Fausto Biancari1, Magnus Dalén2, Andrea Perrotti3, Antonio Fiore4, Daniel Reichart5, Sorosh Khodabandeh2, Helmut Gulbins5, Svante Zipfel5, Mosab Al Shakaki6, Henryk Welp6, Antonella Vezzani7, Tiziano Gherli7, Jaakko Lommi8, Tatu Juvonen8, Peter Svenarud2, Sidney Chocron3, Jean Philippe Verhoye9, Karl Bounader9, Giuseppe Gatti10, Marco Gabrielli10, Matteo Saccocci11, Eeva-Maija Kinnunen12, Francesco Onorati13, Giuseppe Santarpino14, Khalid Alkhamees15, Vito G Ruggieri9, Angelo M Dell'Aquila6. 1. Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: fausto.biancari@oulu.fi. 2. Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. 3. Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France. 4. Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France. 5. Hamburg University Heart Center, Hamburg, Germany. 6. Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany. 7. Division of Cardiac Surgery, University of Parma, Parma, Italy. 8. Cardiac Surgery, Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland. 9. Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France. 10. Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy. 11. Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Milan, Italy. 12. Department of Surgery, Oulu University Hospital, Oulu, Finland. 13. Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy. 14. Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany. 15. Saud Al-Babtain Cardiac Center, Ministry of Health, Dammam, Saudi Arabia.
Abstract
BACKGROUND: The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce. METHODS: We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study. RESULTS: VA-ECMO was employed in 148 patients after CABG for median of 5.0days (mean, 6.4, SD 5.6days). In-hospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I2 8.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p=0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p=0.004, OR 0.98, 95% CI 0.97-0.99), pulmonary disease (p=0.018, OR 4.42, 95% CI 1.29-15.15) and pre-VA-ECMO blood lactate (p=0.015, OR 1.10, 95% CI 1.02-1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively. CONCLUSIONS: One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.
BACKGROUND: The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce. METHODS: We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study. RESULTS:VA-ECMO was employed in 148 patients after CABG for median of 5.0days (mean, 6.4, SD 5.6days). In-hospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I2 8.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p=0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p=0.004, OR 0.98, 95% CI 0.97-0.99), pulmonary disease (p=0.018, OR 4.42, 95% CI 1.29-15.15) and pre-VA-ECMO blood lactate (p=0.015, OR 1.10, 95% CI 1.02-1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively. CONCLUSIONS: One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.
Authors: Paolo Meani; Matteo Matteucci; Federica Jiritano; Dario Fina; Francesco Panzeri; Giuseppe M Raffa; Mariusz Kowalewski; Nuccia Morici; Giovanna Viola; Alice Sacco; Fabrizio Oliva; Amal Alyousif; Sam Heuts; Martijn Gilbers; Rick Schreurs; Jos Maessen; Roberto Lorusso Journal: Ann Cardiothorac Surg Date: 2019-01
Authors: Mariusz Kowalewski; Pietro Giorgio Malvindi; Kamil Zieliński; Gennaro Martucci; Artur Słomka; Piotr Suwalski; Roberto Lorusso; Paolo Meani; Antonio Arcadipane; Michele Pilato; Giuseppe Maria Raffa Journal: J Clin Med Date: 2020-04-07 Impact factor: 4.241
Authors: Ioannis Mastoris; Joseph E Tonna; Jinxiang Hu; Andrew J Sauer; Nicholas A Haglund; Peter Rycus; Yu Wang; William J Wallisch; Travis O Abicht; Matthew R Danter; Ryan J Tedford; James C Fang; Zubair Shah Journal: Circ Heart Fail Date: 2021-12-09 Impact factor: 8.790