Preoperative Venoarterial Extracorporeal Membrane Oxygenation Slashes Risk Score in Advanced Structural Heart Disease

Watkins, A. Claire; Maassel, Nathan; Ghoreishi, Mehrdad; Dawood, Murtaza Y.; Pham, Si M.; Kon, Zachary N.; Taylor, Bradley S.; Griffith, Bartley P.; Gammie, James S.

doi:10.1016/j.athoracsur.2018.07.038

Cited by 25 publications

(21 citation statements)

References 38 publications

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“… 14 , 16 , 29 The use of preoperative MCS devices in VSR represents a relatively recent approach, proposed for patients with more critical illness to improve hemodynamics and delay repair until the patient is in better condition. 6 , 7 , 26 , 29 , 31 , 32 , 33 Indeed, preoperative MCS adoption is sometimes discouraged by the potential interactions of MCS- and VSR-related pathophysiology, which can be anticipated and carefully managed with a patient-tailored, preimplantation analysis. 7 , 34 , 35 …”

Section: Discussionmentioning

confidence: 99%

“…Similar to other reports, we found that the time from VSR occurrence to surgery was significantly shorter for patients who died, reinforcing the association between early intervention and higher mortality and potentially highlighting the need for a paradigm shift in the management of patients with VSR ( Figure 1 B). 6 , 15 , 26 , 29 , 30 , 31 , 35 Timing from AMI to VSR and from VSR to surgery were not included in the multivariate analysis because approximately 30% of patients were missing these data; therefore, we could not perform further between-group comparisons. However, it is reasonable to suppose that the evidence provided by such a difference is strong enough to represent a significant result.…”

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Postinfarction Ventricular Septal Rupture

et al. 2021

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IMPORTANCE Ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction associated with high mortality despite prompt treatment. Surgery represents the standard of care; however, only small single-center series or national registries are usually available in literature, whereas international multicenter investigations have been poorly carried out, therefore limiting the evidence on this topic. OBJECTIVESTo assess the clinical characteristics and early outcomes for patients who received surgery for postinfarction VSR and to identify factors independently associated with mortality. DESIGN, SETTING, AND PARTICIPANTS The Mechanical Complications of Acute Myocardial Infarction: an International Multicenter Cohort (CAUTION) Study is a retrospective multicenter international cohort study that includes patients who were treated surgically for mechanical complications of acute myocardial infarction. The study was conducted from January 2001 to December 2019 at 26 different centers worldwide among 475 consecutive patients who underwent surgery for postinfarction VSR. EXPOSURES Surgical treatment of postinfarction VSR, independent of the technique, alone or combined with other procedures (eg, coronary artery bypass grafting). MAIN OUTCOMES AND MEASURESThe primary outcome was early mortality; secondary outcomes were postoperative complications. RESULTSOf the 475 patients included in the study, 290 (61.1%) were men, with a mean (SD) age of 68.5 (10.1) years. Cardiogenic shock was present in 213 patients (44.8%). Emergent or salvage surgery was performed in 212 cases (44.6%). The early mortality rate was 40.4% (192 patients), and it did not improve during the nearly 20 years considered for the study (median [IQR] yearly mortality, 41.7% [32.6%-50.0%]). Low cardiac output syndrome and multiorgan failure were the most common causes of death (low cardiac output syndrome, 70 [36.5%]; multiorgan failure, 53 [27.6%]). Recurrent VSR occurred in 59 participants (12.4%) but was not associated with mortality. Cardiogenic shock (survived: 95 [33.6%]; died, 118 [61.5%]; P < .001) and early surgery (time to surgery Ն7 days, survived: 105 [57.4%]; died, 47 [35.1%]; P < .001) were associated with lower survival. At multivariate analysis, older age (odds ratio [

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Postinfarction Ventricular Septal Rupture

et al. 2021

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“…Implementation of a strategy of early diagnosis and treatment helps most children to be in a stable preoperative state and significantly reduces the incidence of preoperative acidosis. At the same time, as in previous studies (12,13), we actively tried to use preoperative extracorporeal membrane oxygenation (ECMO) to stabilize the patient's condition prior to surgery, thereby reducing the need for salvage emergency operations. Second, the utilization rate of DHCA declined in the second experimental period compared to the first experimental period (12.0 vs. 30.8%).…”

Section: Mortalitymentioning

confidence: 99%

The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center

Qiu

Liu

et al. 2021

Front. Cardiovasc. Med.

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Background: Recent developments in surgical techniques and hospital care have led to improved outcomes following repair of total anomalous pulmonary venous connection (TAPVC). However, surgical repair of neonatal TAPVC remains associated with a high risk of postoperative mortality and pulmonary venous obstruction (PVO). We conducted this retrospective study to identify risk factors associated with surgical outcomes in the neonatal population.Methods: A retrospective review was conducted for all 127 neonates who underwent operations for isolated TAPVC from January 2009 to January 2019.Results: Preoperative PVO occurred in 33 (26.0%) of the 127 patients. Fifty patients (39.4%) required tracheal intubation before the operation. Twenty-three patients (18.1%) underwent emergency surgery. There were 11 (8.7%) early deaths. Significant risk factors were prolonged cardiopulmonary bypass (CPB) time (p = 0.013) and increased postoperative central venous pressure (CVP, p = 0.036). There were 5 (4.3%) late deaths within 1 year of repair. The risk factors for overall death were preoperative acidosis (p = 0.001), prolonged CPB time (p < 0.001) and increased postoperative CVP (p = 0.007). In particular, mortality was significantly higher (p = 0.007) with a postoperative CVP > 8 mmHg. With an increase in use of sutureless techniques (p = 0.001) and decrease in deep hypothermic circulatory arrest (p = 0.009) over the past 5 years, postoperative mortality greatly decreased (21.2%: 6.7%, p = 0.016). Postoperative PVO occurred in 15 patients (11.8%). Risk factors were mixed TAPVC (p = 0.037), preoperative acidosis (p = 0.001) and prolonged CPB time (p = 0.006).Conclusion: Although postoperative mortality of neonatal TAPVC has dropped to 6.7% over the past 5 years, it is still relatively high. Risk factors for postoperative death include preoperative acidosis, prolonged CPB time and increased postoperative CVP. Mortality was significantly higher for neonates with an average CVP > 8 mmHg 24 h after surgery.

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“…36 Likewise, TandemHeart (Pittsburgh, PA) or peripheral ECMO can be used as a bridge to definitive therapy. 37,38 Positive pressure ventilation should be used with caution, as the reduction in preload that occurs may not be tolerated hemodynamically. 21…”

Section: Aortic Valve Emergenciesmentioning

confidence: 99%

Structural Heart Disease Emergencies

Jentzer

Ternus

Eleid

et al. 2020

J Intensive Care Med

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Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underlying SHD lesion. Patients with chronic SHD lesions which deteriorate due to intercurrent illness (eg, infection or arrhythmia) may not require urgent intervention, whereas patients with an acute SHD lesion often require definitive therapy. Medical stabilization prior to definitive intervention differs substantially between stenotic lesions (aortic stenosis, mitral stenosis, left ventricular outflow tract obstruction) and regurgitant lesions (aortic regurgitation, mitral regurgitation, ventricular septal defect). Patients with regurgitant lesions typically require aggressive afterload reduction and inotropic support, whereas patients with stenotic lesions may paradoxically require β-blockade and vasoconstrictors. Emergent cardiac surgery for patients with decompensated heart failure or cardiogenic shock carries a substantial mortality risk but may be necessary for patients who are not eligible for catheter-based percutaneous SHD intervention. This review explores initial medical stabilization and subsequent definitive therapy for patients with SHD emergencies.

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Preoperative Venoarterial Extracorporeal Membrane Oxygenation Slashes Risk Score in Advanced Structural Heart Disease

Cited by 25 publications

References 38 publications

Surgical Treatment of Postinfarction Ventricular Septal Rupture

Surgical Treatment of Postinfarction Ventricular Septal Rupture

The Outcomes of Total Anomalous Pulmonary Venous Connection in Neonates−10-Year Experience at a Single Center

Structural Heart Disease Emergencies

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