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Five-year survival after post-cardiotomy veno-arterial extracorporeal membrane oxygenation
F. Biancari, A. Perrotti, VG. Ruggieri, G. Mariscalco, M. Dalén, AM. Dell'Aquila, K. Jónsson, S. Ragnarsson, D. Di Perna, K. Bounader, G. Gatti, T. Juvonen, K. Alkhamees, H. Yusuff, A. Loforte, A. Lechiancole, S. Chocron, M. Pol, C. Spadaccio, M....
Language English Country Great Britain
Document type Journal Article
- MeSH
- Adult MeSH
- Cardiac Surgical Procedures * MeSH
- Shock, Cardiogenic etiology therapy MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation * MeSH
- Heart-Assist Devices * MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Heart Transplantation * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
AIMS : Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support for post-cardiotomy cardiogenic shock (PCS) after adult cardiac surgery is associated with satisfactory hospital survival. However, data on long-term survival of these critically ill patients are scarce. METHODS AND RESULTS: Between January 2010 and March 2018, 665 consecutive patients received VA-ECMO for PCS at 17 cardiac surgery centres and herein we evaluated their 5-year survival. The mean follow-up of this cohort was 1.7 ± 2.7 years (for hospital survivors, 4.6 ± 2.5 years). In this cohort, 240 (36.1%) patients survived to hospital discharge. Five-year survival of all patients was 27.7%. The PC-ECMO score was predictive of 5-year survival in these patients (0 point, 50.9%; 1 point, 44.9%; 2 points, 40.0%; 3 points, 34.7%; 4 points, 21.0%; 5 points, 17.6%; ≥6 points, 10.7%; P < 0.0001). Age was among factors independently associated with late survival, patients >70 years old having a remarkably poor 5-year survival (<60 years: 39.2%; 60-69 years: 29.9%; 70-79 years: 12.3%; ≥80 years: 13.0%, P < 0.0001). Implantation of a ventricular assist device or heart transplant was performed in 3.2% of patients and their 5-year survival was 42.9% (for heart transplant, 63.6%). CONCLUSION : Veno-arterial extracorporeal membrane oxygenation for PCS is associated with satisfactory 5-year survival in young patients without critical pre-ECMO conditions. The use of VA-ECMO for PCS in patients >70 years should be considered only after a judicious scrutiny of patient's life expectancy. Future studies should evaluate whether satisfactory mid-term survival of these patients translates into a good functional outcome. TRIAL REGISTRATION: Clinicaltrials.gov-NCT03508505.
Cardiothoracic Department University Hospital of Udine Udine Italy
Department of Cardiac Surgery Karolinska Institutet Karolinska University Hospital Stockholm Sweden
Department of Cardiac Surgery Sahlgrenska University Hospital Gothenburg Sweden
Department of Cardiothoracic Surgery Golden Jubilee National Hospital Glasgow UK
Department of Cardiothoracic Surgery Münster University Hospital Münster Germany
Department of Cardiothoracic Surgery University of Lund Lund Sweden
Department of Cardiovascular Surgery Ziekenhuis Oost Limburg Genk Belgium
Department of Surgery University of Turku Turku Finland
Department of Thoracic and Cardio Vascular Surgery University Hospital Jean Minjoz Besançon France
Division of Cardiac Surgery Ospedali Riuniti Trieste Italy
Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital Rennes France
Division of Cardiothoracic and Vascular Surgery Robert Debré University Hospital Reims France
Institute of Clinical and Experimental Medicine Prague Czech Republic
References provided by Crossref.org
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- $a AIMS : Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support for post-cardiotomy cardiogenic shock (PCS) after adult cardiac surgery is associated with satisfactory hospital survival. However, data on long-term survival of these critically ill patients are scarce. METHODS AND RESULTS: Between January 2010 and March 2018, 665 consecutive patients received VA-ECMO for PCS at 17 cardiac surgery centres and herein we evaluated their 5-year survival. The mean follow-up of this cohort was 1.7 ± 2.7 years (for hospital survivors, 4.6 ± 2.5 years). In this cohort, 240 (36.1%) patients survived to hospital discharge. Five-year survival of all patients was 27.7%. The PC-ECMO score was predictive of 5-year survival in these patients (0 point, 50.9%; 1 point, 44.9%; 2 points, 40.0%; 3 points, 34.7%; 4 points, 21.0%; 5 points, 17.6%; ≥6 points, 10.7%; P < 0.0001). Age was among factors independently associated with late survival, patients >70 years old having a remarkably poor 5-year survival (<60 years: 39.2%; 60-69 years: 29.9%; 70-79 years: 12.3%; ≥80 years: 13.0%, P < 0.0001). Implantation of a ventricular assist device or heart transplant was performed in 3.2% of patients and their 5-year survival was 42.9% (for heart transplant, 63.6%). CONCLUSION : Veno-arterial extracorporeal membrane oxygenation for PCS is associated with satisfactory 5-year survival in young patients without critical pre-ECMO conditions. The use of VA-ECMO for PCS in patients >70 years should be considered only after a judicious scrutiny of patient's life expectancy. Future studies should evaluate whether satisfactory mid-term survival of these patients translates into a good functional outcome. TRIAL REGISTRATION: Clinicaltrials.gov-NCT03508505.
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