EXTRACORPOREAL MEMBRANE-OXYGENATION IN THE PERIOPERATIVE PERIOD OF HEART-TRANSPLANTATION

Mechanical circulatory support is occasionally needed in the periopera tive period of heart transplantation. Between February and May 1995, t hree recipients of cardiac transplant at the National Taiwan Universit y Hospital required tile use of extracorporeal membrane oxygenation (E CMO) for temporary mechanical circulatory support in the perioperative period of heart transplantion. All three patients received ECMO throu gh 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, po ssibly due to ischemia. Patient 3 needed ECMO as a bridge to his first heart transplant after acute myocardial infarction complicated with c ardiogenic shock, and again as a bridge to retransplantation because o f acute failure of the fir-st cardiac transplant and finally for a tem porary circulatory support during rescue treatment for acute vascular rejection of the second cardiac transplant. All three patients were su ccessfully treated with ECMO without major complications. In conclusio n, ECMO provides excellent mechanical circulatory support for some sit uations in the perioperative period of heart transplantation.