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Early graft failure after heart transplantation: Circulatory assist versus retransplantation

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Artificial Heart 3

Summary

Early graft failure requiring mechanical circulatory support occurred in 12 of our first 257 patients following cardiac transplantation. Three patients had biventricular myocardial failure and were supported by means of extracorporeal membrane oxygenation (ECMO). Implantation of a right ventricular assist device (RVAD, n = 3) using a centrifugal pump alone or in combination with the intraaortic balloon pump (RVAD/IABP, n = 3) became necessary because of predominant right heart failure in six recipients. Pulsatile biventricular assist devices (BVAD, n = 3) were used in three instances. In case the patient could be stabilized on assist, cardiac retransplantation was considered. Whenever the patient demonstrated improving myocardial performance, weaning from the device rather than retransplantation was attempted. One patient each from the ECMO and the RVAD/IABP groups are long-term survivors after successful bridging to retransplantation. All patients in the RVAD group could be successfully weaned from the device but died later from infectious complications. Right ventricular failure after heart transplantation appears to be a reversible phenomenon which can be treated by temporary use of a RVAD. However, early retransplantation might be preferred as the treatment of choice for patients developing early graft failure.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Surgical Center, Hannover Medical School, D-3000, Hannover, Germany

    Hans Georg Borst

Authors
  1. Michael J. Jurmann
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  2. Axel Haverich
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  3. Hans-Joachim Schaefers
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  4. Thorsten Wahlers
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  5. Jochen Cremer
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  6. Hans Georg Borst
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Editor information

Editors and Affiliations

  1. Terumo Research and Development Center, 1500 Inokuchi, Nakai, Ashigarakami, Kanagawa, 259-01, Japan

    Tetsuzo Akutsu M.D., Ph.D. (Director) (Director)

  2. Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women’s Medical College, 8-1 Kawadacho, Shinjuku-ku, Tokyo, 162, Japan

    Hitoshi Koyanagi M.D. (Professor and Chairman) (Professor and Chairman)

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© 1991 Springer-Verlag Tokyo

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Jurmann, M.J., Haverich, A., Schaefers, HJ., Wahlers, T., Cremer, J., Borst, H.G. (1991). Early graft failure after heart transplantation: Circulatory assist versus retransplantation. In: Akutsu, T., et al. Artificial Heart 3. Springer, Tokyo. https://doi.org/10.1007/978-4-431-68126-7_33

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  • DOI: https://doi.org/10.1007/978-4-431-68126-7_33

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-68128-1

  • Online ISBN: 978-4-431-68126-7

  • eBook Packages: Springer Book Archive

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