[Right ventricular assistance using a centrifugal pump after heart transplantation]

A case of right ventricular assistance required after emergency heart transplantation is reported. The patient was a 62 year-old man with terminal congestive heart failure due to ischaemic cardiomyopathy. Preoperatively, this patient had a cardiac index of 1.93 1.min-1.m-2, moderate pulmonary hypertension (mean Ppa: 34 mmHg) and pulmonary arteriolar resistances at 440 dyn.s.cm-5; clinical examination revealed pulmonary oedema, cardiac liver and oliguria with renal failure. Cardio-pulmonary bypass lasted 145 min, including 50 min of assistance after graft reperfusion. Despite postoperative dopamine and dobutamine treatment, oliguria and central venous pressure increased, and higher doses of catecholamines (adrenaline, noradrenaline) and pulmonary intraarterial prostaglandin E1 infusions were required. Despite these agents and haemofiltration, mechanical assistance was needed and a centrifugal pump set up. Diuresis and haemodynamic parameters improved. The patient was weaned from this assistance after 102 h. A satisfactory haemodynamic status was then maintained, but still required 1.4 micrograms.kg-1.min-1 noradrenaline and 0.02 microgram.kg-1.min-1 prostaglandin E1. Six days later, the patient was weaned from the ventilator, but he rapidly developed fatal aspergillus septicaemia. This case demonstrates that temporary mechanical assistance can be useful for treating right ventricular failure occurring after transplantation.