Arafat Amr A, AlBarrak Mohammed, Kiddo Musab, Alotaibi Khaled, Ismail Huda H, Adam Adam I, Aboughanima Mohamed A, Albabtain Monirah A, Tantawy Tarek M, Pragliola Claudio
Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
Perfusion. 2024 Apr;39(3):564-570. doi: 10.1177/02676591231152723. Epub 2023 Jan 16.
Limited data evaluated the outcomes of extracorporeal membrane oxygenation (ECMO) in patients with prosthetic valves. This study aimed to compare the outcomes of ECMO support for postcardiotomy cardiogenic shock in patients with mechanical versus bioprosthetic valves.
This retrospective study included patients with ECMO support for postcardiotomy cardiogenic shock after valve replacement. Patients were grouped into bioprosthetic ( = 49) and mechanical valve ( = 22) groups.
There were no differences in ECMO duration, inotropic support, intra-aortic balloon pump (IABP), stroke, duration of ICU, and hospital stay between groups. Postoperative thrombosis occurred in 2 patients with bioprosthetic valves (5.41%) and 2 with mechanical valves (14.29%), = .30. All patients with thrombosis had central ECMO cannulation, concomitant IABP, and inotropic support during ECMO. All thrombi were related to the mitral valve. Three patients with thrombi had hospital mortality.Survival at 6, 12, and 36 months for bioprosthetic valve patients was 30.88%, 28.55%, and 25.34% and for mechanical valves was 36.36% for all time intervals (Log-rank = .93). One patient had bioprosthetic aortic valve endocarditis after 1 year. Three patients with bioprosthetic valves had structural valve degeneration after 1, 2, and 5 years.
Outcomes of ECMO in patients with prosthetic valves are comparable between bioprosthetic and mechanical valves. Thrombosis might occur in both valve types and was associated with high mortality. ECMO could affect the long-term durability of the bioprosthetic valves.
评估人工瓣膜患者体外膜肺氧合（ECMO）治疗效果的数据有限。本研究旨在比较机械瓣膜和生物瓣膜患者在心脏手术后心源性休克接受ECMO支持的治疗效果。
这项回顾性研究纳入了瓣膜置换术后接受ECMO支持治疗心源性休克的患者。患者分为生物瓣膜组（n = 49）和机械瓣膜组（n = 22）。
两组在ECMO持续时间、血管活性药物支持、主动脉内球囊反搏（IABP）、卒中、重症监护病房（ICU）住院时间和住院时间方面无差异。2例生物瓣膜患者（5.41%）和2例机械瓣膜患者（14.29%）发生术后血栓形成，P = 0.30。所有血栓形成患者在ECMO期间均采用中心静脉置管、同时使用IABP和血管活性药物支持。所有血栓均与二尖瓣有关。3例血栓形成患者死亡。生物瓣膜患者在6个月、12个月和36个月时的生存率分别为30.88%、28.55%和25.34%，机械瓣膜患者在所有时间间隔的生存率均为36.36%（对数秩检验P = 0.93）。1例患者在1年后发生生物瓣膜主动脉瓣心内膜炎。3例生物瓣膜患者在1年、2年和5年后发生人工瓣膜结构退化。
生物瓣膜和机械瓣膜患者接受ECMO治疗的效果相当。两种瓣膜类型均可能发生血栓形成，且与高死亡率相关。ECMO可能影响生物瓣膜的长期耐久性。
