Inferior vena cava stenosis after heart transplant: a rare cause of venoarterial extracorporeal membrane oxygenation weaning failure

The discontinuation of venoarterial extracorporeal membrane oxygenation (VA ECMO) is a critical step in patient recovery. To reduce risks, weaning trials must be performed to buttress this important decision. However, a successful weaning trial does not preclude the possibility of complications. Here, we report a case of sudden multiple organ failure in a heart transplant patient, occurring after a successful ECMO weaning trial. We finally diagnosed a rare post-surgical complication of bicaval orthotopic heart transplantation, a severe stenosis of the inferior vena cava (IVC) that had been masked by the post-operative ECMO. Our case report should serve as a cautionary tale: it may be of interest to add a search for complications at the vascular anastomoses to the weaning trial procedure and to keep an eye out for them in the following days