Abstract
Purpose
Postcardiotomy cardiogenic shock is still associated with a poor prognosis. We reviewed patients undergoing extracorporeal membrane oxygenation (ECMO) support for postcardiotomy cardiogenic shock and assessed their long-term outcomes.
Methods
The subjects were 47 patients who received ECMO support for cardiogenic shock after open heart surgery. We analyzed the long-term survival and risk factors for early or late death.
Results
Twenty-nine patients were weaned off ECMO support, but 15 of these patients died during their hospital stay. An independent predictor of mortality during ECMO support was incomplete sternum closure (OR 4.089, 95 % CL 1.003–16.67, p = 0.049) and a predictor of mortality after weaning off ECMO was more than 48 h of support (OR 8.975, 95 % CL 1.281–62.896, p = 0.027). Fourteen patients were discharged from hospital, but seven of these patients died during the follow-up period owing to cardiac events (n = 2) or non-cardiac causes (n = 5). The actuarial survival rates were 34.0 % at 30 days, 29.8 % at 1 year, and 17.6 % at 10 years.
Conclusion
Although postcardiotomy cardiogenic shock requiring ECMO support is associated with high morbidity and mortality, the long-term survival rate is acceptable.
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References
Golding LA. Postcardiotomy mechanical support. Semin Thorac Cardiovasc Surg. 1991;3:29–33.
Muehrcke DD, McCarthy PM, Stewart RW, Seshagiri S, Ogella DA, Foster RC, et al. Complications of extracorporeal life support systems using heparin-bound surfaces. The risk of intracardiac clot formation. J Thorac Cardiovasc Surg. 1995;110:843–51.
Smith C, Bellomo R, Raman JS, Matalanis G, Rosalion A, Buckmaster J, et al. An extracorporeal membrane oxygenation-based approach to cardiogenic shock in an older population. Ann Thorac Surg. 2001;71:1421–7.
Fiser SM, Tribble CG, Kaza AK, Long SM, Zacour RK, Kern JA, et al. When to discontinue extracorporeal membrane oxygenation for postcardiotomy support. Ann Thorac Surg. 2001;71:210–4.
Ko WJ, Lin CY, Chen RJ, Wang SS, Lin FY, Chen YS. Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg. 2002;73:538–45.
Pagani FD, Aaronson KD, Swaniker F, Bartlett RH. The use of extracorporeal life support in adult patients with primary cardiac failure as a bridge to implantable left ventricular assist device. Ann Thorac Surg. 2001;71:S77–85.
Smedira NG, Blackstone EH. Postcardiotomy mechanical support: risk factors and outcomes. Ann Thorac Surg. 2001;71:S82–5.
Magovern GJ Jr, Simpson KA. Extracorporeal membrane oxygenation for adult cardiac support: the Allegheny experience. Ann Thorac Surg. 1999;68:655–61.
Bakhtiary F, Keller H, Dogan S, Dzemali O, Oezaslan F, Meininger D, et al. Venoarterial extracorporeal membrane oxygenation for treatment of cardiogenic shock: clinical experiences in 45 adult patients. J Thorac Cardiovasc Surg. 2008;135:382–8.
Zhang R, Kofidis T, Kamiya H, Shrestha M, Tessmann R, Haverich A, et al. Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients. Eur J Cardiothorac Surg. 2006;30:617–20.
Smedira NG, Moazami N, Golding CM, McCarthy PM, Apperson-Hansen C, Blackstone EH, et al. Clinical experience with 202 adults receiving extracorporeal membrane oxygenation for cardiac failure: survival at five years. J Thorac Cardiovasc Surg. 2001;122:92–102.
Rastan AJ, Dege A, Mohr M, Doll N, Falk V, Walther T, et al. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg. 2010;139:302–11.
Hata M, Shiono M, Orime Y, Yagi SY, Yamamoto T, Okumura H, et al. Strategy of circulatory support with percutaneous cardiopulmonary support. Artif Organs. 2000;24:636–9.
Peek GJ, Killer HM, Sosnowski MA, Firmin RK. Modular extracorporeal life support for multiorgan failure patients. Liver. 2002;22:69–71.
Orime Y, Shiono M, Hata H, Yagi S, Tsukamoto S, Okumura H, et al. Clinical experiences of percutaneous cardiopulmonary support: its effectiveness and limit. Artif Organs. 1998;22:498–501.
Sezai A, Hata M, Niino T, Yoshitake I, Unosawa S, Wakui S, et al. Continuous low-dose infusion of human atrial natriuretic peptide in patients with left ventricular dysfunction undergoing coronary artery bypass grafting: the NU-HIT (Nihon University working group study of low-dose Human ANP Infusion Therapy during cardiac surgery) for left ventricular dysfunction. J Am Coll Cardiol. 2010;55:1844–51.
Hayashida N, Chihara S, Kashikie H, Tayama E, Yokose S, Akasu K, et al. Effects of intraoperative administration of atrial natriuretic peptide. Ann Thorac Surg. 2000;70:1319–26.
Wang J, Han J, Jia Y, Zeng W, Shi J, Hou X, et al. Early and intermediate results of rescue extracorporeal membrane oxygenation in adult cardiogenic shock. Ann Thorac Surg. 2009;88:1897–903.
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Satoshi Unosawa and his co-authors have no conflict of interest.
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Unosawa, S., Sezai, A., Hata, M. et al. Long-term outcomes of patients undergoing extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. Surg Today 43, 264–270 (2013). https://doi.org/10.1007/s00595-012-0322-6
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DOI: https://doi.org/10.1007/s00595-012-0322-6