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Long-term survival after pediatric cardiac transplantation and postoperative ECMO support
Kathleen N Fenton1, Steven A Webber, David A Danford
1Children's Hospital, Omaha, Nebraska 68114, USA. kfenton@chsomaha.org
Insights
Extracorporeal membrane oxygenation (ECMO) can aid pediatric heart transplant patients with graft dysfunction. This mechanical support shows acceptable mortality and good long-term outcomes for early and late graft failure.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Transplantation Medicine
Background:
- Graft failure in pediatric cardiac transplantation necessitates mechanical support, commonly extracorporeal membrane oxygenation (ECMO).
- Evaluating the long-term outcomes of ECMO in pediatric cardiac transplant recipients is crucial for management strategies.
Purpose of the Study:
- To assess the long-term outcomes of extracorporeal membrane oxygenation (ECMO) support in pediatric cardiac transplant recipients.
- To determine the efficacy of ECMO for both early and late graft dysfunction after pediatric heart transplantation.
Main Methods:
- A retrospective review of 168 pediatric cardiac transplant patients from 1982 to 2002.
- Analysis of 20 patients (11.9%) who required mechanical support (ECMO) early or late post-transplantation.
Main Results:
- Fifteen patients received ECMO perioperatively for immediate or early graft dysfunction.
- Five patients received ECMO late (3 months to 7 years) for ventricular dysfunction.
- Successful decannulation and discharge occurred in 53% of perioperative ECMO patients and 60% of late ECMO patients.
Conclusions:
- Extracorporeal membrane oxygenation (ECMO) is a viable strategy for managing early and late graft dysfunction in pediatric cardiac transplant recipients.
- Mechanical circulatory support with ECMO demonstrates acceptable mortality rates and favorable long-term outcomes in this high-risk pediatric population.
Background:
Graft failure after cardiac transplantation in children can be managed acutely with mechanical support, most commonly extracorporeal membrane oxygenation (ECMO). The purpose of this study was to evaluation the long-term outcome of ECMO support early and late after pediatric cardiac transplantation.
Methods:
From February 1982 through October 2002, 168 patients underwent isolated cardiac transplantation. Twenty patients (11.9%) required mechanical support early or late after transplantation. Inpatient and outpatient records of these were reviewed.
Results:
Indication for transplantation was complex congenital heart disease in 12, cardiomyopathy in 7, and graft failure (retransplant) in 1. One patient was also on ECMO preoperatively. Fifteen patients required circulatory support immediately or shortly (less than 6 weeks) after transplantation. The remaining 5 patients were placed on ECMO for ventricular dysfunction late (3 months to 7 years) after transplantation. In the perioperative ECMO group, 8 (53%) were successfully decannulated and subsequently discharged. Three of 5 (60%) patients placed on ECMO late were successfully decannulated, 1 of whom died in hospital 10 days later and 2 of whom are still alive.
Conclusions:
Mechanical circulatory support using ECMO can be a useful strategy is the management of graft dysfunction after pediatric cardiac transplantation both early and late postoperatively. The mortality rate is acceptable in this very high risk group of patients and long-term outcome is good.