Extracorporeal membrane oxygenation in the perioperative period of heart transplantation.

Mechanical circulatory support is occasionally needed in the perioperative period of heart transplantation. Between February and May 1995, three recipients of cardiac transplant at the National Taiwan University Hospital required the use of extracorporeal membrane oxygenation (ECMO) for temporary mechanical circulatory support in the perioperative period of heart transplantation. All three patients received ECMO through the percutaneous femoral veno-arterial route. The ECMO device has a heparin-bound Carmeda Bioactive surface and centrifugal pump. Patient 1 needed ECMO for treatment of a postoperative pulmonary hypertensive crisis. Patient 2 needed ECMO for early cardiac allograft failure, possibly due to ischemia. Patient 3 needed ECMO as a bridge to his first heart transplant after acute myocardial infarction complicated with cardiogenic shock, and again as a bridge to retransplantation because of acute failure of the first cardiac transplant and finally for a temporary circulatory support during rescue treatment for acute vascular rejection of the second cardiac transplant. All three patients were successfully treated with ECMO without major complications. In conclusion, ECMO provides excellent mechanical circulatory support for some situations in the perioperative period of heart transplantation.