PMID- 31185202
OWN - NLM
STAT- MEDLINE
DCOM- 20200116
LR  - 20200116
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 108
IP  - 4
DP  - 2019 Oct
TI  - Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation in Patients Aged 
      70 Years or Older.
PG  - 1257-1264
LID - S0003-4975(19)30809-4 [pii]
LID - 10.1016/j.athoracsur.2019.04.063 [doi]
AB  - BACKGROUND: There is uncertainty whether venoarterial extracorporeal membrane 
      oxygenation (VA-ECMO) should be used in older patients with cardiopulmonary 
      failure after cardiac surgery. METHODS: This was a retrospective multicenter 
      study of 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary 
      failure after adult cardiac surgery from 2010 to 2018 at 19 
      cardiac surgery centers. A parallel systematic review with meta-analysis of the 
      literature was performed. RESULTS: The hospital mortality in the overall 
      Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation (PC-ECMO) series 
      was 64.4%. A total of 255 patients were 70 years old or older (32.7%), and their 
      hospital mortality was significantly higher than in younger patients (76.1% vs 
      58.7%; adjusted odds ratio, 2.199; 95% confidence interval [CI], 1.536 to 3.149). 
      Arterial lactate level greater than 6 mmol/L before starting VA-ECMO was the only 
      predictor of hospital mortality among patients 70 years old or older in 
      univariate analysis (82.6% vs 70.4%; P = .029). Meta-analysis of current and 
      previous studies showed that early mortality after postcardiotomy VA-ECMO was 
      significantly higher in patients aged 70 years or older compared with younger 
      patients (odds ratio, 2.09; 95% CI, 1.59 to 2.75; 5 studies including 1547 
      patients; I(2), 5.9%). The pooled early mortality rate among patients aged 70 
      years or older was 78.8% (95% CI, 74.1 to 83.5; 6 studies including 617 patients; 
      I(2), 41.8%). Two studies reported 1-year mortality (including hospital 
      mortality) of 79.9% and 75.6%, respectively, in patients 70 years old or older. 
      CONCLUSIONS: Advanced age should not be considered a contraindication for 
      postcardiotomy VA-ECMO. However, in view of the high risk of early mortality, 
      meaningful scrutiny is needed before using VA-ECMO after cardiac surgery in older 
      patients.
CI  - Copyright (c) 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Biancari, Fausto
AU  - Biancari F
AD  - Heart Center, Turku University Hospital and Department of Surgery, University of 
      Turku, Turku, Finland; Department of Surgery, University of Oulu, Oulu, Finland. 
      Electronic address: faustobiancari@yahoo.it.
FAU - Saeed, Diyar
AU  - Saeed D
AD  - Department of Cardiovascular Surgery, University Hospital of Dusseldorf, 
      Dusseldorf, Germany.
FAU - Fiore, Antonio
AU  - Fiore A
AD  - Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, 
      Paris-Est University, Creteil, France.
FAU - Dalen, Magnus
AU  - Dalen M
AD  - Department of Molecular Medicine and Surgery, and Department of Cardiac Surgery, 
      Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
FAU - Ruggieri, Vito G
AU  - Ruggieri VG
AD  - Division of Cardiothoracic and Vascular Surgery, Robert Debre University 
      Hospital, Reims, France.
FAU - Jonsson, Kristjan
AU  - Jonsson K
AD  - Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, 
      Sweden.
FAU - Gatti, Giuseppe
AU  - Gatti G
AD  - Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
FAU - Zipfel, Svante
AU  - Zipfel S
AD  - Hamburg University Heart Center, Hamburg, Germany.
FAU - Dell'Aquila, Angelo M
AU  - Dell'Aquila AM
AD  - Department of Cardiothoracic Surgery, Munster University Hospital, Munster, 
      Germany.
FAU - Chocron, Sidney
AU  - Chocron S
AD  - Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean 
      Minjoz, Besancon, France.
FAU - Bounader, Karl
AU  - Bounader K
AD  - Division of Cardiothoracic and Vascular Surgery, Pontchaillou University 
      Hospital, Rennes, France.
FAU - Amr, Gilles
AU  - Amr G
AD  - Division of Cardiothoracic and Vascular Surgery, Robert Debre University 
      Hospital, Reims, France.
FAU - Settembre, Nicla
AU  - Settembre N
AD  - Department of Vascular Surgery, Nancy University Hospital, University of 
      Lorraine, Nancy, France.
FAU - Palve, Kristiina
AU  - Palve K
AD  - Heart Center, Turku University Hospital and Department of Surgery, University of 
      Turku, Turku, Finland.
FAU - Loforte, Antonio
AU  - Loforte A
AD  - Department of Cardiothoracic, Transplantation, and Vascular Surgery, S. Orsola 
      Hospital, University of Bologna, Bologna, Italy.
FAU - Gabrielli, Marco
AU  - Gabrielli M
AD  - Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
FAU - Livi, Ugolino
AU  - Livi U
AD  - Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
FAU - Lechiancole, Andrea
AU  - Lechiancole A
AD  - Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
FAU - Pol, Marek
AU  - Pol M
AD  - Institute of Clinical and Experimental Medicine, Prague, Czech Republic.
FAU - Netuka, Ivan
AU  - Netuka I
AD  - Institute of Clinical and Experimental Medicine, Prague, Czech Republic.
FAU - Spadaccio, Cristiano
AU  - Spadaccio C
AD  - Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, 
      United Kingdom.
FAU - Pettinari, Matteo
AU  - Pettinari M
AD  - Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
FAU - De Keyzer, Dieter
AU  - De Keyzer D
AD  - Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
FAU - Reichart, Daniel
AU  - Reichart D
AD  - Hamburg University Heart Center, Hamburg, Germany.
FAU - Ragnarsson, Sigurdur
AU  - Ragnarsson S
AD  - Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden.
FAU - Alkhamees, Khalid
AU  - Alkhamees K
AD  - Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia.
FAU - Lichtenberg, Artur
AU  - Lichtenberg A
AD  - Department of Cardiovascular Surgery, University Hospital of Dusseldorf, 
      Dusseldorf, Germany.
FAU - Fux, Thomas
AU  - Fux T
AD  - Department of Molecular Medicine and Surgery, and Department of Cardiac Surgery, 
      Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
FAU - El Dean, Zein
AU  - El Dean Z
AD  - Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of 
      Leicester, Leicester, United Kingdom.
FAU - Fiorentino, Mariafrancesca
AU  - Fiorentino M
AD  - Department of Cardiothoracic, Transplantation, and Vascular Surgery, S. Orsola 
      Hospital, University of Bologna, Bologna, Italy.
FAU - Mariscalco, Giovanni
AU  - Mariscalco G
AD  - Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of 
      Leicester, Leicester, United Kingdom.
FAU - Jeppsson, Anders
AU  - Jeppsson A
AD  - Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, 
      Sweden.
FAU - Welp, Henryk
AU  - Welp H
AD  - Department of Cardiothoracic Surgery, Munster University Hospital, Munster, 
      Germany.
FAU - Perrotti, Andrea
AU  - Perrotti A
AD  - Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean 
      Minjoz, Besancon, France.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Multicenter Study
PT  - Systematic Review
DEP - 20190608
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Cardiac Surgical Procedures/*adverse effects
MH  - *Extracorporeal Membrane Oxygenation
MH  - Female
MH  - Heart Arrest/etiology/mortality/*therapy
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Patient Selection
MH  - Postoperative Complications/etiology/mortality/*therapy
MH  - Respiratory Insufficiency/etiology/mortality/*therapy
MH  - Retrospective Studies
EDAT- 2019/06/12 06:00
MHDA- 2020/01/17 06:00
CRDT- 2019/06/12 06:00
PHST- 2019/01/21 00:00 [received]
PHST- 2019/04/01 00:00 [revised]
PHST- 2019/04/15 00:00 [accepted]
PHST- 2019/06/12 06:00 [pubmed]
PHST- 2020/01/17 06:00 [medline]
PHST- 2019/06/12 06:00 [entrez]
AID - S0003-4975(19)30809-4 [pii]
AID - 10.1016/j.athoracsur.2019.04.063 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2019 Oct;108(4):1257-1264. doi: 
      10.1016/j.athoracsur.2019.04.063. Epub 2019 Jun 8.