Year: 2025
Type: article
Study design: Observational Study
Abstract: Aortic surgery carries high risks and complication rates, particularly when extracorporeal life support (ECLS) is required. We compared outcomes of patients receiving post-cardiotomy ECLS after surgeries involving or not involving the thoracic aorta, with a focus on emergency operations. This retrospective multicenter study included adults requiring veno-arterial (V-A) ECLS for post-cardiotomy shock. In-hospital outcomes and long-term survival were analyzed. Among 2,058 patients, 382 (18.6%) underwent aortic and 1,676 (81.4%) non-aortic surgery. Patients undergoing aortic operations were younger (63.0, interquartile range [IQR]: 54.4-70 years; non-aortic: 65.0, IQR: 55-72 years; p = 0.020), with more emergencies (n = 126, 33.1%; non-aortic: n = 402, 24.3%; p < 0.001), longer cross-clamp times (148, IQR: 101-203 mins; non-aortic: 90, IQR: 59-133 mins; p < 0.001) and more postoperative bleeding events (n = 234, 62.4%; non-aortic: n = 922, 56.0%; p = 0.024). Stroke was more frequent after aortic surgery (n = 60, 15.8%; non-aortic: n = 157, 9.4%; p < 0.001), especially in emergency cases (n = 27, 21.6%; p = 0.034). In-hospital mortality was greater after aortic surgery (n = 258, 67.5%; non-aortic: n = 986, 58.8%; p = 0.002), with 49.9% (n = 189) on-ECLS mortality. Neurological injury caused death in 8.9% (n = 22) of patients undergoing aortic and 4.0% (n = 36) non-aortic operations. Post-discharge survival was similar ( p = 0.32), and emergency status did not affect mortality in the aortic group ( p = 0.643). Veno-arterial extracorporeal life support after aortic surgery is associated with higher bleeding, stroke, and in-hospital mortality compared with non-aortic surgery, independent of emergency status.
Source: ASAIO Journal
Authors: Gabor Bari, Silvia Mariani, Bas C. T. van Bussel, Michele Di Mauro, Luca Conci, Diyar Saeed, Matteo Pozzi, Antonio Loforte, Udo Boeken, Robertas Samalavicius, Karl Bounader, Xiaotong Hou, Jeroen J. H. Bunge, Hergen Buscher, Leonardo Salazar, Bart Meyns, Michael Mazzeffi, Sacha Matteucci, Sandro Sponga, Vitaly Sorokin, Claudio Russo, Francesco Formica, Pranya Sakiyalak, Antonio Fiore, Daniele Camboni, Giuseppe Maria Raffa, Rodrigo Diaz, I.-wen Wang, Jae-Seung Jung, Jan Belohlavek, Vin Pellegrino, Giacomo Bianchi, Matteo Pettinari, Alessandro Barbone, José P. Garcia, Kiran Shekar, Glenn Whitman, Roberto Lorusso, on behalf of the PELS Investigators
Institutions: University of Szeged, Maastricht University Medical Centre, Maastricht University, Care and Public Health Research Institute, University of Foggia, Medical University of Vienna, Leipzig Heart Institute, Hôpital Louis Pradel, University of Turin, Heinrich Heine University Düsseldorf, Vilnius University Hospital Santariskiu Klinikos, Hôpital Pontchaillou, Beijing Anzhen Hospital, Erasmus MC, St Vincent's Hospital Sydney, Fundación Cardiovascular de Colombia, Universitair Ziekenhuis Leuven, University of Maryland, Baltimore, Azienda Ospedaliero-Universitaria delle Marche, University of Udine, National University Hospital, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, University of Salento, Siriraj Hospital, Centre Hospitalier Universitaire Henri-Mondor, Hôpitaux Universitaires Henri-Mondor, University Hospital Regensburg, University of Regensburg, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, University of Palermo, Clínica Las Condes, Memorial Healthcare System, Korea University Anam Hospital, The Alfred Hospital, Fondazione Toscana Gabriele Monasterio, Ziekenhuis Oost-Limburg, Fondazione Humanitas per la Ricerca, IRCCS Humanitas Research Hospital, Indiana University Health, Methodist Hospital, Prince Charles Hospital, Johns Hopkins University, Johns Hopkins Hospital
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: green
OpenAlex ID: W4417444995