IMMEDIATE CARDIAC ALLOGRAFT FAILURE - ECMO VERSUS TOTAL ARTIFICIAL-HEART SUPPORT

Optimal support for immediate cardiac allograft failure is unknown. Wi th the introduction of heparin bonded extracorporeal membrane oxygenat ed circuits, prolonged cardiopulmonary support is possible. The author s report a case that involved 2 days of right atrial to ascending aort a extracorporeal membrane oxygenated support after immediate donor org an failure prevented the patient from exiting bypass. Continued deteri oration in cardiac function led to an attempt at conversion to a total artificial heart as a bridge to retransplant. However, this procedure resulted in transbronchial exsanguination and recipient death. The au topsy showed pulmonary thrombosis with infarction and hemorrhage. The authors recommend caution in the use of extracorporeal membrane oxygen ated support for patients with immediate and profound graft failure be cause of the increased risk of stasis thrombosis and pulmonary infarct ion due to sluggish pulmonary and left atrial blood flow. Instead, ins titution of total artificial heart or biventricular support may be pre ferable as the risks of thrombus and infarction are less.