Mechanical Circulatory Support - The FULCRUM of Heart Transplant Unit

Anvay Mulay, Sandeeep Sinha, Neeraj Kamat, Satish Javali, Ashish Gaur

Fortis hospital , mumbai, Mumbai, India

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–A

Abstract

Mechanical Circulatory Support - The FULCRUM of heart transplant unit.

Neeraj K, Ashish G, Sandeep S , Satish J, Anvay Mulay

INTRODUCTION:

ECMO/VAD is being increasingly considered as bridge to transplant and decreasing PVR in high PVR group.In this article we would like to review our experience on ECMO and VADs.

MATERIALS AND METHODS:

A Retrospective study of the role of ventricle assist device/ECMO in heart transplant.

RESULTS:

A total of 66 transplants (64 heart, 1 heart-lung & 1 bilateral lung transplant) were carried out till date of whom 21 needed some form of assist device

IABP statistics:

IABP was put in 4 patients of heart failure.

ECMO statistics:

Out of 21 patients, ECMO was instituted in 16 patients of which 9 patients were put on ECMO as bridge to transplant .5 patients expired on ECMO and 4patients successfully underwent heart transplant however 1 was switched from ECMO to temporary VAD in view of ensuing pulmonary oedema.

ECPR was done in 1 patient who underwent cardiac transplant.

7 patients received ECMO post transplant of whom 4 patients went on V-A ECMO in the immediate post-transplant period because of poor Right ventricular function secondary to high PVR or rejection. Only 2 out of the 4 ECMOs could be weaned off slowly after his Right ventricle improved in 5 days. 1 V-A ECMO was put in post-transplant 1 year for Acute Rejection for Cardiogenic shock.

LVAD/RVAD statistics:

A total of 3 LVAD (1 permanent & 2 temporary) and 1 RVAD (post LVAD) insertion.

CONCLUSION:

In this short experience of 2 years in heart failure program we have experienced mixed results and with every patient our understanding of the need and role for Mechanical Circulatory Support is increasing and hence is helping in improvising our results.