HỖ TRỢ TUẦN HOÀN BẰNG ECMO TRONG GHÉP TIM: BÁO CÁO CA BỆNH VÀ TỔNG QUAN Y VĂN

Abstract

This case report describes the use of extracorporeal membrane oxygenation (ECMO) in the management of end-stage heart failure undergoing heart transplantation in contemporary clinical practice, particularly in a high-risk patient for primary graft dysfunction (PGD), in whom the optimal indication and timing of ECMO remain controversial. A 46-year-old man with ischemic cardiomyopathy and advanced heart failure with a left ventricular ejection fraction (EF) of 21% was admitted for worsening symptoms and listed for heart transplantation. After reperfusion, the graft showed markedly depressed systolic function with an EF of about 20% and hemodynamic instability despite optimized preload and vasopressor support. Veno-arterial ECMO (VA-ECMO) was initiated proactively in the operating room to maintain end-organ perfusion and limit multiorgan injury related to PGD. Postoperatively, the patient was managed in the intensive care unit with aggressive hemodynamic support, coagulation management, and daily echocardiographic monitoring. Graft function gradually improved, and VA-ECMO was successfully weaned on postoperative day 5, with subsequent stable recovery and hospital discharge. This case illustrates that early, planned VA-ECMO support can be an effective strategy to prevent and treat severe PGD, stabilize hemodynamics, and facilitate myocardial recovery and favorable short-term outcomes in carefully selected high-risk heart transplant recipients.