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Eur J Cardiothorac Surg 2007;32:671-673. doi:10.1016/j.ejcts.2007.07.005
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Case reports

Right-left atrium by-pass as salvage treatment for graft failure after heart transplantation

Giorgio Arpesella, Elisa Mikus, Antonino Loforte*, Piero Maria Mikus

Heart and Lung Transplantation Program, Policlinico S.Orsola-Malpighi, Bologna University, Via Massarenti 9, 40138 Bologna, Italy

Received 14 March 2007; received in revised form 30 June 2007; accepted 2 July 2007.

* Corresponding author. Tel.: +39 051 6363361; fax: +39 051 345990. (Email: antonioloforte{at}yahoo.it).

Chronic functional pulmonary hypertension (FPH) secondary to end-stage cardiomyopathy constitutes a risk factor for graft right ventricular failure (RVF) after orthotopic heart transplantation (HTx). A novel form of mechanical assist circuit, the extracorporeal right to left atrium bypass (ECRLAB), has been proposed. Since 1998, at our institution, a total of six patients with FPH who experienced graft RVF after HTx, as ischemic end-stage cardiomyopathy, during the effort to wean from cardiopulmonary bypass, underwent ECRLAB support. There were five men and one woman with a mean age of 55 ± 3.5 years (49–59 years). The Jostra Rota Flow pump was used in five patients and the Bio-Medicus in one. Mean duration of support was 94.3 ± 17.5 h (75–126 h). All (100%) patients were successfully weaned from ECRLAB support. Hemodynamic parameters improved in all patients. Two patients died from cerebral haemorrhage. Four (66.6%) patients were successfully discharged home. ECRLAB could be proposed during HTx in patients with increased preoperative transpulmonary gradient to promote the functional adaptation of the graft and avoid graft RVF, until the decline of pulmonary resistances.

Key Words: Heart transplantation • Graft failure • Biatrial cannulation • Recovery




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Home page
 Eur. J. Cardiothorac. Surg.Home page
P. M. Mikus, E. Mikus, S. Martin-Suarez, N. Galie, A. Manes, S. Pastore, and G. Arpesella
Pulmonary endarterectomy: an alternative to circulatory arrest and deep hypothermia: mid-term results
Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 159 - 163.
[Abstract] [Full Text] [PDF]


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Copyright © 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier. All rights reserved.