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Outcomes after extracorporeal life support for postcardiotomy cardiogenic shock.

Authors
  • Pozzi, Matteo1
  • Alvau, Francesca1
  • Armoiry, Xavier2
  • Grinberg, Daniel1
  • Hugon-Vallet, Elisabeth3
  • Koffel, Catherine4
  • Portran, Philippe4
  • Scollo, Giovanni4
  • Fellahi, Jean Luc4
  • Obadia, Jean Francois1
  • 1 Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France. , (France)
  • 2 University of Lyon, School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/Lyon University Hospitals, "Edouard Herriot" Hospital, Pharmacy Department, Lyon, France. , (France)
  • 3 Department of Cardiology, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France. , (France)
  • 4 Department of Anesthesia and ICU, "Louis Pradel" Cardiologic Hospital, "Claude Bernard" University, Lyon, France. , (France)
Type
Published Article
Journal
Journal of Cardiac Surgery
Publisher
Wiley (Blackwell Publishing)
Publication Date
Feb 01, 2019
Volume
34
Issue
2
Pages
74–81
Identifiers
DOI: 10.1111/jocs.13985
PMID: 30636172
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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). 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. © 2019 Wiley Periodicals, Inc.

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