Primary graft failure following cardiac transplantation-our experience over 18 months

摘要

Background and objectives Primary graft failure (PGF) remains the strongest determinant of perioperative mortality after heart transplantation (HT). It manifests as a severe systolic dysfunction of the graft-left, right, or biventricular-requiring high inotropic doses with or without mechanical circulatory support. PGF was defined by four criteria reflecting significant myocardial dysfunction, severe hemodynamic impairment, and early onset after heart transplantation, and absence of secondary causes of graft dysfunction. This study looks at the incidence and outcomes of PGF at our center after we started heart transplant 18 months ago. Methods Eleven orthotopic heart transplants were done at this center from May 2013 till November 2014. All patients were included in the study. All transplants were done in the same standard biatrial technique and by the same surgeon. PGF was defined as echocardiographic finding of dysfunction of either or both ventricles; cardiogenic shock lasting more than 1 h in the form of systolic blood pressure less than 90 despite adequate filling pressures of 15 mm CVP; or requirement of mechanical circulatory devices like IABP, ECMO, or VAD. Secondary causes of PGF like hyper acute rejection or cardiac tamponade were excluded. Results Four patients out of 11 had PGF (36 ). One had isolated LV dysfunction in the form of sluggish LV on echocardiogram requiring IABP support for 48 h. Three patients required ECMO in the immediate post operative period and only one could be successfully weaned off. Mortality was two patients (18 ). Conclusions PGF is the lone cause of mortality in our series and results are improving with increasing understanding of the causes and better and judicious use of mechanical circulatory devices.