To summarize the single-center experience of extracorporeal membrane oxygenation (ECMO) application in heart transplantation recipients during perioperative period.

The clinical data of 19 recipients who underwent heart transplantation and received ECMO assist during the perioperative period at the Chinese People′s Liberation Army No.924 Hospital from June 2012 to April 2018 were retrospectively analyzed. Among them, 15 recipients were male and 4 recipients were female, with an average age of (42±8) years and an average weight of (58±8) kg. The primary diseases included 13 cases of dilated cardiomyopathy, 2 of ischemic cardiomyopathy, 2 of valvular cardiomyopathy, 1 of arrhythmogenic right ventricular cardiomyopathy and 1 of restrictive cardiomyopathy. The average preoperative left ventricular ejection fraction was (24±7)%, and the average pulmonary artery systolic pressure was (48±7) mmHg. There were 18 male donors and 1 female donor. The body weight difference between the donor and recipient was within ±20%. The cold ischemia time of the donor heart was (92±25) min.

Among the 19 recipients, 1 received ECMO before transplantation, 15 received ECMO during transplantation and 3 received ECMO after transplantation. The ECMO bypass time was (73±36) h. Five recipients could not be withdrawn from the ECMO due to lack of improvement in cardiac function and eventually gave up the treatment, and 2 of them had gastrointestinal bleeding and were forced to withdraw from the ECMO. The remaining 14 cases were successfully withdrawn from the ECMO, 3 of them died of infection, acute rejection and multiple organ failure after weaning. Complications included 5 cases of membrane lung leakage, 8 of bedside thoracotomy to stop bleeding, 2 of lower limb ischemia, 13 of acute kidney injury, 2 of acute liver failure, 4 of gastrointestinal bleeding, and 1 of lung infection. Six recipients were combined with intra-aortic balloon counterpulsation.

ECMO has a good effect in the perioperative period of heart transplantation and can reduce the mortality of patients with severe heart transplantation. Early active application is the key to its success.