Pitts Leonard, Gasser Simone, Uzdenov Murat, Gaisendrees Christopher, Bartkevics Maris, Kreibich Maximilian, Luehr Maximilian, Kempfert Jörg, Schoenhoff Florian, Falk Volkmar, Dumfarth Julia
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Eur J Cardiothorac Surg. 2025 Feb 4;67(2). doi: 10.1093/ejcts/ezae467.
The study's aim was to investigate the outcomes and risk factors for mortality in patients undergoing surgery for acute type A aortic dissection receiving concomitant venoarterial extracorporeal membrane oxygenation (ECMO) support.
Patients from 5 European centre who underwent surgery for acute type A aortic dissection and received perioperative venoarterial ECMO support were included. A multivariable binary logistic regression analysis was performed to identify risk factors for 30-day mortality. A receiver operating characteristic curve and restricted cubic splines were designed to investigate the association between pre-ECMO lactate peak and survival.
The final cohort comprised 117 patients. Mean time on ECMO support was 3 days (interquartile range 1-7). In 36 patients (31%), successful ECMO weaning was achieved. Thirty-day mortality was 72%, leading cause for early mortality was multiorgan failure (39%). In total, 20% of patients were discharged from hospital. Pre-ECMO lactate peak [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.005-1.032], presence of preoperative shock (OR 9.47, 95% CI 1.749-98.257) and need for total arch replacement (OR 6.628, 95% CI 1.492-33.373) were identified as associates for 30-day mortality. For pre-ECMO lactate peak, the area under the curve showed an acceptable value of 0.73 and restricted cubic splines showed a significant correlation to survival (P = 0.004) with an increased risk above a lactate level of 85 mg/dl.
Venoarterial ECMO support may not be futile but should be well balanced against the high-risk profile in this patient cohort. The pre-ECMO lactate peak is an independent risk factor and a valid predictor of 30-day mortality.
本研究旨在调查接受静脉 - 动脉体外膜肺氧合（ECMO）支持的急性A型主动脉夹层手术患者的预后及死亡风险因素。
纳入来自5个欧洲中心接受急性A型主动脉夹层手术并在围手术期接受静脉 - 动脉ECMO支持的患者。进行多变量二元逻辑回归分析以确定30天死亡率的风险因素。设计了受试者工作特征曲线和受限立方样条来研究ECMO前乳酸峰值与生存之间的关联。
最终队列包括117名患者。ECMO支持的平均时间为3天（四分位间距1 - 7天）。36名患者（31%）成功撤机。30天死亡率为72%，早期死亡的主要原因是多器官功能衰竭（39%）。共有20%的患者出院。ECMO前乳酸峰值[比值比（OR）1.02，95%置信区间（CI）1.005 - 1.032]、术前休克的存在（OR 9.47，95% CI 1.749 - 98.257）和全弓置换的需求（OR 6.628，95% CI 1.492 - 33.373）被确定为30天死亡率的相关因素。对于ECMO前乳酸峰值，曲线下面积显示可接受值为0.73，受限立方样条显示与生存有显著相关性（P = 0.004），乳酸水平高于85mg/dl时风险增加。
静脉 - 动脉ECMO支持可能并非徒劳，但应与该患者群体的高风险状况进行权衡。ECMO前乳酸峰值是30天死亡率的独立风险因素和有效预测指标。
