Related Experiment Video
Updated: Jan 7, 2026
Point-of-Care Ultrasound for Peripheral Veno-Arterial Extracorporeal Membrane Oxygenation Without Left Ventricular Venting
Published on: January 17, 2025
Outcomes after postcardiotomy venoarterial extracorporeal membrane oxygenation in young patients: An individual
Ilaria Giambuzzi1, Fausto Biancari2, Giorgio Mastroiacovo2
1Department of Cardiac Surgery, Policlinico di Monza, Monza, Italy.
Insights
Younger patients (≤40 years) treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) after cardiac surgery have better survival rates. However, mortality remains high even in this group, with limited use of heart transplantation.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Post-postcardiotomy cardiogenic shock necessitates advanced support.
- Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a critical intervention for severe cardiogenic shock.
- Outcomes of VA-ECMO in young adult cardiac surgery patients require detailed evaluation.
Purpose of the Study:
- To assess early and midterm mortality in young adult patients undergoing VA-ECMO post-cardiac surgery.
- To identify age-related differences in outcomes and treatment strategies.
- To evaluate the impact of heart transplantation on survival in different age groups.
Main Methods:
- Systematic literature review of studies on postcardiotomy VA-ECMO in adults.
- Individual patient-level data analysis from 10 contributing studies.
- Inclusion of 1268 patients from 25 hospitals, with adjusted mortality analyses.
Main Results:
- Age 40 years was a significant cutoff for in-hospital and 24-month mortality.
- Patients >40 years had significantly higher in-hospital (68.8% vs 43.1%) and 24-month mortality (73.7% vs 45.0%).
- Heart transplantation was more frequent in younger patients (11.0% vs 2.9%) and associated with reduced mortality, particularly in older patients.
Conclusions:
- Younger patients (≤40 years) demonstrate significantly lower early and midterm mortality after postcardiotomy VA-ECMO compared to older patients.
- Despite better outcomes, mortality remains substantial in younger patients.
- Heart-replacement therapies are underutilized in younger patients, potentially due to severe perioperative complications.
Objective:
We aimed to evaluate the early and midterm mortality of young patients treated for cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO) after adult cardiac surgery.
Methods:
Studies reporting the outcome after postcardiotomy VA-ECMO in adult patients were identified through a systematic review of the literature. Individual patient-level data were provided by the authors of 10 studies.
Results:
Data on 1268 patients treated at 25 hospitals were included in this study. Adjusted analysis identified 40 years of age as a cutoff value for in-hospital and mid-term mortality. Patients aged >40 years had significantly greater in-hospital mortality (1129 patients, crude rates 68.8% vs 43.1%, adjusted odds ratio, 3.267; 95% confidence interval, 1.970-5.425) and mortality at 24-month (109 patients, crude rates 73.7% vs 45.0%, adjusted hazard ratio, 3.530, 95% confidence interval, 2.571-4.844). Twelve (11.0%) patients aged ≤40 years received a ventricular assist device and heart transplantation, whereas this strategy was adopted in 33 (2.9%) patients aged >40 years (P < .001). Eventually, 7 (6.4%) patients aged ≤40 years and 12 (1.1%) patients aged >40 years underwent heart transplantation (P < .001). Heart transplantation tended to decrease in-hospital mortality in patients aged ≤40 years (14.3% vs 45.1%, P = .138), whereas this difference reached statistical significance in patients aged >40 years (25.0% vs 69.3%, P = .002).
Conclusions:
The present findings suggest that early and midterm mortality after postcardiotomy VA-ECMO is significantly lower in patients aged ≤40 years compared to older patients. However, mortality remains substantial also among these young patients and heart-replacement therapies are infrequently performed in this subset of patients likely because of severe perioperative complications.
