Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: Results of a multicenter study

Fausto Biancari, Magnus Dalén, Andrea Perrotti, Antonio Fiore, Daniel Reichart, Sorosh Khodabandeh, Helmut Gulbins, Svante Zipfel, Mosab Al Shakaki, Henryk Welp, Antonella Vezzani, Tiziano Gherli, Jaakko Lommi, Tatu Juvonen, Peter Svenarud, Sidney Chocron, Jean Philippe Verhoye, Karl Bounader, Giuseppe Gatti, Marco GabrielliMatteo Saccocci, Eeva Maija Kinnunen, Francesco Onorati, Giuseppe Santarpino, Khalid Alkhamees, Vito G. Ruggieri, Angelo M. Dell'Aquila

Research output: Contribution to journalArticle

Abstract

Background The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce. Methods We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study. Results VA-ECMO was employed in 148 patients after CABG for median of 5.0 days (mean, 6.4, SD 5.6 days). In-hospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I2 8.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p = 0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p = 0.004, OR 0.98, 95% CI 0.97–0.99), pulmonary disease (p = 0.018, OR 4.42, 95% CI 1.29–15.15) and pre-VA-ECMO blood lactate (p = 0.015, OR 1.10, 95% CI 1.02–1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively. Conclusions One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.

Original languageEnglish
Pages (from-to)109-114
Number of pages6
JournalInternational Journal of Cardiology
Volume241
DOIs
Publication statusPublished - Aug 15 2017
Externally publishedYes

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Keywords

  • CABG
  • Coronary artery bypass
  • ECLS
  • ECMO
  • Extracorporeal life support
  • Extracorporeal membrane oxygenation
  • Heart failure
  • Post-cardiotomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Biancari, F., Dalén, M., Perrotti, A., Fiore, A., Reichart, D., Khodabandeh, S., Gulbins, H., Zipfel, S., Al Shakaki, M., Welp, H., Vezzani, A., Gherli, T., Lommi, J., Juvonen, T., Svenarud, P., Chocron, S., Verhoye, J. P., Bounader, K., Gatti, G., ... Dell'Aquila, A. M. (2017). Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: Results of a multicenter study. International Journal of Cardiology, 241, 109-114. https://doi.org/10.1016/j.ijcard.2017.03.120