Hembree Amy, Lawlor Matthew, Nemeth Samantha, Mørk Sivagowry Rasalingam, Kaku Yuji, Spellman Jessica, Miltiades Andrea, Kurlansky Paul, Takeda Koji, George Isaac
Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY.
Division of Cardiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, NY.
JTCVS Open. 2023 Mar 1;14:171-181. doi: 10.1016/j.xjon.2023.02.012. eCollection 2023 Jun.
Tricuspid valve surgery is associated with high rates of shock and in-hospital mortality. Early initiation of venoarterial extracorporeal membrane oxygenation after surgery may provide right ventricular support and improve survival. We evaluated mortality in patients undergoing tricuspid valve surgery based on the timing of venoarterial extracorporeal membrane oxygenation.
All consecutive adult patients undergoing isolated or combined surgical tricuspid valve repair or replacement from 2010 to 2022 requiring venoarterial extracorporeal membrane oxygenation use were stratified by initiation in the operating room (Early) versus outside of the operating room (Late). Variables associated with in-hospital mortality were explored using logistic regression.
There were 47 patients who required venoarterial extracorporeal membrane oxygenation: 31 Early and 16 Late. Mean age was 55.6 years (standard deviation, 16.8), 25 (54.3%) were in New York Heart Association class III/IV, 30 (60.8%) had left-sided valve disease, and 11 (23.4%) had undergone prior cardiac surgery. Median left ventricular ejection fraction was 60.0% (interquartile range, 45-65), right ventricular size was moderately to severely increased in 26 patients (60.5%), and right ventricular function was moderately to severely reduced in 24 patients (51.1%). Concomitant left-sided valve surgery was performed in 25 patients (53.2%). There were no differences in baseline characteristics or invasive measurements immediately before surgery between the Early and Late groups. Venoarterial extracorporeal membrane oxygenation was initiated 194 (23.0-840.0) minutes after cardiopulmonary bypass in the Late venoarterial extracorporeal membrane oxygenation group. In-hospital mortality was 35.5% (n = 11) in the Early group versus 68.8% (n = 11) in the Late group ( = .037). Late venoarterial extracorporeal membrane oxygenation was associated with in-hospital mortality (odds ratio, 4.00; 1.10-14.50; = .035).
Early postoperative initiation of venoarterial extracorporeal membrane oxygenation after tricuspid valve surgery in high-risk patients may be associated with improvement in postoperative hemodynamics and in-hospital mortality.
三尖瓣手术与高休克率和住院死亡率相关。术后早期启动静脉-动脉体外膜肺氧合（VA-ECMO）可能为右心室提供支持并提高生存率。我们根据静脉-动脉体外膜肺氧合的启动时间评估了接受三尖瓣手术患者的死亡率。
2010年至2022年期间所有连续接受单纯或联合三尖瓣修复或置换手术且需要使用静脉-动脉体外膜肺氧合的成年患者，根据在手术室启动（早期）与在手术室之外启动（晚期）进行分层。使用逻辑回归分析与住院死亡率相关的变量。
有47例患者需要静脉-动脉体外膜肺氧合：31例为早期启动，16例为晚期启动。平均年龄为55.6岁（标准差16.8），25例（54.3%）为纽约心脏协会心功能III/IV级，30例（60.8%）有左侧瓣膜疾病，11例（23.4%）曾接受过心脏手术。左心室射血分数中位数为60.0%（四分位间距45 - 65），26例患者（60.5%）右心室大小中度至重度增加，24例患者（51.1%）右心室功能中度至重度降低。25例患者（53.2%）同时进行了左侧瓣膜手术。早期组和晚期组在术前基线特征或有创测量方面无差异。晚期静脉-动脉体外膜肺氧合组在体外循环后194（23.0 - 840.0）分钟启动静脉-动脉体外膜肺氧合。早期组住院死亡率为35.5%（n = 11），晚期组为68.8%（n = 11）（P = 0.037）。晚期静脉-动脉体外膜肺氧合与住院死亡率相关（比值比，4.00；1.10 - 14.50；P = 0.035）。
高危患者三尖瓣手术后早期启动静脉-动脉体外膜肺氧合可能与术后血流动力学改善和住院死亡率降低有关。
