Related Experiment Video
Updated: Oct 9, 2025
Mouse Heterotopic Cervical Cardiac Transplantation Utilizing Vascular Cuffs
Published on: June 23, 2022
Multimodal temporary mechanically circulatory assistance for primary graft dysfunction after heart transplantation: a
Moritz B Immohr1, Artur Lichtenberg1, Payam Akhyari1
1Department of Cardiac Surgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
Background:
Primary graft dysfunction (PGD) remains a serious complication after heart transplantation (HTx). Although there is no therapy available, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may be a bailout strategy in selected cases. Especially in patients with severe biventricular failure, chances of survival remain poor.
Case Summary:
Here, we report a case of a 56-year-old patient suffering from severe PGD after HTx with biventricular failure (ejection fraction < 20%) who was successfully bridged to recovery of the donor graft by temporary multimodal mechanically circulatory assistance by combining both, VA-ECMO and a microaxial pump (Impella®, Abiomed, Inc., Danvers, MA, USA), a concept also referred as ECMELLA. During ECMELLA support, the patient experienced multiple severe thoracic bleeding complications with need for four re-thoracotomies and temporary open chest situation. Nevertheless, ventricular function recovered and the patient could be weaned from mechanical circulatory support after 12 days. During follow-up, the patient recovered and was successfully discharged. After the following rehabilitation, the patient now shows no persistent signs of heart failure with normal biventricular function of the cardiac graft.
Discussion:
ECMELLA may offer a therapeutic option for patients with severe PGD after HTx. Special awareness and further studies addressing targeted anticoagulation strategies for patients on dual-mechanical support are needed to diminish the incidence of bleeding complications.
