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Postcardiotomy extracorporeal life support after isolated or valve-concomitant coronary artery bypass grafting: An
Silvia Mariani1,2, Sacha Matteucci1,3, Bas C T van Bussel1,4,5
1Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands.
Insights
Coronary artery bypass grafting with concomitant left heart valve surgery (LHV-CABG) increases in-hospital mortality for patients needing extracorporeal life support (ECLS). However, long-term survival rates are similar to isolated CABG, suggesting improved early management could enhance LHV-CABG outcomes.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Outcomes Research
Background:
- Outcomes data for isolated coronary artery bypass grafting (CABG) versus CABG with concomitant left heart valve surgery (LHV-CABG) in extracorporeal life support (ECLS) settings are inconsistent.
- Patients requiring postcardiotomy ECLS present complex clinical scenarios with varying surgical interventions.
Purpose of the Study:
- To compare patient characteristics, in-hospital outcomes, and overall survival between isolated CABG and LHV-CABG procedures in patients requiring postcardiotomy ECLS.
- To investigate the association between surgical approach (isolated CABG vs. LHV-CABG) and in-hospital survival within an ECLS context.
Main Methods:
- Retrospective, multicenter observational study of adults requiring postcardiotomy ECLS (2000-2020).
- Comparison of clinical characteristics and outcomes between isolated CABG and LHV-CABG groups.
- Mixed-Cox proportional hazards models used to assess in-hospital survival associations.
Main Results:
- The study included 639 patients: 58.8% isolated CABG and 41.1% LHV-CABG.
- LHV-CABG patients were older, had higher rates of preoperative pulmonary hypertension, and required longer bypass times.
- In-hospital mortality was significantly higher in the LHV-CABG group (63.1%) compared to the isolated CABG group (54.8%).
- No significant difference in 5-year postdischarge survival was observed between the two groups.
Conclusions:
- LHV-CABG surgery is associated with increased in-hospital mortality in ECLS patients compared to isolated CABG.
- Midterm postdischarge survival does not differ significantly between LHV-CABG and isolated CABG patients requiring ECLS.
- Early identification and management of patients needing ECLS after LHV-CABG may improve outcomes.
Objectives:
Data on outcomes of patients undergoing isolated coronary artery bypass grafting (isolated CABG) versus CABG and concomitant left heart valve (LHV-CABG) surgery are conflicting, especially in extracorporeal life support (ECLS) settings. We compared characteristics, in-hospital outcomes, and overall survival between patients undergoing isolated-CABG and concomitant LHV-CABG requiring postcardiotomy ECLS from a large multicenter study.
Methods:
This retrospective, multicenter (34 centers), observational study included adults requiring postcardiotomy ECLS between 2000 and 2020. Clinical characteristics and outcomes were compared between patients who underwent isolated CABG with those who underwent LHV-CABG. Association between type of surgery and in-hospital survival was investigated through mixed-Cox proportional hazards models.
Results:
This study included 639 patients comprising 58.8% (n = 376) isolated CABG and 41.1% (n = 263) LHV-CABG, including 46.7% (n = 123) aortic, 38.8% (n = 102) mitral, and 14.5% (n = 38) combined aortic-mitral valve procedures. The LHV-CABG patients were older (P = .001), more frequently experienced preoperative pulmonary artery hypertension (P < .001), and 6.5% (n = 17) had active endocarditis. They required longer cardiopulmonary bypass times (P < .001) and cardiac surgery reoperations (P = .002). In-hospital mortality was 54.8% (n = 206) and 63.1% (n = 166) in the isolated CABG and LHV-CABG groups (P = .036), respectively. Crude hazard ratio for in-hospital mortality in LHV-CABG was 1.28 (95% CI, 1.03-1.58, P = .023) and did not change after adjustments. The 5-year postdischarge survival probabilities were 71.1% (95% CI, 61.0-82.2) and 69.3% (95% CI, 57.7-83.2; P = .210) for isolated CABG and LHV-CABG groups, respectively.
Conclusions:
LHV-CABG surgery, compared with isolated CABG, was associated with higher in-hospital mortality in patients requiring ECLS, whereas no midterm postdischarge survival differences could be detected. Early identification of patients in need for ECLS following LHV-CABG may improve outcomes.
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