative, and post-transplant clinical variables to 6 months after transplant were compared. Results Pre-operative demographics of the 2 groups were similar. Eight (47%) of the patients in the ECMO group received marginal donor hearts, compared with 1 (1%) in the non-ECMO group ( p p p p Conclusions ECMO allows for salvage of acute graft dysfunction and may allow use of marginal donor hearts. Survival rates are lower in patients who require ECMO compared with optimal donors, but early cardiac dysfunction normalizes in most without long-term cardiac or renal sequelae. Despite longer ventilation times, overall hospitalization is not prolonged.