Extracorporeal membrane oxygenation in the peri-operative period of heart transplantation
10.3760/cma.j.issn.0253-3758.2009.11.017
- VernacularTitle:体外膜肺氧合支持治疗在心脏移植围术期的应用
- Author:
Wei WANG
1
;
Zhong-Kai LIAO
;
Sheng-Shou HU
;
Yun-Hu SONG
;
Jie HUANG
Author Information
1. 中国医学科学院北京协和医学院阜外心血管病医院
- Keywords:
Heart transplantation;
Extracorrporeal membrane oxygenation
- From:
Chinese Journal of Cardiology
2009;37(11):1014-1017
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize and analyze clinical outcomes and experience about using extracorporeal membrane oxygenation (ECMO) in supporting heart transplant patients in the peri-operative period of in Fuwai Hospital retrospectively. Methods We performed 131 orthotopic heart transplantations from June 2004 to December 2008. Fourteen cases used veno-artery ECMO (Medtronic Ltd) for mechanical circulatory support in the peri-operative period of heart transplantation. Active clotting time (ACT) was maintained between 160-200 seconds, mean blood flow was 1.8-3.3 L/min during ECMO assistant period. Results Twelve survivals discharged with NYHA Ⅰ, two patients died of multiple orgen failure with severe infection and complication of central nervous system. The ECMO time was 75-824 h and mean time 149 h. 12 survivals with ECMO assistance decreases the dose of vasoactive drugs,after bedside UCG evaluating heart function recovery with stable circulation, ECMO could be weaned off uneventfully after 100 h. Five patients with seven times bleeding complication and one patient with catheter-associated arterial thrombosis of distal limb, all ECMO patients with low-albuminemia and hyperbilirubinemia at some degree, eleven patients with increasing blood creatine and five patients were treated with continous renal replacement therapy, one patient with pertinacious hyperbilirubinemia was treated with plasma exchange and molecular absorbent recirculating system. Seven patients were extension incision healing and six patients were traeheotomy. Conclusions ECMO can bridge patients with end-stage heart failure to heart transplant, and extend the use of marginal donors, grasp the ECMO indication and timing of application, avoiding irreversible dysfunction of the vital organs and preventing complication during ECMO, ECMO may decrease mortality of severe patients in the peri-operative period of heart transplantation.
