Outcome of Veno-Arterial Extracorporeal Membrane Oxygenation for Patients Undergoing Valvular Surgery

Abstract

BackgroundWe evaluated retrospectively the early and midterm results of using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support in patients undergoing valvular surgery.MethodsA total of 87 patients undergoing valvular surgery received VA-ECMO due to refractory postcardiotomy cardiogenic shock (PCS), who were eligible for inclusion were enrolled in this study. Preoperative, perioperative, and postoperative variables were assessed and analyzed for possible associations with mortality in hospital and after discharge.ResultsThe mean age, additive EuroSCORE, and left ventricular ejection fraction (LVEF) for all patients was 65±7 years, 6.1±1.9 points, and 46% ±12%, respectively. The mean duration of VA-ECMO support was 61±37 hours. Intra-aortic balloon pumps (IABP) were implanted in 47.1% of patients. Weaning from VA-ECMO was successful in 59% of patients, and 49% were discharged. Multivariate analysis revealed that being >65 years old (odds ratio [OR], 2.75), receiving postoperative renal replacement treatment (OR, 2.47), having a peak lactate level ≥12 mmol L–1 (OR, 2.18), and receiving VA-ECMO for >60 hours (OR, 3.2) were independent predictors of in-hospital mortality. IABP support (OR, 0.46) was protective. In addition, persistent heart failure with an LVEF <40% was an independent predictor of mortality after discharge.ConclusionsVA-ECMO is an acceptable technique for the treatment of PCS in patients undergoing valvular surgery, who would otherwise die. It is justified by the good long-term outcomes of hospital survivors, but the use of VA-ECMO must be decided on an individual risk profile basis because of high morbidity and mortality rates.

Veno‐Arterial Extracorporeal Membrane Oxygenation Support in Patients Undergoing Aortic Surgery

“…The clinical criteria for PCS include systolic arterial pressure less than 80 mm Hg, increased central venous pressure greater than 12 mm Hg, signs of end-organ failure (urine <0.5 mL/kg), and metabolic acidosis (pH <7.30, lactate level >3.0 mmol/L) despite optimized supportive measures, such as an intra-aortic balloon pump (IABP), inotropes, nitric oxide, and phosphodiesterase inhibitors (11). Cases of adult patients undergoing aortic surgery who received VA-ECMO support to treat refractory PCS were included.…”

Cardiopulmonary bypass and intra‐aortic balloon pump use is associated with higher short and long term mortality after transcatheter aortic valve replacement: A PARTNER trial substudy

“…Circulatory support (CS) with the use of an intra‐aortic balloon pump (IABP) or cardiopulmonary bypass (CBP) has been employed in both high‐risk percutaneous coronary interventions and as bridging devices to high risk cardiac surgeries, such as left ventricular assist device implantation or coronary artery bypass. However, there is conflicting data as to whether the peri‐procedural use of circulatory support conveys a mortality advantage in these settings . Similarly, although pre‐emptive CS may reduce the procedural risk for TAVR, the risks and outcomes with this strategy are unknown.…”

Nouveautés dans les indications de l’ECMO veino-artérielle périphérique

“…Il survient chez 0,5 % à 2,9 % des patients nécessitant une circulation extracorporelle (CEC) [24][25][26][27]. Le recours à l'ECMO-VAP dans cette indication repose sur la capacité de récupération supposée du myocarde sidéré par la chirurgie cardiaque.…”

“…Une étude récente chinoise incluant 87 malades (âge moyen = 65 +/-7 ans), implantés d'une ECMO-VAP après une chirurgie valvulaire rapportait de meilleurs résultats [26]. Cinquante-neuf pour cent des patients ont pu être sevrés de l'ECMO et 49 % ont pu regagner le domicile après 43 +/-12 jours d'hospitalisation.…”

“…Quatre malades ont dû être transplantés en raison d'une absence de récupération et sont sortis vivants de l'hôpital. Les facteurs prédictifs indépendants en analyse multivariée de mortalité en réanimation étaient un SAPS II ≥ 56 (OR : 10,23 ; IC95 % : 1,75-59,69) et une troponine à l'admission ≥ 12 µg/L (OR : 7,49 ; IC95 % : 1, [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]82).…”