PMID- 38512920
OWN - NLM
STAT- MEDLINE
DCOM- 20240325
LR  - 20240325
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 19
IP  - 3
DP  - 2024
TI  - Mortality in patients with normal left ventricular function requiring emergency 
      VA-ECMO for postcardiotomy cardiogenic shock due to coronary malperfusion.
PG  - e0300568
LID - 10.1371/journal.pone.0300568 [doi]
LID - e0300568
AB  - OBJECTIVES: To analyze outcomes in patients with normal preoperative left 
      ventricular ejection fraction (LVEF) undergoing venoarterial extracorporeal 
      membrane oxygenation (VA-ECMO) therapy due to postcardiotomy cardiogenic shock 
      (PCCS) related to coronary malperfusion. METHODS: Retrospective single-center 
      analysis in patients with normal preoperative LVEF treated with VA-ECMO for 
      coronary malperfusion-related PCCS between May 1998 and May 2018. The primary 
      outcome was 30-day mortality, which was compared using the Kaplan-Meier method 
      and the log-rank test. Multivariable logistic regression was performed to 
      identify predictors of mortality. RESULTS: During the study period, a total of 
      62,125 patients underwent cardiac surgery at our institution. Amongst them, 59 
      patients (0.1%) with normal preoperative LVEF required VA-ECMO support due to 
      coronary malperfusion-related PCCS. The mean duration of VA-ECMO support was 6 
      days (interquartile range 4-7 days). The 30-day mortality was 50.8%. Under 
      VA-ECMO therapy, a complication composite outcome of bleeding, re-exploration for 
      bleeding, acute renal failure, acute liver failure, and sepsis occurred in 51 
      (86.4%) patients. Independent predictors of 30-day mortality were lactate levels 
      > 9.9 mmol/l before VA-ECMO implantation (odds ratio [OR]: 3.3; 95% confidence 
      interval [CI] 1.5-7.0; p = 0.002), delay until revascularization > 278 minutes 
      (OR: 2.9; 95% CI 1.3-6.4; p = 0.008) and peripheral arterial artery disease (OR: 
      3.3; 95% 1.6-7.5; p = 0.001). CONCLUSIONS: Mortality rates are high in patients 
      with normal preoperative LVEF who develop PCCS due to coronary malperfusion. The 
      early implantation of VA-ECMO before the development of profound tissue hypoxia 
      and early coronary revascularization increases the likelihood of survival. 
      Lactate levels are useful to define optimal timing for the VA-ECMO initiation.
CI  - Copyright: (c) 2024 Kang et al. This is an open access article distributed under 
      the terms of the Creative Commons Attribution License, which permits unrestricted 
      use, distribution, and reproduction in any medium, provided the original author 
      and source are credited.
FAU - Kang, Jagdip
AU  - Kang J
AUID- ORCID: 0000-0002-5555-9616
AD  - Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
FAU - Marin-Cuartas, Mateo
AU  - Marin-Cuartas M
AD  - Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
FAU - Flo Forner, Anna
AU  - Flo Forner A
AD  - Department of Anesthesiology and Intensive Care, Leipzig Heart Center, Leipzig, 
      Germany.
FAU - Menon, Priya R
AU  - Menon PR
AD  - Department of Anesthesiology and Intensive Care, Leipzig Heart Center, Leipzig, 
      Germany.
FAU - Ginther, Andre
AU  - Ginther A
AD  - Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
FAU - Saaed, Diyar
AU  - Saaed D
AUID- ORCID: 0000-0001-7449-9455
AD  - Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
FAU - de Waha, Suzanne
AU  - de Waha S
AD  - Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
FAU - Meineri, Massimiliano
AU  - Meineri M
AD  - Department of Anesthesiology and Intensive Care, Leipzig Heart Center, Leipzig, 
      Germany.
FAU - Ender, Jorg
AU  - Ender J
AD  - Department of Anesthesiology and Intensive Care, Leipzig Heart Center, Leipzig, 
      Germany.
FAU - Borger, Michael A
AU  - Borger MA
AD  - Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
LA  - eng
PT  - Journal Article
DEP - 20240321
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Lactates)
SB  - IM
MH  - Humans
MH  - *Shock, Cardiogenic/etiology/therapy
MH  - *Extracorporeal Membrane Oxygenation/methods
MH  - Retrospective Studies
MH  - Ventricular Function, Left
MH  - Stroke Volume
MH  - Lactates
PMC - PMC10956859
COIS- I have read the journal's policy and the authors of this manuscript have the 
      following competing interests: Michael A. Borger discloses that his hospital 
      receives speakers' honoraria and/or consulting fees on his behalf from Edwards 
      Lifesciences, Medtronic, Abbott and CryoLife. The remaining authors have no 
      conflicts of interest or financial relationships with the industry to disclose. 
      This does not alter our adherence to PLOS ONE policies on sharing data and 
      materials.
EDAT- 2024/03/21 18:45
MHDA- 2024/03/25 06:43
PMCR- 2024/03/21
CRDT- 2024/03/21 13:53
PHST- 2023/05/19 00:00 [received]
PHST- 2024/02/29 00:00 [accepted]
PHST- 2024/03/25 06:43 [medline]
PHST- 2024/03/21 18:45 [pubmed]
PHST- 2024/03/21 13:53 [entrez]
PHST- 2024/03/21 00:00 [pmc-release]
AID - PONE-D-23-14194 [pii]
AID - 10.1371/journal.pone.0300568 [doi]
PST - epublish
SO  - PLoS One. 2024 Mar 21;19(3):e0300568. doi: 10.1371/journal.pone.0300568. 
      eCollection 2024.