Utilization and outcomes of postcardiotomy mechanical circulatory support

被引:5
|
作者
Hess, Nicholas R. [1 ]
Wang, Yisi [1 ]
Kilic, Arman [2 ]
机构
[1] Univ Pittsburgh, Div Cardiac Surg, Med Ctr, Pittsburgh, PA USA
[2] Med Univ South Carolina, Div Cardiothorac Surg, 30 Courtenay Dr,MSC 295,Suite BM279, Charleston, SC 29425 USA
关键词
bridge; cardiopulmonary bypass; mechanical circulatory support; outcomes; survival; weaning; EXTRACORPOREAL MEMBRANE-OXYGENATION;
D O I
10.1111/jocs.15908
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background This study evaluated the utilization and outcomes of postcardiotomy mechanical circulatory support (MCS). Methods This was a retrospective, single institution analysis of adult cardiac surgery cases that required de novo MCS following surgery from 2011 to 2018. Patients that were bridged with MCS to surgery were excluded. The primary outcomes were early operative mortality and longitudinal survival. Secondary outcomes included postoperative complications, and 5-year all-cause readmission. Results Five hundred and thirty-three patients required de novo postcardiotomy MCS, with the most commonly performed procedure being isolated coronary artery bypass grafting (29.8%). Median cardiopulmonary bypass and cross-clamp times were 185 (IQR 123-260) min and 122 (IQR 81-179) min, respectively. A total of 442 (82.9%) of patients were supported with intra-aortic balloon pump counterpulsation, 23 (4.3%) with an Impella device, and 115 (21.6%) with extracorporeal membrane oxygenation. Three (0.6%) patients had an unplanned ventricular assist device placed. Operative mortality was 29.8%. Longitudinal survival was 56.1% and 43.0% at 1 and 5 years, respectively. Survival was lowest in those supported with ECMO and highest with those supported with an Impella (p < 0.001). Freedom from readmission was 61.4% at 5 years. Postoperative ECMO was an independent predictor of mortality (HR 5.1, 95% CI 2.0-12.9, p < 0.001), but none of the MCS types predicted long-term hospital readmission after risk adjustment. Conclusions Postcardiotomy MCS is associated with high operative mortality. Even patients that survive to discharge have compromised longitudinal survival, with nearly only half surviving to 1 year. Close follow-up and early referral to advanced heart failure specialists may be prudent in improving these outcomes.
引用
收藏
页码:4030 / 4037
页数:8
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