TABLE 3.

Management of perioperative acute graft failure, complications and outcome

	1	2	3	4	5	6	7	8	9
Etiology of graft failure	Primary graft failure	Primary graft failure	Primary graft failure	Primary graft failure	Particulate coronary embolus	Hyperacute rejection	Right heart failure due to pulmonary hypertension	Right heart failure due to hypertension	Accelerated acute rejection
Type of support after heart transplant	IABP + inotropes; arrest in operating room (TAH inserted)	IABP + inotropes + LVAD	Several hours on cardio-pulmonary bypass	Several hours on cardiopulmonary bypass, ECLS for 24 h, then RVAD (BioMedicus* RVAD for 3 days, then Thoratec† RVAD for 19 days	IABP + inotropes + Thoratec LVAD	Intropes, then TAH after first heart transplant; inotropes and extended reperfusion on cardiopulmonary bypass heart heart transplant	Inotrope (graft failed within a few hours post-operatively)	Inotropes	First heart failed 18 h postoperatively, requiring inotropes + IABP + TAH
Outcome	Retransplant; alive	Died intra-operatively	Died intra-operatively	Died of MOF 23 days post-transplant	Died intra-operatively	Died intra-operatively after second transplant	Died 2 days post-transplant	Died 2 months later, after patient pulled out her tracheostomy tube	Retransplant but died two months later of fulminant pneumonia and MOF
Renal	Acute tubular necrosis; recovered			Acute tubular necrosis (dialysis)			Acute renal failure	Dialysis, but kidneys recovered	Acute renal failure
Pulmonary	Pneumonia			Pneumonia				Tracheostomy	Fulminant cytomegalovirus pneumonia
Stroke						While on a TAH		Recent large cerebral infarct on autopsy
Bleeding	Reopened			Chest left open for 3 days
Sepsis				Septicemia				Yes	Yes

^*Medtronic BioMedicus, USA;

^†Thoratec Laboratories Corporation, USA. ECLS Extracorporeal life support; IABP Intra-aortic balloon pump; LVAD Left ventricular assist device; MOF Multiple organ failure; RVAD Right ventricular assist device; TAH Total artificial heart