Premium
Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock
Author(s) -
Pozzi Matteo,
Alvau Francesca,
Armoiry Xavier,
Grinberg Daniel,
HugonVallet Elisabeth,
Koffel Catherine,
Portran Philippe,
Scollo Giovanni,
Fellahi Jean Luc,
Obadia Jean Francois
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13985
Subject(s) - cardiogenic shock , medicine , extracorporeal , extracorporeal circulation , weaning , cardiopulmonary bypass , life support , cardiac surgery , refractory (planetary science) , shock (circulatory) , clinical endpoint , cardiology , surgery , anesthesia , myocardial infarction , randomized controlled trial , intensive care medicine , physics , astrobiology
Background and Aim of the Study Extracorporeal life support (ECLS) may be necessary in refractory postcardiotomy cardiogenic shock (PCS) unresponsive to optimal medical treatment. We sought to analyze the results and temporal outcomes of ECLS for PCS. Methods We performed an observational analysis of our prospective database. In order to analyze the temporal trends of ECLS for PCS, patients were divided into two groups according to the period of ECLS implantation: Group I from January 2007‐June 2012, Group II from July 2012‐December 2017. The primary endpoint was survival to hospital discharge. Results During the study period, 90 patients required ECLS for PCS (Group I n = 29, 32%; Group II n = 61, 68%). Mean age was 57.5 ± 15.0 years with 62% of males. Preoperative characteristics were comparable over the two periods. A high proportion of patients were in NYHA class III/IV (61%) or cardiogenic shock (22%). Group II showed a significantly higher proportion of miscellaneous cardiac surgery operations (23 vs 3%, P = 0.031). Crossclamp and cardiopulmonary bypass times were significantly shorter in Group II (85.4 vs 114.2 min, P = 0.023 and 135.2 vs 184.2 min, P = 0.022, respectively). The complication rate during ECLS support was comparable between both groups. Successful weaning from ECLS could be accomplished in 45 (50%) patients (Group I = 52% vs Group II = 49%, P = 0.822) after a mean support of 6.4 days. Thirty‐five (39%) patients survived to hospital discharge (Group I = 41% vs Group II = 38%, P = 0.738). Conclusions Outcomes following ECLS remained stable over an 11‐year period. ECLS may be limited in patients with severe preoperative cardiac dysfunction. Our data suggest that these patients may be better served with less invasive, percutaneous procedures.