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Ann Thorac Surg 2004;78:1644-1649
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Extracorporeal Membrane Oxygenation is Superior to Right Ventricular Assist Device for Acute Right Ventricular Failure After Heart Transplantation

Shahrokh Taghavi, MDa,*, Andreas Zuckermann, MDa, Jan Ankersmit, MDa, Georg Wieselthaler, MDa, Angela Rajek, MDb, Günther Laufer, MDa, Ernst Wolner, MDa, Michael Grimm, MDa

a Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
b Department of Cardiothoracic Anesthesiology, University of Vienna, Vienna, Austria

Accepted for publication April 20, 2004.

* Address reprint requests to Dr Taghavi, Department of Cardiothoracic Surgery, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
taghavis{at}hotmail.com

BACKGROUND: Acute right ventricular failure after heart transplantation is a life-threatening condition, and sometimes the use of mechanical circulatory support is inevitable. The aim of this retrospective study was to investigate the effectiveness of two different mechanical circulatory support systems for this indication.

METHODS: From 1984 to 2003, 28 heart transplant recipients exhibited right ventricular failure resistant to drug therapy. Right ventricular assist device (n = 15) or extracorporeal membrane oxygenation (n = 13) was implanted to support the failing heart.

RESULTS: Overall in-hospital survival was 43%. In the right ventricular assist device group, only 2 patients (13%) could be weaned from mechanical circulatory support compared with 10 patients (77%) in the extracorporeal membrane oxygenation group (p = 0.001). Retransplantation was necessary in 6 patients in the right ventricular assist device group and in 1 patient in the extracorporeal membrane oxygenation group (p = 0.049). There was no difference in patient survival between groups, but graft survival was significantly better in the extracorporeal membrane oxygenation group (p = 0.005).

CONCLUSIONS: In view of these results, extracorporeal membrane oxygenation seems to be the better option as mechanical circulatory support for right ventricular failure in heart transplantation.




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