Silvia Mariani MD , Alvaro Perazzo MD, MSc , Maria Elena De Piero MD , Bas C.T. van Bussel PhD , Michele Di Mauro PhD , Dominik Wiedemann PhD , Sven Lehmann PhD , Matteo Pozzi PhD , Antonio Loforte PhD , Udo Boeken PhD , Robertas Samalavicius PhD , Karl Bounader MD , Xiaotong Hou PhD , Jeroen J.H. Bunge MD , Kogulan Sriranjan MD , Leonardo Salazar MD , Bart Meyns PhD , Michael A. Mazzeffi PhD , Sacha Matteucci MD , Sandro Sponga PhD , Roberto Lorusso PhD
{"title":"择期、紧急和急诊心脏手术后切开体外膜氧合：来自PELS观察性研究的见解","authors":"Silvia Mariani MD , Alvaro Perazzo MD, MSc , Maria Elena De Piero MD , Bas C.T. van Bussel PhD , Michele Di Mauro PhD , Dominik Wiedemann PhD , Sven Lehmann PhD , Matteo Pozzi PhD , Antonio Loforte PhD , Udo Boeken PhD , Robertas Samalavicius PhD , Karl Bounader MD , Xiaotong Hou PhD , Jeroen J.H. Bunge MD , Kogulan Sriranjan MD , Leonardo Salazar MD , Bart Meyns PhD , Michael A. Mazzeffi PhD , Sacha Matteucci MD , Sandro Sponga PhD , Roberto Lorusso PhD","doi":"10.1016/j.xjon.2025.01.018","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Outcomes in cardiac surgery are influenced by surgical priority, with higher mortality in emergency cases. Whether this applies to postcardiotomy venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains unknown. This study describes characteristics and outcomes of patients undergoing cardiac operations and requiring VA ECMO, stratified by emergency, urgent, or elective operation.</div></div><div><h3>Methods</h3><div>This retrospective multicenter observational study included adults requiring postcardiotomy VA ECMO between 2000 and 2020. Preoperative and procedural characteristics, complications, and survival were compared among the 3 patient groups. The association between emergency surgery and in-hospital survival was investigated through mixed Cox proportional hazard models.</div></div><div><h3>Results</h3><div>The study cohort comprised 1063 patients (52.2%) with elective operations, 445 (21.8%) with urgent operations, and 528 (26%) with emergency operations. Emergency operations included more coronary artery bypass grafting operations (n = 286; 54.2%; <em>P</em> < .001) and aortic procedures (n = 126; 23.9%; <em>P</em> = .001) in patients with more unstable preoperative hemodynamic conditions compared to elective and urgent patients. VA ECMO was initiated more frequently intraoperatively in emergency patients (n = 353; 66.9%; <em>P</em> < .001). Postoperative bleeding (n = 338; 64.3%; <em>P</em> < .001), stroke (n = 79; 15%; <em>P</em> < .001), and right ventricular failure (n = 124; 25.3%) were more frequent after emergency operations. In-hospital mortality was 60.5% in the elective group, 57.8% in the urgent group, 63.4% in the emergency group (<em>P</em> = .191). The crude hazard ratio for in-hospital mortality in emergency surgery was 1.15 (95% confidence interval [CI], 1.01-1.32; <em>P</em> = .039) and dropped to 1.09 (95% CI, 0.93-1.27; <em>P</em> = .295) after adjustment for indicators of preoperative instability. 5-year survival was comparable in 30-day survivors (<em>P</em> = .083).</div></div><div><h3>Conclusions</h3><div>One-quarter of postcardiotomy VA ECMOs are implemented after emergency operations. Despite more complications in emergency cases, in-hospital and 5-year survival are comparable between emergency, urgent, or elective operations.</div></div>","PeriodicalId":74032,"journal":{"name":"JTCVS open","volume":"24 ","pages":"Pages 280-310"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Postcardiotomy extracorporeal membrane oxygenation after elective, urgent, and emergency cardiac operations: Insights from the PELS observational study\",\"authors\":\"Silvia Mariani MD , Alvaro Perazzo MD, MSc , Maria Elena De Piero MD , Bas C.T. van Bussel PhD , Michele Di Mauro PhD , Dominik Wiedemann PhD , Sven Lehmann PhD , Matteo Pozzi PhD , Antonio Loforte PhD , Udo Boeken PhD , Robertas Samalavicius PhD , Karl Bounader MD , Xiaotong Hou PhD , Jeroen J.H. Bunge MD , Kogulan Sriranjan MD , Leonardo Salazar MD , Bart Meyns PhD , Michael A. Mazzeffi PhD , Sacha Matteucci MD , Sandro Sponga PhD , Roberto Lorusso PhD\",\"doi\":\"10.1016/j.xjon.2025.01.018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Outcomes in cardiac surgery are influenced by surgical priority, with higher mortality in emergency cases. Whether this applies to postcardiotomy venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains unknown. This study describes characteristics and outcomes of patients undergoing cardiac operations and requiring VA ECMO, stratified by emergency, urgent, or elective operation.</div></div><div><h3>Methods</h3><div>This retrospective multicenter observational study included adults requiring postcardiotomy VA ECMO between 2000 and 2020. Preoperative and procedural characteristics, complications, and survival were compared among the 3 patient groups. The association between emergency surgery and in-hospital survival was investigated through mixed Cox proportional hazard models.</div></div><div><h3>Results</h3><div>The study cohort comprised 1063 patients (52.2%) with elective operations, 445 (21.8%) with urgent operations, and 528 (26%) with emergency operations. Emergency operations included more coronary artery bypass grafting operations (n = 286; 54.2%; <em>P</em> < .001) and aortic procedures (n = 126; 23.9%; <em>P</em> = .001) in patients with more unstable preoperative hemodynamic conditions compared to elective and urgent patients. VA ECMO was initiated more frequently intraoperatively in emergency patients (n = 353; 66.9%; <em>P</em> < .001). Postoperative bleeding (n = 338; 64.3%; <em>P</em> < .001), stroke (n = 79; 15%; <em>P</em> < .001), and right ventricular failure (n = 124; 25.3%) were more frequent after emergency operations. In-hospital mortality was 60.5% in the elective group, 57.8% in the urgent group, 63.4% in the emergency group (<em>P</em> = .191). The crude hazard ratio for in-hospital mortality in emergency surgery was 1.15 (95% confidence interval [CI], 1.01-1.32; <em>P</em> = .039) and dropped to 1.09 (95% CI, 0.93-1.27; <em>P</em> = .295) after adjustment for indicators of preoperative instability. 5-year survival was comparable in 30-day survivors (<em>P</em> = .083).</div></div><div><h3>Conclusions</h3><div>One-quarter of postcardiotomy VA ECMOs are implemented after emergency operations. Despite more complications in emergency cases, in-hospital and 5-year survival are comparable between emergency, urgent, or elective operations.</div></div>\",\"PeriodicalId\":74032,\"journal\":{\"name\":\"JTCVS open\",\"volume\":\"24 \",\"pages\":\"Pages 280-310\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JTCVS open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666273625000452\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JTCVS open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666273625000452","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Postcardiotomy extracorporeal membrane oxygenation after elective, urgent, and emergency cardiac operations: Insights from the PELS observational study
Background
Outcomes in cardiac surgery are influenced by surgical priority, with higher mortality in emergency cases. Whether this applies to postcardiotomy venoarterial (VA) extracorporeal membrane oxygenation (ECMO) remains unknown. This study describes characteristics and outcomes of patients undergoing cardiac operations and requiring VA ECMO, stratified by emergency, urgent, or elective operation.
Methods
This retrospective multicenter observational study included adults requiring postcardiotomy VA ECMO between 2000 and 2020. Preoperative and procedural characteristics, complications, and survival were compared among the 3 patient groups. The association between emergency surgery and in-hospital survival was investigated through mixed Cox proportional hazard models.
Results
The study cohort comprised 1063 patients (52.2%) with elective operations, 445 (21.8%) with urgent operations, and 528 (26%) with emergency operations. Emergency operations included more coronary artery bypass grafting operations (n = 286; 54.2%; P < .001) and aortic procedures (n = 126; 23.9%; P = .001) in patients with more unstable preoperative hemodynamic conditions compared to elective and urgent patients. VA ECMO was initiated more frequently intraoperatively in emergency patients (n = 353; 66.9%; P < .001). Postoperative bleeding (n = 338; 64.3%; P < .001), stroke (n = 79; 15%; P < .001), and right ventricular failure (n = 124; 25.3%) were more frequent after emergency operations. In-hospital mortality was 60.5% in the elective group, 57.8% in the urgent group, 63.4% in the emergency group (P = .191). The crude hazard ratio for in-hospital mortality in emergency surgery was 1.15 (95% confidence interval [CI], 1.01-1.32; P = .039) and dropped to 1.09 (95% CI, 0.93-1.27; P = .295) after adjustment for indicators of preoperative instability. 5-year survival was comparable in 30-day survivors (P = .083).
Conclusions
One-quarter of postcardiotomy VA ECMOs are implemented after emergency operations. Despite more complications in emergency cases, in-hospital and 5-year survival are comparable between emergency, urgent, or elective operations.
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