Survival After Endocarditis Surgery Needing Venoarterial Extracorporeal Membrane Oxygenation Support: Results from the Netherlands Heart Registration

IF 2.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiology Pub Date : 2025-02-13 DOI:10.1016/j.amjcard.2025.02.005

Floris J. Heinen MD , Sakir Akin MD, PhD , Floris S. van den Brink MD, PhD , Khalil Ayan MD , Henning Hermanns MD, PhD , Michelle D. van der Stoel MSc , Marco C. Post MD, PhD , Robert J.M. Klautz MD, PhD , Wilco Tanis MD, PhD , Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration

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引用次数: 0

Abstract

The incidence of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support after cardiac surgery ranges from 0.4% to 3.7%, with in-hospital mortality rates reported at 60%. While the incidence of VA-ECMO after endocarditis (IE) surgery is unknown, these patients may face an even greater mortality risk due to additional IE-related complications. The primary objective of this study is to investigate the incidence and mortality rates of postoperative VA-ECMO following endocarditis surgery. The secondary objective is to compare clinical outcomes and to identify factors associated with in-hospital mortality in patients requiring and not requiring VA-ECMO support. Data were retrieved from the Netherlands Heart Registration. Of 3,468 IE surgeries performed between 2013 and 2022, 49 patients (1.4%) received postoperative VA-ECMO. The in-hospital mortality rate was 49% and the 1-year mortality rate was 60.9%. As expected, this was significantly higher compared to patients not requiring VA-ECMO support (49.0% vs 9.8% and 60.9% vs 15.2% respectively; p <0.001). At baseline, VA-ECMO patients had statistically higher rates of previous valve surgery, peripheral vascular disease and pulmonary hypertension, as well as lower renal and left ventricular functions compared to than patients not requiring VA-ECMO support. In addition, VA-ECMO patients more frequently underwent emergency surgeries and required aortic root surgery and coronary artery bypass grafting more often. While several comorbidities were associated with in-hospital mortality in patients not requiring VA-ECMO, no such associations were observed in VA-ECMO patients. In conclusion, while the incidence of VA-ECMO support after IE surgery is low, it comes with high mortality rates. However, mortality rates do not seem to differ from those reported for non-IE postcardiotomy VA-ECMO patients in current literature, and mortality after VA-ECMO support remains difficult to predict. Based on our data, postcardiotomy VA-ECMO should not be withheld from IE patients because of high-anticipated mortality risk.

查看原文本刊更多论文

需要静脉体外膜氧合支持的心内膜炎手术后的生存：来自荷兰心脏登记的结果。

心脏手术后静脉体外膜氧合（VA-ECMO）支持的发生率为0.4% - 3.7%，据报道住院死亡率为60%。虽然心内膜炎（IE）手术后VA-ECMO的发生率尚不清楚，但由于其他IE相关并发症，这些患者可能面临更大的死亡风险。本研究的主要目的是调查心内膜炎手术后VA-ECMO的发生率和死亡率。次要目的是比较临床结果，并确定与需要和不需要VA-ECMO支持的患者住院死亡率相关的因素。数据来源于荷兰心脏登记。在2013年至2022年间进行的3468例IE手术中，49例（1.4%）患者接受了术后VA-ECMO。住院死亡率为49%，1年死亡率为60.9%。正如预期的那样，与不需要VA-ECMO支持的患者相比，这一比例明显更高(分别为49.0%对9.8%和60.9%对15.2%；P < 0.001)。在基线时，与不需要VA-ECMO支持的患者相比，VA-ECMO患者既往瓣膜手术、周围血管疾病和肺动脉高压的发生率更高，肾功能和左心室功能也更低。此外，VA-ECMO患者接受急诊手术的频率更高，需要主动脉根部手术和冠状动脉搭桥术的频率更高。虽然一些合并症与不需要VA-ECMO的患者的住院死亡率相关，但在VA-ECMO患者中没有观察到这种关联。总之，尽管IE手术后VA-ECMO支持的发生率较低，但其死亡率很高。然而，死亡率似乎与目前文献中报道的非ie心切术后VA-ECMO患者的死亡率没有差异，并且VA-ECMO支持后的死亡率仍然难以预测。根据我们的数据，不应该因为预期的高死亡率风险而拒绝对IE患者进行切心术后VA-ECMO。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiology 医学-心血管系统

CiteScore

4.00

自引率

3.60%

发文量

698

审稿时长

33 days

期刊介绍： Published 24 times a year, The American Journal of Cardiology® is an independent journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology throughout the world. AJC is an independent, scientific, peer-reviewed journal of original articles that focus on the practical, clinical approach to the diagnosis and treatment of cardiovascular disease. AJC has one of the fastest acceptance to publication times in Cardiology. Features report on systemic hypertension, methodology, drugs, pacing, arrhythmia, preventive cardiology, congestive heart failure, valvular heart disease, congenital heart disease, and cardiomyopathy. Also included are editorials, readers'' comments, and symposia.