Hohri Yu, Zhao Yanling, Takayama Hiroo, Vinogradsky Alice V, Kurlansky Paul, Fried Justin, Takeda Koji
Division of Cardiothoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA.
Division of Cardiology, Columbia University Medical Center, New York, NY, USA.
Perfusion. 2025 May;40(4):915-922. doi: 10.1177/02676591241271984. Epub 2024 Aug 1.
ObjectivesVeno-arterial extracorporeal life support (V-A ECLS) is increasingly being utilized for postcardiotomy shock (PCS), though data describing the relationship between type of indexed operation and outcomes are limited. This study compared V-A ECLS outcomes across four major cardiovascular surgical procedures.MethodsThis was a single-center retrospective study of patients who required V-A ECLS for PCS between 2015 and 2022. Patients were stratified by the type of indexed operation, which included aortic surgery (AoS), coronary artery bypass grafting (CABG), valve surgery (Valve), and combined CABG and valve surgery (CABG + Valve). Factors associated with postoperative outcomes were assessed using logistic regression.ResultsAmong 149 PCS patients who received V-A ECLS, there were 35 AoS patients (23.5%), 29 (19.5%) CABG patients, 59 (39.6%) Valve patients, and 26 (17.4%) CABG + Valve patients. Cardiopulmonary bypass times were longest in the AoS group ( < 0.01). Regarding causes of PCS, AoS patients had a greater incidence of ventricular failure, while the CABG group had a higher incidence of ventricular arrhythmia ( = 0.04). Left ventricular venting was most frequently utilized in the Valve group ( = 0.07). In-hospital mortality was worst among CABG + Valve patients ( < 0.01), and the incidence of acute kidney injury was highest in the AoS group ( = 0.03). In multivariable logistic regression, CABG + Valve surgery (odds ratio (OR) 4.20, 95% confidence interval 1.30-13.6, = 0.02) and lactate level at ECLS initiation (OR, 1.17; 95% CI, 1.06-1.29; < 0.01) were independently associated with mortality.ConclusionsWe demonstrate that indications, management, and outcomes of V-A ECLS for PCS vary by type of indexed cardiovascular surgery.
目的
静脉-动脉体外膜肺氧合（V-A ECLS）越来越多地用于心脏术后休克（PCS），不过描述索引手术类型与预后之间关系的数据有限。本研究比较了四种主要心血管外科手术中V-A ECLS的预后情况。
方法
这是一项单中心回顾性研究，纳入了2015年至2022年间因PCS需要V-A ECLS的患者。患者按索引手术类型分层，包括主动脉手术（AoS）、冠状动脉旁路移植术（CABG）、瓣膜手术（瓣膜）以及CABG与瓣膜联合手术（CABG + 瓣膜）。采用逻辑回归评估与术后预后相关的因素。
结果
在149例接受V-A ECLS的PCS患者中，有35例AoS患者（23.5%）、29例（19.5%）CABG患者、59例（39.6%）瓣膜手术患者和26例（17.4%）CABG + 瓣膜手术患者。AoS组的体外循环时间最长（<0.01）。关于PCS的病因，AoS患者心室衰竭的发生率更高，而CABG组室性心律失常的发生率更高（=0.04）。瓣膜组最常使用左心室引流（=0.07）。CABG + 瓣膜手术患者的院内死亡率最高（<0.01），AoS组急性肾损伤的发生率最高（=0.03）。在多变量逻辑回归中，CABG + 瓣膜手术（比值比（OR）4.20，95%置信区间1.30 - 13.6，=0.02）和ECLS启动时的乳酸水平（OR，1.17；95%CI，1.06 - 1.29；<0.01）与死亡率独立相关。
结论
我们证明，PCS的V-A ECLS的适应证、管理和预后因索引心血管手术类型而异。
