Temporary Circulatory Support as a Bridge to Retransplantation

Despite the significant advances in recipient selection criteria for cardiac transplantation, organ preservation techniques, novel immunosuppressive agents, and care following transplantation, early and late graft failures are still high in heart transplant recipients. Several therapeutic interventions have been described for these cases; however, the use of ventricular assist devices and cardiac retransplantation still remain as the definite treatment for this subgroup of patients. We describe a case of refractory cardiogenic shock due to acute myocardial infarction in a patient with a history of heart transplantation that was consecutively treated with intraaortic balloon pump and myocardial revascularization surgery. Despite therapy, the patient remained in refractory cardiogenic shock with multiple organ failure and received Levitronix CentriMag as a bridge to retransplantation. After 21 days under circulatory support, multiple organ failure reverted and the patient underwent orthotopic heart transplantation.A pesar de las mejoras significativas en los criterios de selección de los receptores de trasplante cardíaco, la mejor preservación de los órganos, las nuevas terapéuticas inmunosupresoras y los avances en el cuidado postrasplante, los pacientes que recibieron un trasplante cardíaco continúan con una tasa alta de falla temprana y tardía del injerto. Se han propuesto múltiples intervenciones terapéuticas para estos casos; sin embargo, los dispositivos de asistencia ventricular y el retrasplante cardíaco permanecen como el tratamiento definitivo para este subgrupo de pacientes