Relationship between indexed surgery and postcardiotomy extracorporeal life support outcomes.

Autor:	Hohri Y; Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA., Zhao Y; Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA., Takayama H; Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA., Vinogradsky AV; Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA., Kurlansky P; Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA., Fried J; Division of Cardiology, Columbia University Medical Center, New York, NY, USA., Takeda K; Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	Perfusion [Perfusion] 2024 Aug 01, pp. 2676591241271984. Date of Electronic Publication: 2024 Aug 01.
DOI:	10.1177/02676591241271984
Abstrakt:	Objectives: Veno-arterial extracorporeal life support (V-A ECLS) is increasingly being utilized for postcardiotomy shock (PCS), though data describing the relationship between type of indexed operation and outcomes are limited. This study compared V-A ECLS outcomes across four major cardiovascular surgical procedures. Methods: This was a single-center retrospective study of patients who required V-A ECLS for PCS between 2015 and 2022. Patients were stratified by the type of indexed operation, which included aortic surgery (AoS), coronary artery bypass grafting (CABG), valve surgery (Valve), and combined CABG and valve surgery (CABG + Valve). Factors associated with postoperative outcomes were assessed using logistic regression. Results: Among 149 PCS patients who received V-A ECLS, there were 35 AoS patients (23.5%), 29 (19.5%) CABG patients, 59 (39.6%) Valve patients, and 26 (17.4%) CABG + Valve patients. Cardiopulmonary bypass times were longest in the AoS group ( p < 0.01). Regarding causes of PCS, AoS patients had a greater incidence of ventricular failure, while the CABG group had a higher incidence of ventricular arrhythmia ( p = 0.04). Left ventricular venting was most frequently utilized in the Valve group ( p = 0.07). In-hospital mortality was worst among CABG + Valve patients ( p < 0.01), and the incidence of acute kidney injury was highest in the AoS group ( p = 0.03). In multivariable logistic regression, CABG + Valve surgery (odds ratio (OR) 4.20, 95% confidence interval 1.30-13.6, p = 0.02) and lactate level at ECLS initiation (OR, 1.17; 95% CI, 1.06-1.29; p < 0.01) were independently associated with mortality. Conclusions: We demonstrate that indications, management, and outcomes of V-A ECLS for PCS vary by type of indexed cardiovascular surgery. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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