Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"Feasibility of aligning creatine kinase MB activity and mass data in multicentre trials using generalized additive modelling.","authors":"Markus Hoenicka, Arbresha Vokshi, Shaoxia Zhou, Andreas Liebold, Benjamin Mayer","doi":"10.1093/icvts/ivae138","DOIUrl":"10.1093/icvts/ivae138","url":null,"abstract":"<p><strong>Objectives: </strong>Elevated serum creatine kinase isoenzyme MB (CK-MB) levels indicate myocardial ischaemia and periprocedural myocardial injury during treatment of heart diseases. We established a method to predict CK-MB mass from activity data based on a prospective pilot study in order to simplify multicentre trials.</p><p><strong>Methods: </strong>38 elective cardiac surgery patients without acute myocardial ischaemia and terminal renal failure were recruited. CK-MB mass and activity were determined in venous blood samples drawn preoperatively, postoperatively, 6 h post-op, and 12 h post-op. Linear regression and generalized additive models (GAMs) were applied to describe the relationship of mass and activity. Influences of demographic and perioperative factors on the fit of GAMs was evaluated. The agreement of predicted and measured CK-MB masses was assessed by Bland-Altman analyses.</p><p><strong>Results: </strong>Linear regression provided an acceptable overall fit (r2 = 0.834) but showed deviances at low CK-MB levels. GAMs did not benefit from the inclusion of age, body mass index and surgical times. The minimal adequate model predicted CK-MB masses from activities, sex and sampling time with an r2 of 0.981. Bland-Altman analyses confirmed narrow limits of agreement (spread: 8.87 µg/l) and the absence of fixed (P = 0.41) and proportional (P = 0.21) biases.</p><p><strong>Conclusions: </strong>GAM-based modelling of CK-MB data in a representative patient cohort allowed to predict CK-MB masses from activities, sex and sampling time. This approach simplifies the integration of study centres with incompatible CK-MB data into multicentre trials in order to facilitate inclusion of CK-MB levels in statistical models.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11298413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical timing for asphyxiating thoracic dystrophy.","authors":"Xingfei Chen, Huilan Ye, Run Dang, Yiyu Yang","doi":"10.1093/icvts/ivae141","DOIUrl":"10.1093/icvts/ivae141","url":null,"abstract":"<p><p>This report describes a 4-year-old girl diagnosed with asphyxiating thoracic dystrophy who experienced severe respiratory distress and multiple complications after undergoing a corrective operation for a thoracic deformity. The optimal age for children with asphyxiating thoracic dystrophy to receive a corrective operation is between 6 and 12 years old. For children under 6 years old, the decision to undergo an operation should be carefully evaluated.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11316612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-related differences among patients undergoing surgical aortic valve replacement-a propensity score matched study.","authors":"Andreas Zierer, Ruggero De Paulis, Farhad Bakhtiary, Ali El-Sayed Ahmad, Martin Andreas, Rüdiger Autschbach, Peter Benedikt, Konrad Binder, Nikolaos Bonaros, Michael Borger, Thierry Bourguignon, Sergio Canovas, Enrico Coscioni, Francois Dagenais, Philippe Demers, Oliver Dewald, Richard Feyrer, Hans-Joachim Geißler, Martin Grabenwöger, Jürg Grünenfelder, Sami Kueri, Ka Yan Lam, Thierry Langanay, Günther Laufer, Wouter Van Leeuwen, Rainer Leyh, Andreas Liebold, Giovanni Mariscalco, Parwis Massoudy, Arash Mehdiani, Renzo Pessotto, Francesco Pollari, Gianluca Polvani, Alessandro Ricci, Jean-Christian Roussel, Saad Salamate, Matthias Siepe, Pierluigi Stefano, Justus Strauch, Alexis Theron, Andreas Vötsch, Alberto Weber, Olaf Wendler, Matthias Thielmann, Matthias Eden, Beate Botta, Peter Bramlage, Bart Meuris","doi":"10.1093/icvts/ivae140","DOIUrl":"10.1093/icvts/ivae140","url":null,"abstract":"<p><strong>Objectives: </strong>We investigated the sex-related difference in characteristics and 2-year outcomes after surgical aortic valve replacement (SAVR) by propensity-score matching (PSM).</p><p><strong>Methods: </strong>Data from 2 prospective registries, the INSPIRIS RESILIA Durability Registry (INDURE) and IMPACT, were merged, resulting in a total of 933 patients: 735 males and 253 females undergoing first-time SAVR. The PSM was performed to assess the impact of sex on the SAVR outcomes, yielding 433 males and 243 females with comparable baseline characteristics.</p><p><strong>Results: </strong>Females had a lower body mass index (median 27.1 vs 28.0 kg/m2; P = 0.008), fewer bicuspid valves (52% vs 59%; P = 0.036), higher EuroSCORE II (mean 2.3 vs 1.8%; P < 0.001) and Society of Thoracic Surgeons score (mean 1.6 vs 0.9%; P < 0.001), were more often in New York Heart Association functional class III/IV (47% vs 30%; P < 0.001) and angina Canadian Cardiovascular Society III/IV (8.2% vs 4.4%; P < 0.001), but had a lower rate of myocardial infarction (1.9% vs 5.2%; P = 0.028) compared to males. These differences vanished after PSM, except for the EuroSCORE II and Society of Thoracic Surgeons scores, which were still significantly higher in females. Furthermore, females required smaller valves (median diameter 23.0 vs 25.0 mm, P < 0.001). There were no differences in the length of hospital stay (median 8 days) or intensive care unit stay (median 24 vs 25 hours) between the 2 sexes. At 2 years, post-SAVR outcomes were comparable between males and females, even after PSM.</p><p><strong>Conclusions: </strong>Despite females presenting with a significantly higher surgical risk profile, 2-year outcomes following SAVR were comparable between males and females.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early left atrial reverse remodelling in patients with hypertrophic obstructive cardiomyopathy receiving transapical beating-heart septal myectomy.","authors":"Shirui Lu, Jun Zhang, Ying Zhu, Wei Zhou, Xueqing Cheng, Hui Wang, Yue Chen, Xiang Wei, Yani Liu","doi":"10.1093/icvts/ivae145","DOIUrl":"10.1093/icvts/ivae145","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to investigate the short-term effects of transapical beating-heart septal myectomy (TA-BSM) on left atrial (LA) anatomy and function and its association with clinical indicators in patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><strong>Methods: </strong>A total of 105 HOCM patients who received TA-BSM were included. Clinical and comprehensive echocardiographic data were obtained before surgery, at discharge, and 3 months after myectomy. LA reverse remodelling was defined as LA maximum volume index (LAVI) ≤34 ml/m2 and a change of ≥10%.</p><p><strong>Results: </strong>At 3 months after TA-BSM, New York Heart Association (NYHA) functional class and 6-min walking test were significantly improved, N-terminal pro-B-type natriuretic peptide (NT-proBNP) decreased, left ventricular outflow tract (LVOT) peak gradient and mitral regurgitation were significantly reduced. LAVI decreased in 76%, with a median change of 20%, and the criteria for LA reverse remodelling were met in 48%. LA strain parameters were improved at 3 months after TA-BSM. Moreover, left ventricular (LV) diastolic function was significantly improved, but LV global longitudinal strain was not significantly changed at 3 months after operation. Improvement in LVOT peak gradient, LAVI, LA reservoir strain (LASr) and conduit strain (LAScd) were associated with reduction in NT-proBNP.</p><p><strong>Conclusions: </strong>Along with effectively relieving the obstruction of the LVOT and mitral regurgitation, TA-BSM could significantly improve LA size and function during the short-term follow-up for HOCM patients. The indicators of LA reverse remodelling were associated with reduction in a biomarker of myocardial wall stress, indicating the early recovery of LV relaxation and clinical status for patients.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11343364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of university and training standards in clinical perfusion, an European-wide survey.","authors":"André Giesbrecht, Christian Klüß, Gerdy Debeuckelaere, Maria Angeles Bruño, Folker Wenzel, Matthias Kohl, Filip De Somer, Adrian Bauer","doi":"10.1093/icvts/ivae134","DOIUrl":"10.1093/icvts/ivae134","url":null,"abstract":"<p><strong>Objectives: </strong>Adequate theoretical and practical training of prospective clinical perfusionists is essential for maintaining clinical standards and ensuring patient safety during cardiac surgery procedures. Perfusion schools play a crucial role in establishing and maintaining higher education and training standards in clinical perfusion. The aim of this study is to obtain a comprehensive overview of European training standards in clinical perfusion in 2023.</p><p><strong>Methods: </strong>For this study, 53 perfusion schools in Europe were found and contacted, of which 30 (56.6%) responded, giving a sample size of n = 30, which were then included in the data analysis. The quantitative data of the survey are analysed using descriptive methods.</p><p><strong>Results: </strong>The university and training standards in clinical perfusion in Europe vary in many respects. Starting with the entry criterion for studies (most frequently a required bachelor's degree 36.7% or 2nd most common an university entrance qualification 30%), the duration [from <12 months (13.3%) up to 36 months (13.3%)] and regarding the content of the teaching in clinical perfusion [<30 European Credit Transfer System (ECTS) (33.3%) and more than 180 ECTS (6.7%)]. The mean value for teaching in clinical perfusion content is 62.63 ECTS credits.</p><p><strong>Conclusions: </strong>The obtained results show important differences between countries and schools. As such, they form a valuable database for future discussions establishing a common European curriculum and training standards for perfusionists. For the generalizability of the results, further evaluations and larger samples are needed.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11335367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The surgical outcome of standard lobectomy versus sleeve lobectomy in patients with non-small cell lung cancer: propensity score matching.","authors":"Melike Ülker, Melek Ağkoç, Fahmin Amirov, Salih Duman, Berker Özkan, Mustafa Erelel, Murat Kara, Alper Toker","doi":"10.1093/icvts/ivae133","DOIUrl":"10.1093/icvts/ivae133","url":null,"abstract":"<p><strong>Objectives: </strong>The goal of this study was to compare the patients who underwent standard or sleeve lobectomy for non-small cell lung cancer in terms of postoperative outcomes, prognostic factors and overall survival.</p><p><strong>Methods: </strong>Between January 2002 and January 2020, the patients with squamous cell carcinoma or adenocarcinoma who underwent standard lobectomy or sleeve lobectomy by thoracotomy in our clinic were analysed retrospectively. Standard and sleeve groups were compared after propensity score matching in terms of age, comorbidity, T status, N status and pathological stage. Primary outcomes were morbidity and mortality; the secondary outcome was overall survival.</p><p><strong>Results: </strong>The study included 476 patients, and sleeve lobectomy was performed in 196 (41.1%) patients. Multivariable analysis revealed that age over 61 years (P = 0.003 and P = 0.005, respectively), forced expiratory volume in 1 s (FEV1) below 84% (P = 0.013 and P = 0.205, respectively) and the presence of perineural invasion (P = 0.052 and P = 0.001, respectively) were poor prognostic factors in the standard lobectomy and the sleeve groups. The propensity matching analysis included 276 patients (138 sleeve lobectomy and 138 standard lobectomy). Complications occurred in 96 (69.6%) and 92 (66.7%) patients in the standard and sleeve groups, respectively (P = 0.605). Three (2.2%) patients in the standard group and 5 (3.6%) patients in the sleeve group died within 90 days postoperatively (P = 0.723).</p><p><strong>Conclusions: </strong>Bronchial sleeve lobectomy is a safe procedure that can be applied in oncologically suitable cases without causing higher mortality than a standard lobectomy.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11298412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141604606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of coronary artery reimplantation for anomalous right coronary artery originating from the opposite sinus of Valsalva: preliminary outcomes and insights from a Latin American country.","authors":"Kevin Maldonado-Cañón, Andrés Felipe Motta, Silvia Alejandra Prada, Javier Maldonado-Escalante","doi":"10.1093/icvts/ivae142","DOIUrl":"10.1093/icvts/ivae142","url":null,"abstract":"<p><p>Despite promising results, reimplantation appears to have fallen into oblivion among the multiple possible approaches for repairing anomalous coronary arteries. We describe the outcomes of 12 patients with an anomalous right coronary artery originating from the opposite sinus of Valsalva with an interarterial course who were surgically treated with this technique between 2018 and 2023 in 2 institutions in Bogota, Colombia. We provide preliminary evidence of the value reimplantation as a more than suitable technique, particularly in resource-constrained settings. It offers high rates of control of symptoms and functional class recovery while assessing all potential high-risk features, with a low risk of complications, even in middle-aged patients. We also advocate using noninvasive anatomical descriptions and patient symptoms over inducible ischaemia tests in decision making.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11316611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of patent complete revascularization on the akinetic myocardial segments.","authors":"Min-Seok Kim, Min-Jeong Kim, Hyeon Ju Jeong, Seong Wook Hwang, Ki-Bong Kim","doi":"10.1093/icvts/ivae143","DOIUrl":"10.1093/icvts/ivae143","url":null,"abstract":"<p><strong>Objectives: </strong>The aims of the study were (i) to examine the changes in echocardiographic parameters and (ii) to compare the fate of myocardial segments with akinesia and without akinesia on preoperative echocardiography after coronary artery bypass grafting.</p><p><strong>Methods: </strong>One hundred one patients who underwent complete revascularization, who were assessed by preoperative, before discharge, postoperative 3- and 12-month echocardiographic examinations, and who showed all patent grafts at postoperative 1-year angiograms were included. Echocardiographic left ventricular ejection fraction was assessed, and a 16-segment model was adopted for regional analysis of the left ventricle. A total of 1616 segments were analysed based on a 6-point scale: 1 = normal (N = 1083), 2 = mild hypokinesia (N = 2), 3 = moderate hypokinesia (N = 74), 4 = severe hypokinesia (N = 150), 5 = akinesia without thinning (N = 259) and 6 = akinesia with thinning (N = 48).</p><p><strong>Results: </strong>The serial left ventricular ejection fraction measured preoperatively, before discharge, at postoperative 3- and 12-months were 0.48 ± 0.14, 0.49 ± 0.12, 0.49 ± 0.10 and 0.54 ± 0.10, respectively. The left ventricular ejection fraction significantly increased over time during the postoperative 12 months (P < 0.001). Wall motion scores tended to decrease over time in both segment groups with akinesia and without akinesia (P < 0.001), and improvement of the wall motion was significantly higher in the segment group with akinesia than in the segment group without akinesia (P < 0.001).</p><p><strong>Conclusions: </strong>The left ventricular ejection fraction and regional wall motion improved over time during the postoperative 12 months, regardless of the presence of an akinetic segment. Complete revascularization including akinetic myocardium should be considered when performing coronary artery bypass grafting.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141794189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative and mid-term outcomes of mitral valve surgery with and without concomitant surgical ablation for atrial fibrillation: a retrospective analysis.","authors":"Fabio Pregaldini, Mevlüt Çelik, Selim Mosbahi, Stefania Barmettler, Fabien Praz, David Reineke, Matthias Siepe, Clarence Pingpoh","doi":"10.1093/icvts/ivae144","DOIUrl":"10.1093/icvts/ivae144","url":null,"abstract":"<p><strong>Objectives: </strong>We retrospectively analysed perioperative and mid-term outcomes for patients undergoing mitral valve surgery with and without atrial fibrillation.</p><p><strong>Methods: </strong>Patients who underwent mitral valve surgery between January 2018 and February 2023 were included and categorized into 3 groups: 'No AF' (no documented atrial fibrillation), 'AF no SA' (atrial fibrillation without surgical ablation) and 'AF and SA' (atrial fibrillation with concomitant surgical ablation). Groups were compared for perioperative and mid-term outcomes, including mortality, stroke, bleeding and pacemaker implantation. A P-value <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Of the 400 patients included, preoperative atrial fibrillation was present in 43%. Mean follow-up was 1.8 (standard deviation: 1.1) years. The patients who underwent surgical ablation for atrial fibrillation exhibited similar overall outcomes compared to patients without preoperative atrial fibrillation. Patients with untreated atrial fibrillation showed higher mortality ('No AF': 2.2% versus 'AF no SA': 8.3% versus 'AF and SA': 3.2%; P-value 0.027) and increased postoperative pacemaker implantation rates ('No AF': 5.7% versus 'AF no SA': 15.6% versus 'AF and SA': 7.9%, P-value: 0.011). In a composite analysis of adverse events (Mortality, Bleeding, Stroke), the highest incidence was observed in patients with untreated atrial fibrillation, while patients with treated atrial fibrillation had similar outcomes as those without preoperative documented atrial fibrillation ('No AF': 9.6% versus 'AF no SA': 20.2% versus 'AF and SA' 3: 9.5%, P-value: 0.018).</p><p><strong>Conclusions: </strong>Concomitant surgical ablation should be considered in mitral valve surgery for atrial fibrillation, as it leads to similar mid-term outcomes compared to patients without preoperative documented atrial fibrillation.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11315649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141857251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of veno-arterial extracorporeal life support in awake patients with cardiogenic shock.","authors":"Iris Feng, Sameer Singh, Serge S Kobsa, Yanling Zhao, Paul A Kurlansky, Ashley Zhang, Anna J Vaynrub, Justin A Fried, Koji Takeda","doi":"10.1093/icvts/ivae148","DOIUrl":"10.1093/icvts/ivae148","url":null,"abstract":"<p><strong>Objectives: </strong>This study sought to demonstrate outcomes of veno-arterial extracorporeal life support (VA-ECLS) in non-intubated ('awake') patients with cardiogenic shock, as very few studies have investigated safety and feasibility in this population.</p><p><strong>Methods: </strong>This was a retrospective review of 394 consecutive VA-ECLS patients at our institution from 2017 to 2021. We excluded patients cannulated for indications definitively associated with intubation. Patients were stratified by intubation status at time of cannulation and baseline differences were balanced by inverse probability of treatment weighting. The primary outcome was in-hospital mortality while secondary outcomes included adverse events during ECLS and destination at discharge.</p><p><strong>Results: </strong>Out of 135 patients in the final cohort, 79 were intubated and 56 were awake at time of cannulation. All awake patients underwent percutaneous femoral cannulation with technical success of 100% without intubation. Indications for VA-ECLS in awake patients included acute decompensated heart failure (64.3%), pulmonary hypertension or massive pulmonary embolism (12.5%), myocarditis (8.9%) and acute myocardial infarction (5.4%). After adjustment, awake and intubated patients had similar ECLS duration (7 vs 6 days, P = 0.19), in-hospital mortality (39.6% vs 51.7%, P = 0.28), and rates of various adverse events. Intubation status was not a significant risk factor for 90-day mortality (hazard ratio [95% confidence interval]: 1.26 [0.64, 2.45], P = 0.51) in multivariable analysis. Heart transplantation (15.1% vs 4.9%) and ventricular assist device (17.4% vs 2.2%) were more common destinations at discharge in awake patients than intubated patients (P = 0.02).</p><p><strong>Conclusions: </strong>Awake VA-ECLS is safe and feasible with comparable outcomes as intubated counterparts in select cardiogenic shock patients.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}