Makhoul Maged, Mariani Silvia, van Bussel Bas C T, Wiedemann Dominik, Saeed Diyar, Di Mauro Michele, Pozzi Matteo, Botta Luca, Boeken Udo, Samalavicius Robertas, Bounader Karl, Hou Xiaotong, Bunge Jeroen J H, Buscher Hergen, Salazar Leonardo, Meyns Bart, Mazzeffi Michael A, Sacha Matteucci Marco L, Sponga Sandro, MacLaren Graeme, Russo Claudio, Formica Francesco, Sakiyalak Pranya, Fiore Antonio, Camboni Daniele, Raffa Giuseppe Maria, Diaz Rodrigo, Wang I-Wen, Jung Jae-Seung, Belohlavek Jan, Pellegrino Vin, Bianchi Giacomo, Pettinari Matteo, Barbone Alessandro, Garcia José P, Shekar Kiran, Whitman Glenn, Bolotin Gil, Lorusso Roberto
Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Cardiac Surgery Department, Rambam Medical Centre, Haifa, Israel.
JTCVS Open. 2025 May 3;25:163-172. doi: 10.1016/j.xjon.2025.04.004. eCollection 2025 Jun.
Age is the main determinant for mortality in patients requiring postcardiotomy extracorporeal membrane oxygenation (PC-ECMO), but strategies to reverse this trend are unknown. This study investigates PC-ECMO outcomes in older patients (≥70 years) compared with younger patients (<70 years).
This retrospective study included patients who required PC-ECMO between 2000 and 2020. Variables independently associated with in-hospital mortality were identified using mixed Cox proportional hazards models.
The study included 2057 patients (mean age: 62.3 [first and third quartile: 19-94]; male patients: n = 1213 [59%]): 1376 (67%) were <70 years and 680 (33%) were ≥70 years old. Older patients had more preoperative comorbidities, whereas younger patients had lower cardiac function and more preoperative intubation and vasopressor use. In-hospital mortality was 56.3% (n = 775) and 68.8% (n = 468) in the <70 year and ≥70 year groups, respectively ( < .001). The 7-year postdischarge survival rate was greater for the younger patient group ( < .001). Variables associated with in-hospital mortality in older patients were previous stroke (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.05-1.84), preoperative right ventricular failure (HR, 1.45; 95% CI, 1-2.1), aortic surgery (HR 1.65; 95% CI, 1.2-2.2), and postoperative complications including bleeding (HR 1.24; 95% CI, 1.0-1.5), cardiac arrest (HR, 1.65; 95% CI, 1.3-2.1), and right ventricular failure (HR, 1.29; 95% CI, 1.0-1.6).
PC-ECMO mortality is high in older patients. Preoperative factors including previous stroke and right ventricular failure and postoperative factors including bleeding, cardiac arrest, and right ventricular failure should be targeted to reduce in-hospital mortality after appropriate initial selection in older patients.
年龄是心脏术后体外膜肺氧合（PC-ECMO）患者死亡率的主要决定因素，但逆转这一趋势的策略尚不清楚。本研究调查了老年患者（≥70岁）与年轻患者（<70岁）的PC-ECMO治疗结果。
这项回顾性研究纳入了2000年至2020年间需要PC-ECMO治疗的患者。使用混合Cox比例风险模型确定与院内死亡率独立相关的变量。
该研究纳入了2057例患者（平均年龄：62.3岁[第一和第三四分位数：19-94岁]；男性患者：n = 1213例[59%]）：1376例（67%）年龄<70岁，680例（33%）年龄≥70岁。老年患者术前合并症更多，而年轻患者心功能较差，术前插管和使用血管升压药更多。<70岁和≥70岁组的院内死亡率分别为56.3%（n = 775）和68.8%（n = 468）（P <.001）。年轻患者组出院后7年生存率更高（P <.001）。与老年患者院内死亡率相关的变量包括既往中风（风险比[HR]，1.39；95%置信区间[CI]，1.05-1.84）、术前右心室衰竭（HR，1.45；95%CI，1-2.1）、主动脉手术（HR 1.65；95%CI，1.2-2.2）以及术后并发症，包括出血（HR 1.24；95%CI，1.0-1.5）、心脏骤停（HR，1.65；95%CI，1.3-2.1）和右心室衰竭（HR，1.29；95%CI，1.0-1.6）。
老年患者PC-ECMO死亡率较高。术前因素包括既往中风和右心室衰竭，术后因素包括出血、心脏骤停和右心室衰竭，应在对老年患者进行适当的初始筛选后加以针对性处理，以降低院内死亡率。
