Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: Results of a multicenter study

Fausto Biancari (1) , Magnus Dalen (2) , Andrea Perrotti (3) , Antonio Fiore , Daniel Reichart (4) , Sorosh Khodabandeh (2) , Helmut Gulbins (4) , Svante Zipfel (5) , Mosab Al Shakaki , Henryk Welp , Antonella Vezzani , Tiziano Gherli , Jaakko Lommi (6) , Tatu Juvonen , Peter Svenarud (5) , Sidney Chocron (5) , Jean Philippe Verhoye (7) , Karl Bounader (7) , Giuseppe Gatti , Marco Gabrielli , Matteo Saccocci , Eeva-Maija Kinnunen , Francesco Onorati , Giuseppe Santarpino , Khalid Alkhamees , Vito G. Ruggieri (7) , Angelo M. Dell'Aquila

1 Oulu University Hospital [Oulu]
2 Karolinska Institutet [Stockholm]
3 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920)
4 University Heart Center Hamburg
5 IRCCS - Istituti di Ricovero e Cura a Carattere Scientifico
6 UNIPR - Università degli studi di Parma = University of Parma
7 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]

Background The evidence of the benefits of using venoarterial extracorporeal membrane oxygenation (VA-ECMO) after coronary artery bypass grafting (CABG) is scarce. Methods We analyzed the outcomes of patients who received VA-ECMO therapy due to cardiac or respiratory failure after isolated CABG in 12 centers between 2005 and 2016. Patients treated preoperatively with ECMO were excluded from this study. Results VA-ECMO was employed in 148 patients after CABG for median of 5.0 days (mean, 6.4, SD 5.6 days). Inhospital mortality was 64.2%. Pooled in-hospital mortality was 65.9% without significant heterogeneity between the centers (I-2 8.6%). The proportion of VA-ECMO in each center did not affect in-hospital mortality (p = 0.861). No patients underwent heart transplantation and six patients received a left ventricular assist device. Logistic regression showed that creatinine clearance (p = 0.004, OR 0.98, 95% CI 0.97-0.99), pulmonary disease (p = 0.018, OR 4.42, 95% CI 1.29-15.15) and pre-VA-ECMO blood lactate (p = 0.015, OR 1.10, 95% CI 1.02-1.18) were independent baseline predictors of in-hospital mortality. One-, 2-, and 3-year survival was 31.0%, 27.9%, and 26.1%, respectively. Conclusions One third of patients with need for VA-ECMO after CABG survive to discharge. In view of the burden of resources associated with VA-ECMO treatment and the limited number of patients surviving to discharge, further studies are needed to identify patients who may benefit the most from this treatment.

Mots clés: Extracorporeal life support; CABG; ECMO; Coronary artery bypass; ECLS; Post-cardiotomy; Heart failure; Extracorporeal membrane oxygenation

Domaines: Chirurgie

Fausto Biancari, Magnus Dalen, Andrea Perrotti, Antonio Fiore, Daniel Reichart, et al.. Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: Results of a multicenter study. International Journal of Cardiology, 2017, 241, pp.109-114. ⟨10.1016/j.ijcard.2017.03.120⟩. ⟨hal-01921754⟩