Early graft failure after heart transplantation: management by extracorporeal circulatory assist and retransplantation.

Early graft failure represents a serious complication after orthotopic heart transplantation. Various modes of extracorporeal mechanical circulatory assistance, however, allow for "bridging" to heart retransplantation in these instances. We report a case of bridging to heart transplantation by means of intraaortic balloon counterpulsation. After transplantation a right ventricular assist device was required because of early graft failure while the intraaortic balloon pump was left in place. A retransplantation was successful, and 13 months after the operation the patient is in New York Heart Association functional class I. The cause of early graft failure, especially the tendency toward failure of the right ventricle, is not well understood and seems to be multifactorial, which suggests that an elevated pulmonary vascular resistance in the recipient possibly represents a considerable risk factor. Bridging to heart retransplantation with the use of extracorporeal blood pumps can be performed effectively.