Extracorporeal Life Support for Post-Cardiotomy Acute Right Ventricular Failure: A Retrospective Observational Multicenter Study.
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Bianchi Giacomo, Perazzo Alvaro, Mariani Silvia, van Bussel Bas C T, Di Mauro Michele, Wiedemann Dominik, Saeed Diyar, Pozzi Matteo, Botta Luca, Boeken Udo, Samalavicius Robertas, Bounader Karl, Hou Xiaotong, Bunge Jeroen J H, Buscher Hergen, Salazar Leonardo, Meyns Bart, Mazzeffi Michael A, Matteucci Sacha, Sponga Sandro, Ramanathan Kollengode, Russo Claudio Francesco, Formica Francesco, Sakiyalak Pranya, Fiore Antonio, Camboni Daniele, Raffa Giuseppe Maria, Diaz Rodrigo, Wang I-Wen, Jung Jae-Seung, Belohlavek Jan, Pellegrino Vin, Pettinari Matteo, Barbone Alessandro, Gaiotto Fabio Antonio, Garcia José P, Shekar Kiran, Whitman Glenn, Solinas Marco, Lorusso Roberto, PELS-1 Investigators
Аннотация
METHODS: In this multicenter, international, retrospective study, we analyzed patients undergoing post-cardiotomy ECLS from January 2000 to December 2020 and compared patients' characteristics and in-hospital mortality between aRVF and other indications.
RESULTS: Of 2010 patients, 240 (12%) had aRVF and 1770 (88%) had other indications for ECLS. Demographics were similar between groups; median age was 65 (55-72) years (P = .217), and 60% were male (P = .675). The aRVF group showed higher preoperative right-sided cardiac dysfunction, including preexisting right ventricular failure (aRVF, 22%; other indications, 8%; P < .001) and biventricular failure (aRVF, 12%; other indications, 7%; P = .013). Patients with aRVF more frequently underwent tricuspid valve surgery (aRVF, 20%; other indications, 13%; P = .003) and aortic root procedures (aRVF, 24%; other indications, 13%). They also required longer ECLS support (aRVF, 135 [70-221] hours; other indications, 116 [58-192] hours; P = .025) and longer intensive care unit stay (aRVF, 15 [7-29] days; other indications, 13 [6-25] days; P = .042). Despite more complications, including nonsurgical bleeding (aRVF, 31%; other indications, 25%; P = .042) and persistent right-sided heart failure (aRVF, 50%; other indications, 17%; P < .001), both in-hospital survival (aRVF, 59%; other indications, 61%; P = .526) and long-term survival were comparable (log-rank P = .17).
CONCLUSIONS: Patients requiring ECLS for post-cardiotomy aRVF, despite higher preoperative risks and complex clinical courses, achieve survival rates comparable to those of patients with other indications.