Abstract
Background: Cardiogenic shock (CS) is characterized by end-organ hypoperfusion resulting from low cardiac output. Venous-artery extracorporeal membrane oxygenation (VA-ECMO), is widely used in patients presenting with refractory cardiogenic shock. The decision to use VA-ECMO as a bridge to heart transplantation has become widely accepted as a short-term option. However, complications can develop within weeks, which makes it unsuitable for bridging to transplantation and even affects the prognosis.
Methods：Data were collected from 12 patients who received extracorporeal membrane oxygenation (ECMO) as a bridge to heart transplantation between October 2020 and October 2021. General perioperative characteristics, ECMO-related complications, and posttransplantation survival were summarized.
Results：The 12 patients were male, with an average age of 45.33 years and an average BMI of 22.87 kg/m2. The main primary diseases were myocardial infarction (7 cases), dilated cardiomyopathy (4 cases), and fulminant myocarditis (1 case); the average ECMO maintenance time before transplantation was 14.25 days, the longest preoperative maintenance time was 37 days, the overall ECMO perioperative survival rate was 75.00%, and the 30-day survival rate was 91.67%. The main complications in the perioperative period are gastrointestinal bleeding, distal limb ischemia of the perfusion tube and distal limb ischemia requiring fasciotomy during ECMO maintenance, bleeding after transplantation in the operative area requiring reoperation for bleeding, and poor healing at the ECMO cannulation insertion site.
Conclusion：ECMO as a bridge to heart transplantation is a feasible treatment option for patients with end-stage heart failure and refractory cardiogenic shock. We should be aware of the complications related to ECMO management.