A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Five-year survival after post-cardiotomy veno-arterial extracorporeal membrane oxygenation
Tekijät: Biancari Fausto, Perrotti Andrea, Ruggieri Vito G, Mariscalco Giovanni, Dalén Magnus, Dell'Aquila Angelo M, Jónsson Kristján, Ragnarsson Sigurdur, Di Perna Dario, Bounader Karl, Gatti Giuseppe, Juvonen Tatu, Alkhamees Khalid, Yusuff Hakeem, Loforte Antonio, Lechiancole Andrea, Chocron Sidney, Pol Marek, Spadaccio Cristiano, Pettinari Matteo, De Keyzer Dieter, Fiore Antonio, Welp Henryk
Kustantaja: OXFORD UNIV PRESS
Julkaisuvuosi: 2021
Journal: European Heart Journal: Acute Cardiovascular Care
Tietokannassa oleva lehden nimi: EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
Lehden akronyymi: EUR HEART J-ACUTE CA
Vuosikerta: 10
Numero: 6
Aloitussivu: 595
Lopetussivu: 601
Sivujen määrä: 7
ISSN: 2048-8726
DOI: https://doi.org/10.1093/ehjacc/zuaa039
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 1.72.7years (for hospital survivors, 4.62.5years). 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%; 60-69years: 29.9%; 70-79years: 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.
