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Wert L, Stewart GC, Mehra MR, Milwidsky A, Jorde UP, Goldstein DJ, Selzman CH, Stehlik J, Alshamdin FD, Khaliel FH, Gustafsson F, Boschi S, Loforte A, Ajello S, Scandroglio AM, Tučanová Z, Netuka I, Schlöglhofer T, Zimpfer D, Zijderhand CF, Caliskan K, Dogan G, Schmitto JD, Maier S, Schibilsky D, Jawad K, Saeed D, Faerber G, Morshuis M, Hanuna M, Müller CS, Mulzer J, Kempfert J, Falk V, Potapov EV. A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device. J Thorac Cardiovasc Surg 2024; 167:1322-1330.e6. [PMID: 36562497 DOI: 10.1016/j.jtcvs.2022.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/18/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The HeartMate 3 (HM 3; Abbott) left ventricular assist device (LVAD) has improved hemocompatibility-related adverse outcomes. In sporadic cases, external compression of the outflow graft causing obstruction (eOGO) can result from substance accumulation between the outflow graft and its bend relief. We sought to evaluate the prevalence, course, and clinical implications of eOGO in an international study. METHODS A multicenter retrospective analysis of HM 3 LVADs implanted between November 2014 and April 2021 (n = 2108) was conducted across 17 cardiac centers in 8 countries. We defined eOGO as obstruction >25% in the cross-sectional area in imaging (percutaneous angiography, computed tomography, or intravascular ultrasound). The prevalence and annual incidence were calculated. Serious adverse events and outcomes (death, transplantation, or device exchange) were analyzed for eOGO cases. RESULTS Of 2108 patients, 62 were diagnosed with eOGO at a median LVAD support duration of 953 (interquartile range, 600-1267) days. The prevalence of eOGO was 3.0% and the incidence at 1, 2, 3, 4, and 5 years of support was 0.6%, 2.8%, 4.0%, 5.2%, and 9.1%, respectively. Of 62 patients, 9 were observed, 27 underwent surgical revision, 15 underwent percutaneous stent implantation, 8 received a heart transplant, and 2 died before intervention. One patient underwent surgical revision and later stent implantation. The mortality with therapeutic intervention was 9/53 (17.0%). CONCLUSIONS Although uncommon, HM 3 LVAD-supported patients might develop eOGO with an increasing incidence after 1 year of support. Although engineering efforts to reduce this complication are under way, clinicians must maintain a focus on early detection and remain vigilant.
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Affiliation(s)
- Leonhard Wert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
| | - Garrick C Stewart
- Division of Cardiovascular Medicine, Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Mass
| | - Mandeep R Mehra
- Division of Cardiovascular Medicine, Center for Advanced Heart Disease, Brigham and Women's Hospital, Boston, Mass
| | - Assi Milwidsky
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ulrich P Jorde
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Daniel J Goldstein
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Craig H Selzman
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Faisal D Alshamdin
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Feras H Khaliel
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Silvia Boschi
- Department of Cardiac Surgery, IRCCS Bologna, S. Orsola University Hospital, Bologna, Italy
| | - Antonio Loforte
- Department of Cardiac Surgery, IRCCS Bologna, S. Orsola University Hospital, Bologna, Italy
| | - Silvia Ajello
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Anna M Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Zuzana Tučanová
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Thomas Schlöglhofer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Casper F Zijderhand
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Günes Dogan
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Heart Center University Freiburg-Bad Krozingen, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Schibilsky
- Department of Cardiovascular Surgery, Heart Center University Freiburg-Bad Krozingen, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Michiel Morshuis
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Maja Hanuna
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Christoph S Müller
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Munich, Germany
| | - Johanna Mulzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany; Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany; Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland
| | - Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Polastri M, Eden A, Loforte A, Dell'Amore A, Antonini MV, Riera J, Barrett NA, Swol J. Physiotherapy for patients on extracorporeal membrane oxygenation support: How, When, and Who. An international EuroELSO survey. Perfusion 2024; 39:162-173. [PMID: 36239077 DOI: 10.1177/02676591221133657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Extracorporeal membrane oxygenation (ECMO) continues to play an essential role in organ support in cardiogenic shock or acute respiratory distress syndrome and bridging to transplantation. The main purpose of the present survey was to define which clinical and organizational practices are adopted for the administration of physiotherapy in adult patients undergoing ECMO support worldwide. METHODS This international survey was conceived in November 2021. The survey launch was announced at the 10th EuroELSO (European ELSO chapter) Congress, London, May 2022. RESULTS The survey returned 32 questionnaires from 29 centers across 14 countries. 17 centers (53.1%) had more than 30 intensive care unit beds available and most (46.8%) were able to care for five to 10 patients on extracorporeal life support simultaneously. The predominant physiotherapist-to-patient ratio was 1:>5 (37.5%); physiotherapy was available 5/7 days and 7/7 days by 31.2% and 25% respectively. Respiratory physiotherapy was not defined by a specific protocol in most centers (46.8%) while 31.2% declared that the treatment commences less than 12 h after sedation is stopped/reduced. Mostly, early physiotherapy in non-cooperative ventilated patients was provided within the first 48 h (68.6%) and consisted of as passive range of motion, in-bed positioning, and splinting. Postural passages and sitting were provided to patients and walking was included in those advanced motor activities which are part of the treatment. CONCLUSION Physiotherapy in patients on ECLS is feasible, however substantial variability exists between centers with a trend of delivering not protocolized and understaffed rehabilitation practices.
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Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Allaina Eden
- Department of Rehabilitation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Antonio Loforte
- Department of Cardiac-Thoracic-Vascular Diseases, Cardiac Surgery and Transplantation, IRCCS Azienda, Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Dell'Amore
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Division of Thoracic Surgery, University of Padua, Padua, Italy
| | - Marta Velia Antonini
- Intensive Care Unit, Bufalini Hospital, AUSL della Romagna, Cesena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy
| | - Jordi Riera
- Critical Care Department, Vall D´Hebron Research Institute, Barcelona, Spain
| | - Nicholas A Barrett
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Centre for Human & Applied Physiological Sciences (CHAPS), School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Justyna Swol
- Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg, Germany
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Biancari F, Mäkikallio T, Loforte A, Kaserer A, Ruggieri VG, Cho SM, Kang JK, Dalén M, Welp H, Jónsson K, Ragnarsson S, Hernández Pérez FJ, Gatti G, Alkhamees K, Fiore A, Lechiancole A, Rosato S, Spadaccio C, Pettinari M, Perrotti A, Sahli SD, L'Acqua C, Arafat AA, Albabtain MA, AlBarak MM, Laimoud M, Djordjevic I, Krasivskyi I, Samalavicius R, Jankuviene A, Alonso-Fernandez-Gatta M, Wilhelm MJ, Juvonen T, Mariscalco G. Inter-institutional analysis of the outcome after postcardiotomy veno-arterial extracorporeal membrane oxygenation. Int J Artif Organs 2024; 47:25-34. [PMID: 38053227 DOI: 10.1177/03913988231214934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Patients requiring postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) have a high risk of early mortality. In this analysis, we evaluated whether any interinstitutional difference exists in the results of postcardiotomy V-A-ECMO. METHODS Studies on postcardiotomy V-A-ECMO were identified through a systematic review for individual patient data (IPD) meta-analysis. Analysis of interinstitutional results was performed using direct standardization, estimation of observed/expected in-hospital mortality ratio and propensity score matching. RESULTS Systematic review of the literature yielded 31 studies. Data from 10 studies on 1269 patients treated at 25 hospitals were available for the present analysis. In-hospital mortality was 66.7%. The relative risk of in-hospital mortality was significantly higher in six hospitals. Observed versus expected in-hospital mortality ratio showed that four hospitals were outliers with significantly increased mortality rates, and one hospital had significantly lower in-hospital mortality rate. Participating hospitals were classified as underperforming and overperforming hospitals if their observed/expected in-hospital mortality was higher or lower than 1.0, respectively. Among 395 propensity score matched pairs, the overperforming hospitals had significantly lower in-hospital mortality (60.3% vs 71.4%, p = 0.001) than underperforming hospitals. Low annual volume of postcardiotomy V-A-ECMO tended to be predictive of poor outcome only when adjusted for patients' risk profile. CONCLUSIONS In-hospital mortality after postcardiotomy V-A-ECMO differed significantly between participating hospitals. These findings suggest that in many centers there is room for improvement of the results of postcardiotomy V-A-ECMO.
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Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Helsinki, Finland
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Helsinki, Finland
| | - Antonio Loforte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna, and Department of Surgical Science, University of Turin, Turin, Italy
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Vito G Ruggieri
- Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
| | - Sung-Min Cho
- Division of Neurosciences, Critical Care and Cardiac Surgery, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jin Kook Kang
- Division of Neurosciences, Critical Care and Cardiac Surgery, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Magnus Dalén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Henryk Welp
- Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany
| | - Kristján Jónsson
- Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Trieste, Trieste, Italy
| | | | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Creteil, France
| | | | - Stefano Rosato
- Center for Global Health, Italian National Institute, Rome, Italy
| | | | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Andrea Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Sebastian D Sahli
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Camilla L'Acqua
- Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino, Milan, Italy
- Anesthesia and Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Amr A Arafat
- Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Monirah A Albabtain
- Cardiology Clinical Pharmacy, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mohammed M AlBarak
- Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mohamed Laimoud
- Cardiac Surgical Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Ihor Krasivskyi
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Robertas Samalavicius
- II Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Clinic of Emergency Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Agne Jankuviene
- II Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Marta Alonso-Fernandez-Gatta
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
- CIBER-CV Instituto de Salud Carlos III, Madrid, Spain
| | - Markus J Wilhelm
- Clinic for Cardiac Surgery, University Heart Center, University and University Hospital Zurich, Zurich, Switzerland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Research Unit of Surgery, Anesthesia and Intensive Care, University of Oulu, Oulu, Finland
| | - Giovanni Mariscalco
- Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK
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4
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Mariani S, Wang IW, van Bussel BCT, Heuts S, Wiedemann D, Saeed D, van der Horst ICC, Pozzi M, Loforte A, Boeken U, Samalavicius R, Bounader K, Hou X, Bunge JJH, Buscher H, Salazar L, Meyns B, Herr D, Matteucci S, Sponga S, Ramanathan K, Russo C, Formica F, Sakiyalak P, Fiore A, Camboni D, Raffa GM, Diaz R, Jung JS, Belohlavek J, Pellegrino V, Bianchi G, Pettinari M, Barbone A, Garcia JP, Shekar K, Whitman G, Lorusso R. The importance of timing in postcardiotomy venoarterial extracorporeal membrane oxygenation: A descriptive multicenter observational study. J Thorac Cardiovasc Surg 2023; 166:1670-1682.e33. [PMID: 37201778 DOI: 10.1016/j.jtcvs.2023.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/05/2023] [Accepted: 04/22/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Postcardiotomy extracorporeal membrane oxygenation (ECMO) can be initiated intraoperatively or postoperatively based on indications, settings, patient profile, and conditions. The topic of implantation timing only recently gained attention from the clinical community. We compare patient characteristics as well as in-hospital and long-term survival between intraoperative and postoperative ECMO. METHODS The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support (PELS-1) study includes adults who required ECMO due to postcardiotomy shock between 2000 and 2020. We compared patients who received ECMO in the operating theater (intraoperative) with those in the intensive care unit (postoperative) on in-hospital and postdischarge outcomes. RESULTS We studied 2003 patients (women: 41.1%; median age: 65 years; interquartile range [IQR], 55.0-72.0). Intraoperative ECMO patients (n = 1287) compared with postoperative ECMO patients (n = 716) had worse preoperative risk profiles. Cardiogenic shock (45.3%), right ventricular failure (15.9%), and cardiac arrest (14.3%) were the main indications for postoperative ECMO initiation, with cannulation occurring after (median) 1 day (IQR, 1-3 days). Compared with intraoperative application, patients who received postoperative ECMO showed more complications, cardiac reoperations (intraoperative: 19.7%; postoperative: 24.8%, P = .011), percutaneous coronary interventions (intraoperative: 1.8%; postoperative: 3.6%, P = .026), and had greater in-hospital mortality (intraoperative: 57.5%; postoperative: 64.5%, P = .002). Among hospital survivors, ECMO duration was shorter after intraoperative ECMO (median, 104; IQR, 67.8-164.2 hours) compared with postoperative ECMO (median, 139.7; IQR, 95.8-192 hours, P < .001), whereas postdischarge long-term survival was similar between the 2 groups (P = .86). CONCLUSIONS Intraoperative and postoperative ECMO implantations are associated with different patient characteristics and outcomes, with greater complications and in-hospital mortality after postoperative ECMO. Strategies to identify the optimal location and timing of postcardiotomy ECMO in relation to specific patient characteristics are warranted to optimize in-hospital outcomes.
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Affiliation(s)
- Silvia Mariani
- Cardio-Thoracic Surgery Department, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht (CAIRM), Maastricht, The Netherlands.
| | - I-Wen Wang
- Division of Cardiac Surgery, Memorial Healthcare System, Hollywood, Calif
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Samuel Heuts
- Cardio-Thoracic Surgery Department, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht (CAIRM), Maastricht, The Netherlands
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Diyar Saeed
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | - Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - Robertas Samalavicius
- II Department of Anesthesiology, Centre of Anesthesia, Intensive Care and Pain management, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Karl Bounader
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Beijing, China
| | - Jeroen J H Bunge
- Department of Intensive Care Adults, Erasmus MC, Rotterdam, The Netherlands
| | - Hergen Buscher
- Department of Intensive Care Medicine, Center of Applied Medical Research, St Vincent's Hospital, Darlinghurst, Australia
| | - Leonardo Salazar
- Department of Cardiology, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Daniel Herr
- Departments of Medicine and Surgery, University of Maryland, Baltimore, Md
| | - Sacha Matteucci
- SOD Cardiochirurgia Ospedali Riuniti 'Umberto I-Lancisi-Salesi' Università Politecnica delle Marche, Ancona, Italy
| | - Sandro Sponga
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Claudio Russo
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy
| | - Francesco Formica
- Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy, and Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Pranya Sakiyalak
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Antonio Fiore
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Créteil, Paris, France
| | - Daniele Camboni
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Rodrigo Diaz
- ECMO Unit, Departamento de Anestesia, Clínica Las Condes, Santiago, Chile
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jan Belohlavek
- 2nd Department of Internal Medicine, Cardiovascular Medicine General Teaching Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Vin Pellegrino
- Intensive Care Unit, The Alfred Hospital, Melbourne, Australia
| | - Giacomo Bianchi
- Ospedale del Cuore Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | - José P Garcia
- IU Health Advanced Heart & Lung Care, Indiana University Methodist Hospital, Indianapolis, Ind
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia
| | - Glenn Whitman
- Cardiac Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Md
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht (CAIRM), Maastricht, The Netherlands
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5
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Dardi F, Rotunno M, Guarino D, Suarez SM, Niro F, Loforte A, Taglieri N, Ballerini A, Magnani I, Bertozzi R, Donato F, Martini G, Manes A, Saia F, Pacini D, Galiè N, Palazzini M. Comparison of different treatment strategies in patients with chronic thromboembolic pulmonary hypertension: a single centre real-world experience. Int J Cardiol 2023; 391:131333. [PMID: 37673403 DOI: 10.1016/j.ijcard.2023.131333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Pulmonary endarterectomy (PEA) has been the most effective therapy for chronic thromboembolic pulmonary hypertension (CTEPH). However, there is a substantial proportion of patients deemed not operable in whom other treatment strategies are available: medical therapy and balloon pulmonary angioplasty (BPA). We aimed to compare different CTEPH treatment strategies effect in a real-world setting. METHODS All patients with CTEPH referred to our centre were included. We compare the short-term clinical, functional, exercise and haemodynamic effect of medical therapy (irrespective of subsequent treatment strategies), PEA and BPA (irrespective of previous/subsequent treatment strategies); we also describe the long-term outcome of the different patient groups. RESULTS We included 467 patients (39% were treated only with medical therapy, 43% underwent PEA, 13% underwent BPA and 5% were not treated with any therapy). Patients treated only with medical therapy were the oldest; compared to patients undergoing PEA, they had a lower exercise capacity, a higher risk profile and gained a lower haemodynamic, functional and survival benefit from the treatment. Patients undergoing BPA had a lower haemodynamic improvement but a comparable functional, exercise and risk improvement and a similar survival compared to patients undergoing PEA; their survival is anyway better than patients undergoing only medical treatment. Untreated historical control patients had the worst survival. CONCLUSIONS We confirm the superiority of PEA compared to any alternative treatment in CTEPH patients and we observe that BPA, in patients deemed not operable or with persistent/recurrent PH after PEA, leads to a better outcome than medical therapy alone.
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Affiliation(s)
- Fabio Dardi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy.
| | - Mariangela Rotunno
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Daniele Guarino
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Sofia Martin Suarez
- Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy; Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Fabio Niro
- Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Antonio Loforte
- Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy; Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Nevio Taglieri
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Alberto Ballerini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Ilenia Magnani
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Riccardo Bertozzi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Federico Donato
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Giulia Martini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Alessandra Manes
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Davide Pacini
- Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy; Cardiac Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
| | - Massimiliano Palazzini
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Dipartimento DIMEC (Dipartimento di scienze mediche e chirurgiche), Università di Bologna, Italy
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6
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Mariani S, Schaefer AK, van Bussel BCT, Di Mauro M, Conci L, Szalkiewicz P, De Piero ME, Heuts S, Ravaux J, van der Horst ICC, Saeed D, Pozzi M, Loforte A, Boeken U, Samalavicius R, Bounader K, Hou X, Bunge JJH, Buscher H, Salazar L, Meyns B, Herr D, Matteucci S, Sponga S, MacLaren G, Russo C, Formica F, Sakiyalak P, Fiore A, Camboni D, Raffa GM, Diaz R, Wang IW, Jung JS, Belohlavek J, Pellegrino V, Bianchi G, Pettinari M, Barbone A, Garcia JP, Whitman G, Shekar K, Wiedemann D, Lorusso R. On-Support and Postweaning Mortality in Postcardiotomy Extracorporeal Membrane Oxygenation. Ann Thorac Surg 2023; 116:1079-1089. [PMID: 37414384 DOI: 10.1016/j.athoracsur.2023.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/24/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Postcardiotomy venoarterial extracorporeal membrane oxygenation (VA ECMO) is characterized by discrepancies between weaning and survival-to-discharge rates. This study analyzes the differences between postcardiotomy VA ECMO patients who survived, died on ECMO, or died after ECMO weaning. Causes of death and variables associated with mortality at different time points are investigated. METHODS The retrospective, multicenter, observational Postcardiotomy Extracorporeal Life Support Study (PELS) includes adults requiring postcardiotomy VA ECMO between 2000 and 2020. Variables associated with on-ECMO mortality and postweaning mortality were modeled using mixed Cox proportional hazards, including random effects for center and year. RESULTS In 2058 patients (men, 59%; median age, 65 years; interquartile range [IQR], 55-72 years), weaning rate was 62.7%, and survival to discharge was 39.6%. Patients who died (n = 1244) included 754 on-ECMO deaths (36.6%; median support time, 79 hours; IQR, 24-192 hours), and 476 postweaning deaths (23.1%; median support time, 146 hours; IQR, 96-235.5 hours). Multiorgan (n = 431 of 1158 [37.2%]) and persistent heart failure (n = 423 of 1158 [36.5%]) were the main causes of death, followed by bleeding (n = 56 of 754 [7.4%]) for on-ECMO mortality and sepsis (n = 61 of 401 [15.4%]) for postweaning mortality. On-ECMO death was associated with emergency surgery, preoperative cardiac arrest, cardiogenic shock, right ventricular failure, cardiopulmonary bypass time, and ECMO implantation timing. Diabetes, postoperative bleeding, cardiac arrest, bowel ischemia, acute kidney injury, and septic shock were associated with postweaning mortality. CONCLUSIONS A discrepancy exists between weaning and discharge rate in postcardiotomy ECMO. Deaths occurred during ECMO support in 36.6% of patients, mostly associated with unstable preoperative hemodynamics. Another 23.1% of patients died after weaning in association with severe complications. This underscores the importance of postweaning care for postcardiotomy VA ECMO patients.
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Affiliation(s)
- Silvia Mariani
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
| | | | - Bas C T van Bussel
- Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Luca Conci
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Philipp Szalkiewicz
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Maria Elena De Piero
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Samuel Heuts
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Justine Ravaux
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Iwan C C van der Horst
- Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Diyar Saeed
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | - Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich Heine University, Duesseldorf, Germany
| | - Robertas Samalavicius
- II Department of Anesthesiology, Centre of Anesthesia, Intensive Care and Pain Management, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Karl Bounader
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jeroen J H Bunge
- Department of Intensive Care Adults, Erasmus MC, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands
| | - Hergen Buscher
- Department of Intensive Care Medicine, Center of Applied Medical Research, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Leonardo Salazar
- Department of Cardiology, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Daniel Herr
- Department of Medicine, University of Maryland, Baltimore, Maryland; Department of Surgery, University of Maryland, Baltimore, Maryland
| | - Sacha Matteucci
- Struttura Organizzativa Dipartimentale Cardiochirurgia, Ospedali Riuniti 'Umberto I - Lancisi - Salesi' Università Politecnica delle Marche, Ancona, Italy
| | - Sandro Sponga
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Claudio Russo
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy
| | - Francesco Formica
- Cardiac Surgery Unit, San Gerardo Hospital, Monza, Italy; Cardiac Surgery Unit, Department of Medicine and Surgery, University Hospital of Parma, University of Parma, Parma, Italy
| | - Pranya Sakiyalak
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Antonio Fiore
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Créteil, Paris, France
| | - Daniele Camboni
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Rodrigo Diaz
- ECMO Unit, Departamento de Anestesia, Clínica Las Condes, Las Condes, Santiago, Chile
| | - I-Wen Wang
- Division of Cardiac Surgery, Memorial Healthcare System, Hollywood, Florida
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Jan Belohlavek
- Second Department of Internal Medicine, Cardiovascular Medicine General Teaching Hospital, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Vin Pellegrino
- Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Giacomo Bianchi
- Ospedale del Cuore, Fondazione Toscana "G. Monasterio," Massa, Italy
| | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Alessandro Barbone
- Cardiac Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - José P Garcia
- IU Health Advanced Heart & Lung Care, Indiana University Methodist Hospital, Indianapolis, Indiana
| | - Glenn Whitman
- Cardiac Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands
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7
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Francica A, Loforte A, Attisani M, Maiani M, Iacovoni A, Nisi T, Comisso M, Terzi A, De Bonis M, Vendramin I, Boffini M, Musumeci F, Luciani GB, Rinaldi M, Pacini D, Onorati F. Corrigendum: Five-Year Outcome After Continuous Flow LVAD With Full-Magnetic (HeartMate 3) Versus Hybrid Levitation System (HeartWare): A Propensity-Score Matched Study From an All-Comers Multicentre Registry. Transpl Int 2023; 36:12088. [PMID: 37877015 PMCID: PMC10593037 DOI: 10.3389/ti.2023.12088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023]
Abstract
[This corrects the article DOI: 10.3389/ti.2023.11675.].
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Affiliation(s)
| | - Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
- City of Health and Science Hospital, Cardiac Surgery University Unit, University of Turin, Turin, Italy
| | - Matteo Attisani
- City of Health and Science Hospital, Cardiac Surgery University Unit, University of Turin, Turin, Italy
| | - Massimo Maiani
- Division of Cardiac Surgery, Ospedale S. Maria della Misericordia, Udine, Italy
| | - Attilio Iacovoni
- Division of Cardiac Surgery, Papa Giovanni XXII Hospital of Bergamo, Bergamo, Italy
| | - Teodora Nisi
- Division of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Marina Comisso
- Division of Cardiac Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Amedeo Terzi
- Division of Cardiac Surgery, Papa Giovanni XXII Hospital of Bergamo, Bergamo, Italy
| | - Michele De Bonis
- Division of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Igor Vendramin
- Division of Cardiac Surgery, Ospedale S. Maria della Misericordia, Udine, Italy
| | - Massimo Boffini
- City of Health and Science Hospital, Cardiac Surgery University Unit, University of Turin, Turin, Italy
| | - Francesco Musumeci
- Division of Cardiac Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Mauro Rinaldi
- City of Health and Science Hospital, Cardiac Surgery University Unit, University of Turin, Turin, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, University Hospital of Verona, Verona, Italy
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8
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Saxena A, Curran J, Ahmad D, Nasher N, Miyamoto T, Brailovsky E, Shah MK, Rajapreyar IN, Rame JE, Loforte A, Entwistle JW, Massey HT, Tchantchaleishvili V. Utilization and outcomes of V-AV ECMO: A systematic review and meta-analysis. Artif Organs 2023; 47:1559-1566. [PMID: 37537953 DOI: 10.1111/aor.14610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Veno-arterial-venous extracorporeal membrane oxygenation (V-AV ECMO) is a less commonly used configuration of ECMO. We sought to understand the indications, utilization patterns, and outcomes of V-AV ECMO by quantitatively pooling the existing evidence from the literature. METHODS Electronic search was performed to identify all relevant studies reporting V-AV ECMO usage. Five studies comprising 77 patients were selected and cohort-level data were extracted for further analysis. RESULTS Mean patient age was 61 (95% CI: 55.2, 66.5) years and 30% (23/77) were female. The majority of cases [91% (70/77)] were transitioned to V-AV ECMO from another pre-existing ECMO configuration: V-A ECMO in 55% (42/77) vs. V-V ECMO in 36% (28/77), p = 0.04. Only 9% (7/77) of cases were directly placed on V-AV ECMO. The mean duration of hospital stay was 42.3 (95% CI: 10.5, 74.2) days, while ICU mortality was 46% (29, 64). Transition to durable left ventricular assist device was performed in 3% (2/64) of patients, while 3% (2/64) underwent heart transplantation. V-AV ECMO was successfully weaned to explantation in 33% (21/64) of patients. CONCLUSION V-AV ECMO is a viable option for optimizing cardiopulmonary support in selected patients. Survival to weaning or bridging therapy appears comparable to more common ECMO configurations.
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Affiliation(s)
- Abhiraj Saxena
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John Curran
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Danial Ahmad
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nayeem Nasher
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Takuma Miyamoto
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eugene Brailovsky
- Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mahek K Shah
- Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Indranee N Rajapreyar
- Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - J Eduardo Rame
- Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Antonio Loforte
- Dipartimento Cardio-Toraco-Vascolare, UOC di Cardiochirurgia, Policlinico di S. Orsola, Università di Bologna, Bologna, Italy
| | - John W Entwistle
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - H Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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9
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Saeed D, Stark C, Otto W, Loforte A, Zimpfer D, Bernhardt AM, Potapov E, Morshius M, Schibilsky D, Albert A, Raweh A, Riebandt J, Pappalardo F, Attisani M, Rinaldi M, Haneya A, Huenges K, Ramjankhan F, Jorde UP, Lewin D, Jawad K, Aubin H, Ayala R, Reichenspurner H, Lichtenberg A, Borger M, Gummert J. Outcome of patients supported with the HeartMate 3 after extracorporeal life support: On behalf of the Durable Mechanical Circulatory Support After Extracorporeal Life Support Study Group. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00763-8. [PMID: 37689237 DOI: 10.1016/j.jtcvs.2023.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/04/2023] [Accepted: 08/18/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVES The Durable Mechanical Circulatory Support System After Extracorporeal Life Support registry is a multicenter registry of patients who were bridged from extracorporeal life support to a durable mechanical circulatory support system. Although numerous studies have highlighted the favorable outcomes after implantation of the HeartMate 3 (Abbott), the objective of our study is to examine the outcomes of patients who received HeartMate 3 support after extracorporeal life support. METHODS Data of patients undergoing HeartMate 3 implantation from January 2016 to April 2022 at 14 centers were collected and evaluated. Inclusion criteria were patients with extracorporeal life support before HeartMate 3 implantation. The outcome was reported and compared with patients receiving other types of pumps. RESULTS A total of 337 patients were bridged to durable mechanical circulatory support system after extracorporeal life support in the study period. Of those patients, 140 were supported with the HeartMate 3. The other types of pumps included 170 HeartWare HVADs (Medtronic) (86%), 14 HeartMate II devices (7%), and 13 (7%) other pumps (7%). Major postoperative complications included right heart failure requiring temporary right ventricular assist device in 60 patients (47%). Significantly lower postoperative stroke (16% vs 28%, P = .01) and pump thrombosis (3% vs 8%, P = .02) rates were observed in the patients receiving the HeartMate 3. The 30-day, 1-year, and 3-year survivals in patients receiving the HeartMate 3 were 87%, 73%, and 65%, respectively. CONCLUSIONS In this critically ill patient population, the survivals of patients who were transitioned to the HeartMate 3 are deemed acceptable and superior to those observed when extracorporeal life support was bridged to other types of durable mechanical circulatory support systems.
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Affiliation(s)
- Diyar Saeed
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
| | - Christoffer Stark
- Department of Cardiac Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Wolfgang Otto
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Antonio Loforte
- Department of Cardiac Surgery, Bologna University, Bologna, Italy; Department of Cardiac Surgery, Klinikum Dortmund, Dortmund, Germany
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Michiel Morshius
- Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | - David Schibilsky
- Department of Cardiac and Vascular Surgery, Freiburg University, Freiburg, Germany
| | | | | | - Julia Riebandt
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - Federico Pappalardo
- Advanced Heart Failure and Mechanical Circulatory Support Program, San Raffaele Hospital, Vita Salute University, Milan, Italy
| | - Matteo Attisani
- Department of Cardiac Surgery, Klinikum Dortmund, Dortmund, Germany
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Klinikum Dortmund, Dortmund, Germany
| | - Assad Haneya
- Department of Cardiac Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Katharina Huenges
- Department of Cardiac Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Faiz Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ulrich P Jorde
- Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Daniel Lewin
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Khalil Jawad
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Hug Aubin
- Department for Cardiac Surgery, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Rafael Ayala
- Department of Cardiac and Vascular Surgery, Freiburg University, Freiburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Artur Lichtenberg
- Department for Cardiac Surgery, Duesseldorf University Hospital, Duesseldorf, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Jan Gummert
- Department of Cardiovascular and Thoracic Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
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10
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Francica A, Loforte A, Attisani M, Maiani M, Iacovoni A, Nisi T, Comisso M, Terzi A, De Bonis M, Vendramin I, Boffini M, Musumeci F, Luciani GB, Rinaldi M, Pacini D, Onorati F. Five-Year Outcome After Continuous Flow LVAD With Full-Magnetic (HeartMate 3) Versus Hybrid Levitation System (HeartWare): A Propensity-Score Matched Study From an All-Comers Multicentre Registry. Transpl Int 2023; 36:11675. [PMID: 37727385 PMCID: PMC10505657 DOI: 10.3389/ti.2023.11675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023]
Abstract
Despite the withdrawal of the HeartWare Ventricular Assist Device (HVAD), hundreds of patients are still supported with this continuous-flow pump, and the long-term management of these patients is still under debate. This study aims to analyse 5 years survival and freedom from major adverse events in patients supported by HVAD and HeartMate3 (HM3). From 2010 to 2022, the MIRAMACS Italian Registry enrolled all-comer patients receiving a LVAD support at seven Cardiac Surgery Centres. Out of 447 LVAD implantation, 214 (47.9%) received HM3 and 233 (52.1%) received HVAD. Cox-regression analysis adjusted for major confounders showed an increased risk for mortality (HR 1.5 [1.2-1.9]; p = 0.031), for both ischemic stroke (HR 2.08 [1.06-4.08]; p = 0.033) and haemorrhagic stroke (HR 2.6 [1.3-4.9]; p = 0.005), and for pump thrombosis (HR 25.7 [3.5-188.9]; p < 0.001) in HVAD patients. The propensity-score matching analysis (130 pairs of HVAD vs. HM3) confirmed a significantly lower 5 years survival (81.25% vs. 64.1%; p 0.02), freedom from haemorrhagic stroke (90.5% vs. 70.1%; p < 0.001) and from pump thrombosis (98.5% vs. 74.7%; p < 0.001) in HVAD cohort. Although similar perioperative outcome, patients implanted with HVAD developed a higher risk for mortality, haemorrhagic stroke and thrombosis during 5 years of follow-up compared to HM3 patients.
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Affiliation(s)
| | - Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
- City of Health and Science Hospital, Cardiac Surgery University Unit, University of Turin, Turin, Italy
| | - Matteo Attisani
- City of Health and Science Hospital, Cardiac Surgery University Unit, University of Turin, Turin, Italy
| | - Massimo Maiani
- Division of Cardiac Surgery, Ospedale S. Maria della Misericordia, Udine, Italy
| | - Attilio Iacovoni
- Division of Cardiac Surgery, Papa Giovanni XXII Hospital of Bergamo, Bergamo, Italy
| | - Teodora Nisi
- Division of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Marina Comisso
- Division of Cardiac Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Amedeo Terzi
- Division of Cardiac Surgery, Papa Giovanni XXII Hospital of Bergamo, Bergamo, Italy
| | - Michele De Bonis
- Division of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Igor Vendramin
- Division of Cardiac Surgery, Ospedale S. Maria della Misericordia, Udine, Italy
| | - Massimo Boffini
- City of Health and Science Hospital, Cardiac Surgery University Unit, University of Turin, Turin, Italy
| | - Francesco Musumeci
- Division of Cardiac Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Mauro Rinaldi
- City of Health and Science Hospital, Cardiac Surgery University Unit, University of Turin, Turin, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, University Hospital of Verona, Verona, Italy
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11
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Mariani S, Heuts S, van Bussel BCT, Di Mauro M, Wiedemann D, Saeed D, Pozzi M, Loforte A, Boeken U, Samalavicius R, Bounader K, Hou X, Bunge JJH, Buscher H, Salazar L, Meyns B, Herr D, Matteucci MLS, Sponga S, MacLaren G, Russo C, Formica F, Sakiyalak P, Fiore A, Camboni D, Raffa GM, Diaz R, Wang I, Jung J, Belohlavek J, Pellegrino V, Bianchi G, Pettinari M, Barbone A, Garcia JP, Shekar K, Whitman GJR, Lorusso R. Patient and Management Variables Associated With Survival After Postcardiotomy Extracorporeal Membrane Oxygenation in Adults: The PELS-1 Multicenter Cohort Study. J Am Heart Assoc 2023; 12:e029609. [PMID: 37421269 PMCID: PMC10382118 DOI: 10.1161/jaha.123.029609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/25/2023] [Indexed: 07/10/2023]
Abstract
Background Extracorporeal membrane oxygenation (ECMO) has been increasingly used for postcardiotomy cardiogenic shock, but without a concomitant reduction in observed in-hospital mortality. Long-term outcomes are unknown. This study describes patients' characteristics, in-hospital outcome, and 10-year survival after postcardiotomy ECMO. Variables associated with in-hospital and postdischarge mortality are investigated and reported. Methods and Results The retrospective international multicenter observational PELS-1 (Postcardiotomy Extracorporeal Life Support) study includes data on adults requiring ECMO for postcardiotomy cardiogenic shock between 2000 and 2020 from 34 centers. Variables associated with mortality were estimated preoperatively, intraoperatively, during ECMO, and after the occurrence of any complications, and then analyzed at different time points during a patient's clinical course, through mixed Cox proportional hazards models containing fixed and random effects. Follow-up was established by institutional chart review or contacting patients. This analysis included 2058 patients (59% were men; median [interquartile range] age, 65.0 [55.0-72.0] years). In-hospital mortality was 60.5%. Independent variables associated with in-hospital mortality were age (hazard ratio [HR], 1.02 [95% CI, 1.01-1.02]) and preoperative cardiac arrest (HR, 1.41 [95% CI, 1.15-1.73]). In the subgroup of hospital survivors, the overall 1-, 2-, 5-, and 10-year survival rates were 89.5% (95% CI, 87.0%-92.0%), 85.4% (95% CI, 82.5%-88.3%), 76.4% (95% CI, 72.5%-80.5%), and 65.9% (95% CI, 60.3%-72.0%), respectively. Variables associated with postdischarge mortality included older age, atrial fibrillation, emergency surgery, type of surgery, postoperative acute kidney injury, and postoperative septic shock. Conclusions In adults, in-hospital mortality after postcardiotomy ECMO remains high; however, two-thirds of those who are discharged from hospital survive up to 10 years. Patient selection, intraoperative decisions, and ECMO management remain key variables associated with survival in this cohort. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03857217.
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Affiliation(s)
- Silvia Mariani
- Cardio‐Thoracic Surgery Department and Cardiovascular Research Institute MaastrichtMaastrichtthe Netherlands
| | - Samuel Heuts
- Cardio‐Thoracic Surgery Department and Cardiovascular Research Institute MaastrichtMaastrichtthe Netherlands
| | - Bas C. T. van Bussel
- Department of Intensive Care Medicine and Cardiovascular Research Institute MaastrichtMaastrichtthe Netherlands
| | - Michele Di Mauro
- Cardio‐Thoracic Surgery Department and Cardiovascular Research Institute MaastrichtMaastrichtthe Netherlands
| | - Dominik Wiedemann
- Department of Cardiac SurgeryMedical University of ViennaViennaAustria
| | - Diyar Saeed
- Department of Cardiac SurgeryLeipzig Heart CenterLeipzigGermany
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Cardiologic HospitalLyonFrance
| | - Antonio Loforte
- Division of Cardiac SurgeryIstituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero–Universitaria di BolognaBolognaItaly
- Department of Surgical SciencesUniversity of TurinTurinItaly
| | - Udo Boeken
- Department of Cardiac Surgery, Medical FacultyHeinrich Heine UniversityDuesseldorfGermany
| | - Robertas Samalavicius
- II Department of Anesthesiology, Centre of Anesthesia, Intensive Care and Pain ManagementVilnius University Hospital Santariskiu KlinikosVilniusLithuania
| | - Karl Bounader
- Division of Cardiothoracic and Vascular SurgeryPontchaillou University HospitalRennesFrance
| | - Xiaotong Hou
- Center for Cardiac Intensive CareBeijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Jeroen J. H. Bunge
- Department of Intensive Care AdultsErasmus Medical CenterRotterdamthe Netherlands
| | - Hergen Buscher
- Department of Intensive Care Medicine, Center of Applied Medical ResearchSt Vincent’s HospitalDarlinghursNew South WalesAustralia
- University of New South WalesSydneyAustralia
| | - Leonardo Salazar
- Department of Cardiology, Fundación Cardiovascular de ColombiaBucaramangaColombia
| | - Bart Meyns
- Department of Cardiac SurgeryUniversity Hospitals Leuven and Department of Cardiovascular Sciences, University of LeuvenLeuvenBelgium
| | - Daniel Herr
- Departments of Medicine and SurgeryUniversity of MarylandBaltimoreMD
| | - Marco L. Sacha Matteucci
- Struttura Organizzativa Dipartimentale di CardiochirurgiaOspedali Riuniti ‘Umberto I–Lancisi‐Salesi’ Università Politecnica delle MarcheAnconaItaly
| | - Sandro Sponga
- Division of Cardiac Surgery, Cardiothoracic DepartmentUniversity Hospital of UdineUdineItaly
| | - Graeme MacLaren
- Cardiothoracic Intensive Care UnitNational University Heart Centre, National University HospitalSingaporeSingapore
| | - Claudio Russo
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda HospitalMilanItaly
| | - Francesco Formica
- Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo HospitalUniversity of Milano‐BicoccaMonzaItaly
- Department of Medicine and SurgeryUniversity of Parma, Cardiac Surgery Unit, University Hospital of ParmaParmaItaly
| | - Pranya Sakiyalak
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Antonio Fiore
- Department of Cardio‐Thoracic SurgeryUniversity Hospital Henri‐Mondor, CréteilParisFrance
| | - Daniele Camboni
- Department of Cardiothoracic SurgeryUniversity Medical Center RegensburgRegensburgGermany
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIstituti di Ricovero e Cura a Carattere Scientifico ‐ Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione)PalermoItaly
| | - Rodrigo Diaz
- Extracorporeal Membrane Oxygenation Unit, Departamento de AnestesiaClínica Las Condes, Las CondesSantiagoChile
| | - I‐wen Wang
- Division of Cardiac Surgery, Memorial Healthcare SystemHollywoodFL
| | - Jae‐Seung Jung
- Department of Thoracic and Cardiovascular SurgeryKorea University Anam HospitalSeoulSouth Korea
| | - Jan Belohlavek
- 2nd Department of Internal Medicine, Cardiovascular Medicine General Teaching Hospital and 1st Faculty of MedicineCharles University in PraguePragueCzech Republic
| | - Vin Pellegrino
- Intensive Care Unit, The Alfred HospitalMelbourneVictoriaAustralia
| | - Giacomo Bianchi
- Ospedale del Cuore Fondazione Toscana "G. Monasterio"MassaItaly
| | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost‐LimburgGenkBelgium
| | - Alessandro Barbone
- Cardiac Surgery UnitIstituto di Ricovero e Cura a Carattere Scientifico Humanitas Research HospitalRozzanoMilanItaly
| | - José P. Garcia
- Indiana University Health Advanced Heart and Lung Care, Indiana University Methodist HospitalIndianapolisIN
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles HospitalBrisbaneAustralia
| | | | - Roberto Lorusso
- Cardio‐Thoracic Surgery Department and Cardiovascular Research Institute MaastrichtMaastrichtthe Netherlands
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12
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Heuts S, Mariani S, van Bussel BCT, Boeken U, Samalavicius R, Bounader K, Hou X, Bunge JJH, Sriranjan K, Wiedemann D, Saeed D, Pozzi M, Loforte A, Salazar L, Meyns B, Mazzeffi MA, Matteucci S, Sponga S, Sorokin V, Russo C, Formica F, Sakiyalak P, Fiore A, Camboni D, Raffa GM, Diaz R, Wang IW, Jung JS, Belohlavek J, Pellegrino V, Bianchi G, Pettinari M, Barbone A, Garcia JP, Shekar K, Whitman G, Lorusso R. The Relation Between Obesity and Mortality in Postcardiotomy Venoarterial Membrane Oxygenation. Ann Thorac Surg 2023; 116:147-154. [PMID: 37015310 DOI: 10.1016/j.athoracsur.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Obesity is an important health problem in cardiac surgery and among patients requiring postcardiotomy venoarterial extracorporeal membrane oxygenation (V-A ECMO). Still, whether these patients are at risk for unfavorable outcomes after postcardiotomy V-A ECMO remains unclear. The current study evaluated the association between body mass index (BMI) and in-hospital outcomes in this setting. METHODS The Post-cardiotomy Extracorporeal Life Support (PELS-1) study is an international, multicenter study. Patients requiring postcardiotomy V-A ECMO in 36 centers from 16 countries between 2000 and 2020 were included. Patients were divided in 6 BMI categories (underweight, normal weight, overweight, class I, class II, and class III obesity) according to international recommendations. Primary outcome was in-hospital mortality, and secondary outcomes included major adverse events. Mixed logistic regression models were applied to evaluate associations between BMI and mortality. RESULTS The study cohort included 2046 patients (median age, 65 years; 838 women [41.0%]). In-hospital mortality was 60.3%, without statistically significant differences among BMI classes for in-hospital mortality (P = .225) or major adverse events (P = .126). The crude association between BMI and in-hospital mortality was not statistically significant after adjustment for comorbidities and intraoperative variables (class I: odds ratio [OR], 1.21; 95% CI, 0.88-1.65; class II: OR, 1.45; 95% CI, 0.86-2.45; class III: OR, 1.43; 95% CI, 0.62-3.33), which was confirmed in multiple sensitivity analyses. CONCLUSIONS BMI is not associated to in-hospital outcomes after adjustment for confounders in patients undergoing postcardiotomy V-A ECMO. Therefore, BMI itself should not be incorporated in the risk stratification for postcardiotomy V-A ECMO.
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Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+ and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Silvia Mariani
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+ and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Bas C T van Bussel
- Department of Intensive Care Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht, the Netherlands
| | - Udo Boeken
- Heinrich Heine University, Düsseldorf, Germany
| | | | | | - Xiaotong Hou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Kogulan Sriranjan
- Centre of Applied Medical Research, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; University of New South Wales, Sidney, New South Wales, Australia
| | | | | | | | - Antonio Loforte
- Istituto di Ricovero e Cura a Carattere Scientifico Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Bart Meyns
- Department of Cardiovascular Sciences, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | | | - Sacha Matteucci
- Strutture Organizzative Dipartimentali Cardiochirurgia Ospedali Riuniti 'Umberto I-Lancisi-Salesi' Università Politecnica delle Marche, Ancona, Italy
| | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Vitaly Sorokin
- National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Claudio Russo
- Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy
| | - Francesco Formica
- San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Pranya Sakiyalak
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Antonio Fiore
- University Hospital Henri-Mondor, Créteil, Paris, France
| | | | - Giuseppe Maria Raffa
- IRCCS-ISMETT (Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Rodrigo Diaz
- ECMO Unit, Departamento de Anestesia, Clínica Las Condes, Las Condes, Santiago, Chile
| | - I-Wen Wang
- Memorial Healthcare System, Hollywood, Florida
| | - Jae-Seung Jung
- Korea University College of Medicine, Seoul, South Korea
| | - Jan Belohlavek
- General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Giacomo Bianchi
- Ospedale del Cuore Fondazione Toscana "G. Monasterio," Massa, Italy
| | | | - Alessandro Barbone
- Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Milan, Italy
| | - José P Garcia
- Indiana University Methodist Hospital, Indianapolis, Indiana
| | - Kiran Shekar
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | | | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+ and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
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13
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Saeed D, Feldman D, Banayosy AE, Birks E, Blume E, Cowger J, Hayward C, Jorde U, Kremer J, MacGowan G, Maltais S, Maybaum S, Mehra M, Shah KB, Mohacsi P, Schweiger M, Schroeder SE, Shah P, Slepian M, Tops LF, Alvarez P, Arabia F, Aslam S, Benson-Louis L, Birati E, Buchholz HW, Cedars A, Christensen D, Ciarka A, Coglianese E, Cogswell R, Cook J, Copeland J, Costello JG, Drakos SG, Eghtesady P, Elliot T, Estep JD, Eulert-Grehn JJ, Fabrizio DR, Garbade J, Gelow J, Guglin M, Hernandez-Montfort J, Horstmanshof D, John R, Kanwar M, Khaliel F, Kim G, Kumar S, Lavee J, Leache M, Leprince P, Lim S, Loforte A, Maly J, Najjar S, Netuka I, Pamboukian SV, Patel SR, Pinney S, Pluym CV, Potapov E, Robson D, Rochlani Y, Russell S, Sandau K, Sandoval E, Sayer G, Schettle S, Schibilsky D, Schlöglhofer T, Schmitto J, Siddique A, Silvestry S, Slaughter MS, Sun B, Takayama H, Tedford R, Teuteberg JJ, Ton VK, Uriel N, Vierecke J, Zimpfer D, D'Alessandro D. The 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: A 10- Year Update. J Heart Lung Transplant 2023; 42:e1-e222. [PMID: 37245143 DOI: 10.1016/j.healun.2022.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/05/2022] [Indexed: 05/29/2023] Open
Affiliation(s)
- Diyar Saeed
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany..
| | - David Feldman
- University of Cincinnati & Cincinnati Childrens Hosptial, Cincinnati, Ohio, USA.
| | - Aly El Banayosy
- Integris Nazih Zuhdi Transplant Institute, Oklahoma City, OK, USA
| | - Emma Birks
- University of Louisville, Louisville, KY, USA
| | | | - Jennifer Cowger
- Department of Cardiology, Henry Ford Hospital, Detroit, MI, USA
| | - Christopher Hayward
- Faculty of Medicine, St Vincent's Hospital, University of New South Wales, Sydney, Australia
| | | | - Jamila Kremer
- Department of Cardiothoracic Surgery, Heidelberg University, Heidelberg, Germany
| | - Guy MacGowan
- Newcastle Upon Tyne Hospitals, and Newcastle University, Newcastle upon Tyne, UK
| | - Simon Maltais
- Department of cardiac Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Keyur B Shah
- Department of Cardiology, Virginia Commonwealth University, Virginia
| | - Paul Mohacsi
- CardioVascular Center Im Park, Seestrasse 247, CH-8038 Zürich
| | | | | | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church VA, USA
| | | | - Laurens F Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Paulino Alvarez
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francisco Arabia
- Advanced Heart Program, Banner University Medical Group, Phoenix, AZ, USA
| | - Saima Aslam
- University of California, San Diego, San Diego, CA, USA
| | | | - Edo Birati
- Cardiovascular Division, Padeh-Poriya Medical Center, Bar Ilan University, Israel
| | | | - Ari Cedars
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Erin Coglianese
- Department of Medicine/Cardiology, Mass General Hospital, Harvard School of Medicine, Boston Massachusetts USA
| | | | - Jennifer Cook
- University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jack Copeland
- Department of Surgery, Division of Cardiothoracic Surgery, University of Arizona, Tucson, AZ, USA
| | | | - Stavros G Drakos
- University of Utah Health and School of Medicine and Salt Lake VA Medical Center, Salt Lake City, Utah, USA
| | - Pirooz Eghtesady
- Department of Pediatrics, Washington University in St. Louis, USA
| | | | - Jerry D Estep
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | | | - De Rita Fabrizio
- Consultant in Congenital Heart Surgery, Adult and Paediatric Congenital Heart Unit Freeman Hospital, Newcastle Upon Tyne, UK
| | - Jens Garbade
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzg, Germany
| | - Jill Gelow
- Department of Pediatrics, Providence Heart Institute, Portland, Oregon, USA
| | | | | | | | - Ranjit John
- University of Minnesota, Minneapolis, MN, USA
| | | | - Feras Khaliel
- King Faisal Specialist Hospital & Research Center, Riyadh
| | - Gene Kim
- Department of Cardiology, University of Chicago, Illinois, USA
| | - Sachin Kumar
- Division of Cardiovascular Surgery, Advanced Heart Failure Program, University of Texas Medical Center, Houston, Texas, USA
| | - Jacob Lavee
- Department of Cardiac Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Marzia Leache
- Department of Cardiac Surgery, New Yok University Medical Center, New York, NY, USA
| | - Pascal Leprince
- Department of Thoracic and Cardiovascular Surgery, Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Sern Lim
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Antonio Loforte
- Bologna University, Cardiothorac, Transplant and Vasc Surg Dept, Bologna, Italy
| | - Jiri Maly
- Department of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czeck Republic
| | - Samer Najjar
- Department of Medicine, MedStar Washington Hospital Center, Georgetown University, Wahington DC USA
| | - Ivan Netuka
- Dept. of Cardiac Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | - Snehal R Patel
- Cardiology Division, Montefiore Medical Center, Bronx, NY, USA
| | - Sean Pinney
- Mount Sinai Medical Center, New York, NY, USA
| | - Christina Vander Pluym
- Division of Cardiology, Boston Children's Hospital/Harvard School of Medicine, Boston, Massachusetts, USA
| | | | - Desiree Robson
- Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | | | | | | | | | - Gabriel Sayer
- University of Chicago Medical Center, Chicago, IL, USA
| | | | - David Schibilsky
- Department of Surgery, Universitats- Herzzentrum, Freiburg Germany
| | | | - Jan Schmitto
- Dept. of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Aleem Siddique
- Department of Surgery, University of Nebraska Medical Center, Omha, Nebraska, USA
| | - Scott Silvestry
- Department of Cardiac Surgery, Florida Hospital, Orlando, FL, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Kentucky, USA
| | - Benjamin Sun
- Cardiac Surgery department, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Hiroo Takayama
- Department of Cardiac Surgery, Columbia University Medical Center, New York, NY, USA
| | - Ryan Tedford
- Department of Medicine/Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Van-Khue Ton
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nir Uriel
- Department of Cardiology, Columbia University, New York, NY, USA
| | - Juliane Vierecke
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Daniel Zimpfer
- Department of Cardiac Surgery, Medical University Vienna, Vienna, Austria
| | - David D'Alessandro
- Massachusetts General Hospital, Boston, Harvard School of Medicine, Boston, MA, USA.
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14
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Mariani S, Bari G, Ravaux JM, van Bussel BCT, De Piero ME, Schaefer AK, Jawad K, Pozzi M, Loforte A, Kalampokas N, Jankuviene A, Flecher E, Hou X, Bunge JJH, Sriranjan K, Salazar L, Meyns B, Mazzeffi MA, Matteucci S, Sponga S, Ramanathan K, Costetti A, Formica F, Sakiyalak P, Fiore A, Schmid C, Raffa GM, Castillo R, Wang IW, Jung JS, Grus T, Pellegrino V, Bianchi G, Pettinari M, Barbone A, Garcia JP, Kowalewski M, Shekar K, Whitman G. Heterogeneity in Clinical Practices for Post-Cardiotomy Extracorporeal Life Support: a Pilot Survey from the PELS-1 Multicenter Study. Artif Organs 2023. [PMID: 37351569 DOI: 10.1111/aor.14601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/13/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND High-quality evidence for post-cardiotomy extracorporeal life support (PC-ECLS) management is lacking. This study investigated the real-world PC-ECLS clinical practices. METHODS This cross-sectional, multi-institutional, international pilot survey explored center organization, anticoagulation management, left ventricular unloading, distal limb perfusion, PC-ECLS monitoring and transfusions practices. Twenty-nine questions were distributed among 34 hospitals participating in the Post-cardiotomy Extra-Corporeal Life Support Study. RESULTS Of the 32 centers [16 low-volume (50%); 16 high-volume (50%)] that responded, 16 (50%) had dedicated ECLS specialists. Twenty-six centers (81.3%) reported using additional mechanical circulatory supports. Anticoagulation practices were highly heterogeneous: 24 hospitals (75%) reported using patient's bleeding status as a guide, without a specific threshold in 54.2% of cases. Transfusion targets ranged 7-10 g/dL. Most centers used cardiac venting on a case-by-case basis (78.1%) and regular distal limb perfusion (84.4%). Nineteen (54.9%) centers reported dedicated monitoring protocols including daily echocardiography (87.5%), Swan-Ganz catheterization (40.6%), cerebral near-infrared spectroscopy (53.1%) and multimodal assessment of limb ischemia. Inspection of the circuit (71.9%), oxygenator pressure drop (68.8%), plasma free hemoglobin (75%), d-dimer (59.4%), lactate dehydrogenase (56.3%) and fibrinogen (46.9%) are used to diagnose hemolysis and thrombosis. CONCLUSIONS This study shows remarkable heterogeneity in clinical practices for PC-ECLS management. More standardized protocols and better implementation of available evidence are recommended.
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Affiliation(s)
- Silvia Mariani
- Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Gabor Bari
- Clinic of Internal Medicine, Department of Cardiac Surgery, University of Szeged, Szeged, Hungary
| | - Justine M Ravaux
- Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Bas C T van Bussel
- Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
- Department of Intensive Care Medicine, and Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Maria Elena De Piero
- Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | | | - Khalil Jawad
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | - Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- University of Turin, Department of Surgical Sciences, Turin, Italy
| | - Nikolaos Kalampokas
- Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany
| | - Agne Jankuviene
- II Department of Anesthesiology, Centre of Anesthesia, Intensive Care and Pain management, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania
| | - Erwan Flecher
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Xiaotong Hou
- Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung, and Blood Vessels Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jeroen J H Bunge
- Department of Intensive Care Adults, and Department of cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Kogulan Sriranjan
- Department of Intensive Care Medicine, Center of Applied Medical Research, St Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Leonardo Salazar
- Department of Cardiology, Fundación Cardiovascular de Colombia, Bucaramanga, Colombia
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospitals Leuven and Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Michael A Mazzeffi
- Departments of Medicine and Surgery, University of Maryland, Baltimore, USA
| | - Sacha Matteucci
- SOD Cardiochirurgia Ospedali Riuniti 'Umberto I - Lancisi - Salesi' Università Politecnica delle Marche, Ancona, Italy
| | - Sandro Sponga
- Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Alessandro Costetti
- Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy
| | - Francesco Formica
- Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Pranya Sakiyalak
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Antonio Fiore
- Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Créteil, Paris, France
| | - Chistof Schmid
- Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Giuseppe Maria Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - Roberto Castillo
- ECLS Unit, Departamento de Anestesia, Clínica Las Condes, Las Condes, Santiago, Chile
| | - I-Wen Wang
- Division of Cardiac Surgery, Memorial Healthcare System, Hollywood, FL, USA
| | - Jae-Seung Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Tomas Grus
- 2nd Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Vin Pellegrino
- Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia
| | - Giacomo Bianchi
- Ospedale del Cuore Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-, Limburg, Genk, Belgium
| | - Alessandro Barbone
- Cardiac Surgery Unit, IRCCS Humanitas Research Hospital -, Rozzano(MI), Italy
| | - José P Garcia
- IU Health Advanced Heart & Lung Care, Indiana University Methodist Hospital, Indianapolis, IN, USA
| | - Mariusz Kowalewski
- Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Kiran Shekar
- Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia
| | - Glenn Whitman
- Cardiac Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Maryland, USA
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15
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Loforte A, Ziacchi M, Comentale G, Piemontese GP, Gliozzi G, Suarez SM, Biffi M, Pacini D. Single-chamber leadless endocardial pacing in last-generation centrifugal-flow left ventricle assist devices: a case report. J Cardiovasc Med (Hagerstown) 2023; 24:361-364. [PMID: 37016769 DOI: 10.2459/jcm.0000000000001467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Affiliation(s)
| | - Matteo Ziacchi
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | | | | | - Mauro Biffi
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Abdelshafy M, Caliskan K, Simpkin AJ, Elkoumy A, Kimman JR, Elsherbini H, Elzomor H, de By TMMH, Gollmann-Tepeköylü C, Berchtold-Herz M, Loforte A, Reineke D, Schoenrath F, Paluszkiewicz L, Gummert J, Mohacsi P, Meyns B, Soliman O. Efficacy of levosimendan infusion in patients undergoing a left ventricular assist device implant in a propensity score matched analysis of the EUROMACS registry-the Euro LEVO-LVAD study. Eur J Cardiothorac Surg 2023; 63:ezad095. [PMID: 36912728 PMCID: PMC10693438 DOI: 10.1093/ejcts/ezad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVES Early right-sided heart failure (RHF) was seen in 22% of recipients of a left ventricular assist device (LVAD) in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). However, the optimal treatment of post-LVAD RHF is not well known. Levosimendan has proven to be effective in patients with cardiogenic shock and in those with end-stage heart failure. We sought to evaluate the efficacy of levosimendan on post-LVAD RHF and 30-day and 1-year mortality. METHODS The EUROMACS Registry was used to identify adults with mainstream continuous-flow LVAD implants who were treated with preoperative levosimendan compared to a propensity matched control cohort. RESULTS In total, 3661 patients received mainstream LVAD, of which 399 (11%) were treated with levosimendan pre-LVAD. Patients given levosimendan had a higher EUROMACS RHF score [4 (2- 5.5) vs 2 (2- 4); P < 0.001], received more right ventricular assist devices (RVAD) [32 (8%) vs 178 (5.5%); P = 0.038] and stayed longer in the intensive care unit post-LVAD implant [19 (8-35) vs 11(5-25); P < 0.001]. Yet, there was no significant difference in the rate of RHF, 30-day, or 1-year mortality. Also, in the matched cohort (357 patients taking levosimendan compared to an average of 622 controls across 20 imputations), we found no evidence for a difference in postoperative severe RHF, RVAD implant rate, length of stay in the intensive care unit or 30-day and 1-year mortality. CONCLUSIONS In this analysis of the EUROMACS registry, we found no evidence for an association between levosimendan and early RHF or death, albeit patients taking levosimendan had much higher risk profiles. For a definitive conclusion, a multicentre, randomized study is warranted.
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Affiliation(s)
- Mahmoud Abdelshafy
- Discipline of Cardiology, Saolta Healthcare Group, Galway University Hospital, Health Service Executive, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Andrew J Simpkin
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
- Insight Centre for Data Analytics, University of Galway, Galway, Ireland
| | - Ahmed Elkoumy
- Discipline of Cardiology, Saolta Healthcare Group, Galway University Hospital, Health Service Executive, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo, Egypt
| | - Jesse R Kimman
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Hagar Elsherbini
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Hesham Elzomor
- Discipline of Cardiology, Saolta Healthcare Group, Galway University Hospital, Health Service Executive, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- Islamic Center of Cardiology and Cardiac Surgery, Al-Azhar University, Cairo, Egypt
| | | | | | - Michael Berchtold-Herz
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Bologna, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - David Reineke
- Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Lech Paluszkiewicz
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Centre NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Paul Mohacsi
- HerzGefässZentrum im Park, Zürich, Switzerland
- Department of Internal Medicine, Division of Cardiology, Medical University of Graz, Graz, Austria
| | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Osama Soliman
- Discipline of Cardiology, Saolta Healthcare Group, Galway University Hospital, Health Service Executive, Galway, Ireland
- CORRIB Core Lab, University of Galway, Galway, Ireland
- CÚRAM Centre for Medical Devices, Galway, Ireland
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Biancari F, Kaserer A, Perrotti A, Ruggieri VG, Cho SM, Kang JK, Dalén M, Welp H, Jónsson K, Ragnarsson S, Hernández Pérez FJ, Gatti G, Alkhamees K, Loforte A, Lechiancole A, Rosato S, Spadaccio C, Pettinari M, Mariscalco G, Mäkikallio T, Sahli SD, L'Acqua C, Arafat AA, Albabtain MA, AlBarak MM, Laimoud M, Djordjevic I, Krasivskyi I, Samalavicius R, Puodziukaite L, Alonso-Fernandez-Gatta M, Spahn DR, Fiore A. Hyperlactatemia and poor outcome After postcardiotomy veno-arterial extracorporeal membrane oxygenation: An individual patient data meta-Analysis. Perfusion 2023:2676591231170978. [PMID: 37066850 DOI: 10.1177/02676591231170978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
INTRODUCTION Postcardiotomy veno-arterial extracorporeal membrane oxygenation (V-A-ECMO) is associated with significant mortality. Identification of patients at very high risk for death is elusive and the decision to initiate V-A-ECMO is based on clinical judgment. The prognostic impact of pre-V-A-ECMO arterial lactate level in these critically ill patients has been herein evaluated. METHODS A systematic review was conducted to identify studies on postcardiotomy VA-ECMO for the present individual patient data meta-analysis. RESULTS Overall, 1269 patients selected from 10 studies were included in this analysis. Arterial lactate level at V-A-ECMO initiation was increased in patients who died during the index hospitalization compared to those who survived (9.3 vs 6.6 mmol/L, p < 0.0001). Accordingly, in hospital mortality increased along quintiles of pre-V-A-ECMO arterial lactate level (quintiles: 1, 54.9%; 2, 54.9%; 3, 67.3%; 4, 74.2%; 5, 82.2%, p < 0.0001). The best cut-off for arterial lactate was 6.8 mmol/L (in-hospital mortality, 76.7% vs. 55.7%, p < 0.0001). Multivariable multilevel mixed-effect logistic regression model including arterial lactate level significantly increased the area under the receiver operating characteristics curve (0.731, 95% CI 0.702-0.760 vs 0.679, 95% CI 0.648-0.711, DeLong test p < 0.0001). Classification and regression tree analysis showed the in-hospital mortality was 85.2% in patients aged more than 70 years with pre-V-A-ECMO arterial lactate level ≥6.8 mmol/L. CONCLUSIONS Among patients requiring postcardiotomy V-A-ECMO, hyperlactatemia was associated with a marked increase of in-hospital mortality. Arterial lactate may be useful in guiding the decision-making process and the timing of initiation of postcardiotomy V-A-ECMO.
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Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Andrea Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Vito G Ruggieri
- Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
| | - Sung-Min Cho
- Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jin Kook Kang
- Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Magnus Dalén
- Department of Molecular Medicine and Surgery, and Cardiac Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henryk Welp
- Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany
| | - Kristján Jónsson
- Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Giuseppe Gatti
- Cardio-Thoracic and Vascular Department, University Hospital of Trieste, Trieste, Italy
| | | | - Antonio Loforte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, Bologna, Italy
| | | | - Stefano Rosato
- Center for Global Health, Italian National Institute, Rome, Italy
| | | | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
| | - Giovanni Mariscalco
- Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, Leicester, UK
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland
| | - Sebastian D Sahli
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Camilla L'Acqua
- Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino, Italy
- Anesthesia and Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Italy
| | - Amr A Arafat
- Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Monirah A Albabtain
- Cardiology Clinical Pharmacy, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mohammed M AlBarak
- Intensive Care Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Mohamed Laimoud
- Cardiac Surgical Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Critical Care Medicine Department, Cairo University, Cairo, Egypt
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Ihor Krasivskyi
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Robertas Samalavicius
- 2nd Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
- Clinic of Emergency Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Lina Puodziukaite
- 2nd Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Marta Alonso-Fernandez-Gatta
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
- CIBER-CV Instituto de Salud Carlos III, Madrid, Spain
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Creteil, France
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Saeed D, Stark C, Loforte A, Zimpfer D, Bernhardt A, Schibilsky D, Riebandt J, Jawad K, Lichtenberg A, Haneya A, Potapov E, Albert A, Otto W, Huenges K, Aubin H, Lewin D, Raweh A, Morshuis M, Jorde U, Reichenspurner H, Borger M, Gummert J. Optimal Patient Selection on Extra-Corporeal Life Support for Durable Mechanical Circulatory Support: Validation Study on Behalf of Durable MCS after ECLS Study Group. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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19
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Aleksova N, Buchan TA, Foroutan F, Zhu A, Conte S, Macdonald P, Noly PE, Carrier M, Marasco SF, Takeda K, Pozzi M, Baudry G, Atik FA, Lehmann S, Jawad K, Hickey GW, Defontaine A, Baron O, Loforte A, Cavalli GG, Absi DO, Kawabori M, Mastroianni MA, Simonenko M, Sponga S, Moayedi Y, Orchanian-Cheff A, Ross HJ, Rao V, Guyatt G, Billia F, Alba AC. Extracorporeal Membrane Oxygenation for Graft Dysfunction Early After Heart Transplantation: A Systematic Review and Meta-analysis. J Card Fail 2023; 29:290-303. [PMID: 36513273 DOI: 10.1016/j.cardfail.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/27/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a prevailing option for the management of severe early graft dysfunction. This systematic review and individual patient data (IPD) meta-analysis aims to evaluate (1) mortality, (2) rates of major complications, (3) prognostic factors, and (4) the effect of different VA-ECMO strategies on outcomes in adult heart transplant (HT) recipients supported with VA-ECMO. METHODS AND RESULTS We conducted a systematic search and included studies of adults (≥18 years) who received VA-ECMO during their index hospitalization after HT and reported on mortality at any timepoint. We pooled data using random effects models. To identify prognostic factors, we analysed IPD using mixed effects logistic regression. We assessed the certainty in the evidence using the GRADE framework. We included 49 observational studies of 1477 patients who received VA-ECMO after HT, of which 15 studies provided IPD for 448 patients. There were no differences in mortality estimates between IPD and non-IPD studies. The short-term (30-day/in-hospital) mortality estimate was 33% (moderate certainty, 95% confidence interval [CI] 28%-39%) and 1-year mortality estimate 50% (moderate certainty, 95% CI 43%-57%). Recipient age (odds ratio 1.02, 95% CI 1.01-1.04) and prior sternotomy (OR 1.57, 95% CI 0.99-2.49) are associated with increased short-term mortality. There is low certainty evidence that early intraoperative cannulation and peripheral cannulation reduce the risk of short-term death. CONCLUSIONS One-third of patients who receive VA-ECMO for early graft dysfunction do not survive 30 days or to hospital discharge, and one-half do not survive to 1 year after HT. Improving outcomes will require ongoing research focused on optimizing VA-ECMO strategies and care in the first year after HT.
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Affiliation(s)
- Natasha Aleksova
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Tayler A Buchan
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Farid Foroutan
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Alice Zhu
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sean Conte
- Heart Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Peter Macdonald
- Heart Transplant Unit, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Pierre-Emmanuel Noly
- Department of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Montréal, Canada
| | - Michel Carrier
- Department of Cardiac Surgery, Montreal Heart Institute, University of Montreal, Montréal, Canada
| | - Silvana F Marasco
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Koji Takeda
- Department of Surgery, Division of Cardiac, Thoracic & Vascular Surgery, Columbia University, New York, New York
| | - Matteo Pozzi
- Service de Chirurgie Cardiaque et Cardiologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Guillaume Baudry
- Service de Chirurgie Cardiaque et Cardiologie, Hospices Civils de Lyon, Hôpital Louis Pradel, Lyon, France
| | - Fernando A Atik
- Instituto de Cardiologia e Transplantes do Distrito Federal (ICDF), Brasília, Brazil
| | - Sven Lehmann
- Clinic of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Khalil Jawad
- Clinic of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gavin W Hickey
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Oliver Baron
- Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | | | - Daniel O Absi
- Cardiovascular and Intrathoracic Transplant Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Masashi Kawabori
- Department of Cardiovascular Surgery, Tufts Medical Center, Boston, Massachusetts
| | | | - Maria Simonenko
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Yasbanoo Moayedi
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Heather J Ross
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Vivek Rao
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario. Canada
| | - Filio Billia
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ana C Alba
- Women's College Hospital, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
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20
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Loforte A, Nersesian G, Lewin D, Lanmueller P, Gliozzi G, Stein J, Cavalli GG, Schoenrath F, Netuka I, Zimpfer D, de By TMMH, Gummert J, Falk V, Meyns B, Faerber G, Pacini D, Potapov E. Impact of preoperative mitral regurgitation on left ventricular assist device patients: propensity score-matched analysis of the EUROMACS dataset. Eur J Cardiothorac Surg 2023; 63:6986977. [PMID: 36637204 DOI: 10.1093/ejcts/ezad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/02/2022] [Accepted: 01/11/2023] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Mitral regurgitation (MR) is frequently observed in patients undergoing left ventricular assist device implantation. We investigated the impact of preoperative MR on left ventricular assist device patients. METHODS A retrospective propensity score-matched analysis of adult patients enrolled in the EUROMACS registry between 1 January 2011 and 30 November 2021 was performed. Patients were divided into 2 groups according to the grade of preoperative MR: none-to-mild (MR 0-II) or moderate-to-severe (MR III-IV). RESULTS Following 1:1 propensity score matching, each group consisted of 914 patients. Incidence of postoperative temporary right ventricular support, reoperation for bleeding and dialysis was similar. MR III-IV demonstrated shorter median intensive care unit stay [14 days (6; 27.8) vs 10 days (5; 22), P = 0.004] and ventilation time [72 h (22, 320) vs 31 h (18, 150), P < 0.001]. Mortality was lower for MR III-IV patients [subdistribution hazard ratio: 0.66, 95% confidence interval (CI): 0.59-0.73, P < 0.001]. The 1-year survival was 68.1% (95% CI: 65.1-71.3%) in MR 0-II and 75% (95% CI: 72.1-78%) in MR III-IV. A lower incidence of total complications [odds ratio (OR): 0.93 (0.89-0.98), P = 0.003] and trend towards a lower risk of neurological dysfunction (subdistribution hazard ratio: 0.79; 95% CI: 0.61-1.01, P = 0.063) and sustained ventricular tachycardia [OR: 0.93 (0.54-1.03), P = 0.074] were demonstrated for MR III-IV. The risk of fatal stroke and pump thrombosis was similar. CONCLUSIONS Moderate-to-severe MR in patients undergoing left ventricular assist device implantation is associated with better mid-term survival and lower incidence of total major adverse events and complications. The incidence of severe postoperative complications including fatal stroke and device thrombosis was similar.
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Affiliation(s)
- Antonio Loforte
- Department of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Gaik Nersesian
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Daniel Lewin
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Pia Lanmueller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Gregorio Gliozzi
- Department of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Julia Stein
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | | | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ivan Netuka
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Daniel Zimpfer
- Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Jan Gummert
- Department of Thoracic, Cardiac and Vascular Surgery (Heart and Diabetes Centre), North Rhine Westphalia, Bad Oeynhausen, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Bart Meyns
- Department of Cardiac Surgery, University Hospital Leuven, Leuven, Belgium
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, S. Orsola University Hospital, IRCCS Bologna, Bologna, Italy
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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21
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Lorusso R, De Piero ME, Mariani S, Di Mauro M, Folliguet T, Taccone FS, Camporota L, Swol J, Wiedemann D, Belliato M, Broman LM, Vuylsteke A, Kassif Y, Scandroglio AM, Fanelli V, Gaudard P, Ledot S, Barker J, Boeken U, Maier S, Kersten A, Meyns B, Pozzi M, Pedersen FM, Schellongowski P, Kirali K, Barrett N, Riera J, Mueller T, Belohlavek J, Lorusso R, De Piero ME, Mariani S, Di Mauro M, Folliguet T, Taccone FS, Camporota L, Swol J, Wiedemann D, Belliato M, Broman LM, Vuylsteke A, Kassif Y, Scandroglio AM, Fanelli V, Gaudard P, Ledot S, Barker J, Boeken U, Maier S, Kersten A, Meyns B, Pozzi M, Pedersen FM, Schellongowski P, Kirali K, Barrett N, Riera J, Mueller T, Belohlavek J, Lo Coco V, Van der Horst ICC, Van Bussel BCT, Schnabel RM, Delnoij T, Bolotin G, Lorini L, Schmiady MO, Schibilsky D, Kowalewski M, Pinto LF, Silva PE, Kornilov I, Blandino Ortiz A, Vercaemst L, Finney S, Roeleveld PP, Di Nardo M, Hennig F, Antonini MV, Davidson M, Jones TJ, Staudinger T, Mair P, Kilo J, Krapf C, Erbert K, Peer A, Bonaros N, Kotheletner F, Krenner Mag N, Shestakova L, Hermans G, Dauwe D, Meersseman P, Stockman B, Nobile L, Lhereux O, Nrasseurs A, Creuter J, De Backer D, Giglioli S, Michiels G, Foulon P, Raes M, Rodrigus I, Allegaert M, Jorens P, Debeucklare G, Piagnarelli M, Biston P, Peperstraete H, Vandewiele K, Germay O, Vandeweghe D, Havrin S, Bourgeois M, Lagny MG, Alois G, Lavios N, Misset B, Courcelle R, Timmermans PJ, Yilmaz A, Vantomout M, Lehaen J, Jassen A, Guterman H, Strauven M, Lormans P, Verhamme B, Vandewaeter C, Bonte F, Vionne D, Balik M, Blàha J, Lips M, Othal M, Bursa F, Spacek R, Christensen S, Jorgensen V, Sorensen M, Madsen SA, Puss S, Beljantsev A, Saiydoun G, Fiore A, Colson P, Bazalgette F, Capdevila X, Kollen S, Muller L, Obadia JF, Dubien PY, Ajrhourh L, Guinot PG, Zarka J, Besserve P, Malfertheiner MV, Dreier E, Heinze B, Akhyari P, Lichtenberg A, Aubin H, Assman A, Saeed D, Thiele H, Baumgaertel M, Schmitto JD, Ruslan N, Haverich A, Thielmann M, Brenner T, Ruhpawar A, Benk C, Czerny M, Staudacher DL, Beyersdorf F, Kalbhenn J, Henn P, Popov AF, Iuliu T, Muellenbach R, Reyher C, Rolfes C, Lotz G, Sonntagbauer M, Winkels H, Fichte J, Stohr R, Kalverkamp S, Karagiannidis C, Schafer S, Svetlitchny A, Fichte J, Hopf HB, Jarczak D, Groesdonk H, Rommer M, Hirsch J, Kaehny C, Soufleris D, Gavriilidis G, Pontikis K, Kyriakopoulou M, Kyriakoudi A, O'Brien S, Conrick-Martin I, Carton E, Makhoul M, Ben-Ari J, Hadash A, Kogan A, Kassif Lerner R, Abu-Shakra A, Matan M, Balawona A, Kachel E, Altshuler R, Galante O, Fuchs L, Almog Y, Ishay YS, Lichter Y, Gal-oz A, Carmi U, Nini A, Soroksky A, Dekel H, Rozman Z, Tayem E, Ilgiyaev E, Hochman Y, Miltau D, Rapoport A, Eden A, Kompanietz D, Yousif M, Golos M, Grazioli L, Ghitti D, Loforte A, Di Luca D, Baiocchi M, Pacini D, Cappai A, Meani P, Mondino M, Russo CF, Ranucci M, Fina D, Cotza M, Ballotta A, Landoni G, Nardelli P, Fominski EV, Brazzi L, Montrucchio G, Sales G, Simonetti U, Livigni S, Silengo D, Arena G, Sovatzis SS, Degani A, Riccardi M, Milanesi E, Raffa G, Martucci G, Arcadipane A, Panarello G, Chiarini G, Cattaneo S, Puglia C, Benussi S, Foti G, Giani M, Bombino M, Costa MC, Rona R, Avalli L, Donati A, Carozza R, Gasparri F, Carsetti A, Picichè M, Marinello A, Danzi V, Zanin A, Condello I, Fiore F, Moscarelli M, Nasso G, Speziale G, Sandrelli L, Montalto A, Musumeci F, Circelli A, Russo E, Agnoletti V, Rociola R, Milano AD, Pilato E, Comentale G, Montisci A, Alessandri F, Tosi A, Pugliese F, Giordano G, Carelli S, Grieco DL, Dell'Anna AM, Antonelli M, Ramoni E, Zulueta J, Del Giglio M, Petracca S, Bertini P, Guarracino F, De Simone L, Angeletti PM, Forfori F, Taraschi F, Quintiliani VN, Samalavicius R, Jankuviene A, Scupakova N, Urbonas K, Kapturauskas J, Soerensen G, Suwalski P, Linhares Santos L, Marques A, Miranda M, Teixeira S, Salgueiro A, Pereira F, Ketskalo M, Tsarenko S, Shilova A, Afukov I, Popugaev K, Minin S, Shelukhin D, Malceva O, Gleb M, Skopets A, Kornelyuk R, Kulikov A, Okhrimchuk V, Turchaninov A, Shelukhin D, Petrushin M, Sheck A, Mekulov A, Ciryateva S, Urusov D, Gorjup V, Golicnik A, Goslar T, Ferrer R, Martinez-Martinez M, Argudo E, Palmer N, De Pablo Sanchez R, Juan Higuera L, Arnau Blasco L, Marquez JA, Sbraga F, Fuset MP, De Gopegui PR, Claraco LM, De Ayala JA, Peiro M, Ricart P, Martinez S, Chavez F, Fabra M, Sandoval E, Toapanta D, Carraminana A, Tellez A, Ososio J, Milan P, Rodriguez J, Andoni G, Gutierrez C, Perez de la Sota E, Eixeres-Esteve A, Garcia-Maellas MT, Gutierrez-Gutierrez J, Arboleda-Salazar R, Santa Teresa P, Jaspe A, Garrido A, Castaneda G, Alcantara S, Martinez N, Perez M, Villanueva H, Vidal Gonzalez A, Paez J, Santon A, Perez C, Lopez M, Rubio Lopez MI, Gordillo A, Naranjo-Izurieta J, Munoz J, Alcalde I, Onieva F, Gimeno Costa R, Perez F, Madrid I, Gordon M, Albacete Moreno CL, Perez D, Lopez N, Martinenz D, Blanco-Schweizer P, Diez C, Perez D, Prieto A, Renedo G, Bustamante E, Cicuendez R, Citores R, Boado V, Garcia K, Voces R, Domezain M, Nunez Martinez JM, Vicente R, Martin D, Andreu A, Gomez Casal V, Chico I, Menor EM, Vara S, Gamacho J, Perez-Chomon H, Javier Gonzales F, Barrero I, Martin-Villen L, Fernandez E, Mendoza M, Navarro J, Colomina Climent J, Gonzales-Perez A, Muniz-Albaceita G, Amado L, Rodriguez R, Ruiz E, Eiras M, Grins E, Magnus R, Kanetoft M, Eidevald M, Watson P, Vogt PR, Steiger P, Aigner T, Weber A, Grunefelder J, Kunz M, Grapow M, Aymard T, Reser D, Agus G, Consiglio J, Haenggi M, Hansjoerg J, Iten M, Doeble T, Zenklusen U, Bechtold X, Faedda G, Iafrate M, Rohjer A, Bergamaschi L, Maessen J, Reis Miranda D, Endeman H, Gommers D, Meuwese C, Maas J, Van Gijlswijk MJ, Van Berg RN, Candura D, Van der Linden M, Kant M, Van der Heijden JJ, Scholten E, Van Belle-van Haren N, Lagrand WK, Vlaar AP, De Jong S, Cander B, Sargin M, Ugur M, Kaygin MA, Daly K, Agnew N, Head L, Kelly L, Anoma G, Russell C, Aquino V, Scott I, Flemming L, Gillon S, Moore O, Gelandt E, Auzinger G, Patel S, Loveridge R. In-hospital and 6-month outcomes in patients with COVID-19 supported with extracorporeal membrane oxygenation (EuroECMO-COVID): a multicentre, prospective observational study. Lancet Respir Med 2023; 11:151-162. [PMID: 36402148 PMCID: PMC9671669 DOI: 10.1016/s2213-2600(22)00403-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation. METHODS EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing. FINDINGS Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms. INTERPRETATION Patient's age, timing of cannulation (<4 days vs ≥4 days from intubation), and use of inotropes and vasopressors are essential factors to consider when analysing the outcomes of patients receiving ECMO for COVID-19. Despite post-discharge survival being favourable, persisting long-term symptoms suggest that dedicated post-ECMO follow-up programmes are required. FUNDING None.
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Affiliation(s)
- Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
| | - Maria Elena De Piero
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Silvia Mariani
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands,Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Thierry Folliguet
- Department of Cardiac Surgery, Assistance Publique–Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Luigi Camporota
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Justyna Swol
- Department of Medicine, Paracelsus Medical University, Nuremberg, Germany
| | - Dominik Wiedemann
- Department of Cardiac Surgery, Medical University Hospital of Vienna, Vienna, Austria
| | - Mirko Belliato
- Anestesia e Rianimazione II Cardiopolmonare, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Karolinska University Hospital, Stockholm, Sweden,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Alain Vuylsteke
- ECMO Retrieval Service & Critical Care, Royal Papworth Hospital, NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, UK
| | - Yigal Kassif
- Heart Transplantation Unit, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Ramat Gan, Israel
| | - Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vito Fanelli
- Department of Surgical Sciences, Anesthesia and Intensive Care Medicine, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Philippe Gaudard
- Department of Anesthesiology and Critical Care Medicine, Arnaud de Villeneuve Hospital, Centre Hospitalier Universitaire Montpellier, Montpellier, France,Le laboratoire de Physiologie et Médecine Expérimentale du Coeur et des Muscles (PhyMedExp), Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Stephane Ledot
- Intensive Care Unit, Royal Brompton & Harefield hospitals, London, UK
| | - Julian Barker
- Cardiothoracic Critical Care Unit, Whythenshawe Hospital, Manchester, UK
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Sven Maier
- Department of Cardiovascular Surgery, Heart Center University Freiburg, Bad Krozingen, Germany,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Kersten
- Medizinische Klinik, Uniklinik Rheinisch-Westfälische Technische Hochschule, Aachen, Germany
| | - Bart Meyns
- Department of Cardiac Surgery, Universitair Ziekenhuis Leuven Gasthuisberg University Hospital, Leuven, Belgium
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Hospital, Lyon, France
| | - Finn M Pedersen
- Cardiothoracic Intensive Care Unit, University Hospital, Copenhagen, Denmark
| | - Peter Schellongowski
- Department of Medicine I, Intensive Care Unit, Comprehensive Cancer Center, Center of Excellence in Medical Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Kaan Kirali
- Cardiovascular Surgery Department, Kosuyolu High Specialization Education and Research Hospital, Istanbul, Türkiye
| | - Nicholas Barrett
- Department of Adult Critical Care, Guy's and St Thomas' NHS Foundation, Health Centre for Human and Applied Physiological Sciences, London, UK
| | - Jordi Riera
- Critical Care Department, Val d'Hebron Research Institute, Barcelona, Spain
| | - Thomas Mueller
- Department of Internal Medicine II, University Hospital of Regensburg, Regensburg, Germany
| | - Jan Belohlavek
- 2nd Department of Internal Medicine, Cardiovascular Medicine General Teaching Hospital, Prague, Czech Republic,1st Faculty of Medicine, Charles University, Prague, Czech Republic
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Fiorentino M, Loforte A, Murana G, Gliozzi G, Cavalli GG, Santamaria V, Mariani C, Botta L, Martin-Suarez S, Potena L, Pacini D. Effect of Preoperative Right Ventricular Dysfunction on Heart Transplantation Outcomes. Transplant Proc 2023; 55:199-207. [PMID: 36577636 DOI: 10.1016/j.transproceed.2022.09.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/15/2022] [Accepted: 09/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND We investigated if the occurrence of preoperative right ventricular dysfunction is capable of influencing heart transplant results in terms of in-hospital mortality, incidence of primary graft dysfunction, and follow-up mortality. METHODS We retrospectively analyzed 517 patients who underwent heart transplant between January 2000 and December 2020. We defined right ventricular dysfunction (RVD), as central venous pressure (CVP) > 15 mm Hg and CVP/pulmonary capillary wedge pressure ratio > 0.63. We identified 2 subgroups in our population: 33 patients with preoperative RVD and 484 patients without RVD. RESULTS In-hospital mortality was 7.9%. Severe early graft failure occurred in 6.6% of patients, with 26 patients (5.1%) needing intra-aortic balloon pump and 17 patients (3.3%) needing extracorporeal membrane oxygenation support. Clinical variables that significantly influenced in-hospital mortality were age, peripheral artery disease, and bilirubin > 1.5 mg/dL, while hemodynamic variables influencing in-hospital mortality were CVP (odds ratio [OR], 1.09 [confidence interval {CI}, 1.03-1.15], P = .004], pulmonary artery systolic pressure (OR, 1.02 [CI, 1.00-1.04], P = .05), CVP/pulmonary capillary wedge pressure ratio (OR, 2.78 [CI, 1.14-6.80], P = .025), pulmonary vascular resistance (OR, 1.15 [CI, 1.01-1.32], P = .042), transpulmonary gradient (TPG) (OR, 1.11 [CI, 1.03-1.18], P = .003) , diastolic transpulmonary gradient (OR, 1.10 [CI, 1.02-1.20], P = .015], together with right ventricular dysfunction (OR, 3.56 [CI, 1.44-8.80], P = .011). On the other hand, clinical variables influencing the incidence of early graft failure were body mass index (calculated as weight in kilograms divided by height in meters squared) > 30, peripheral artery disease, bilirubin > 1.5 mg/dL, Model for End-Stage Liver Disease score excluding international normalized ratio before transplant, and preoperative extracorporeal membrane oxygenation support, while hemodynamic variables were pulmonary arterial systolic pressure (OR, 1.03 [CI, 1.00-1.05], P = .016), TPG (OR, 1.08 [1.01-1.17], P = .03), and right ventricular dysfunction (OR, 3.00 [CI, 1.07-8.40] P = .046). On the multivariable analysis, RVD and TPG were independent predictors of in-hospital mortality, while only TPG was a predictor of early graft failure. Follow-up mortality was 38.7% and was influenced by recipient age, recipient body mass index, and preoperative diabetes. Moreover, 1-, 5-, and 10-year survival of patients with preoperative RVD was significantly worse than patients without RVD (log-rank = 0.001). CONCLUSIONS In our population, RVD influenced both in-hospital and long-term results after heart transplant. For these reasons, it appears crucially important to optimize preoperative right ventricular function to improve these patients' outcomes.
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Affiliation(s)
- Mariafrancesca Fiorentino
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy.
| | - Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Giacomo Murana
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Gregorio Gliozzi
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Valeria Santamaria
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Carlo Mariani
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Botta
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Sofia Martin-Suarez
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Luciano Potena
- Division of Cardiology, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, Bologna, Italy
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Marcelli C, Sabatino M, Spitaleri G, Masetti M, Martin-suarez S, Loforte A, Galiè N, Potena L. 1121 USE OF IMPELLA 5.0 AS BRIDGE TO LVAD IN CARDIOGENIC SHOCK: REPORT OF TWO CASES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Left ventricle assist devices (LVAD) are an option in end stage heart failure (HF) as bridge to or alterative to heart transplantation. Adequate compensation of patient is key to obtain a good outcome. We report two cases of Impella 5.0 bridge to LVAD in patients with cardiogenic shock (CS) in which intra-aortic balloon pump (IABP) failed to obtain hemodynamic stability.
Case series
A) A 60 years old man developed CS after anterior myocardial infarction treated with primary PCI of left main coronary artery. At presentation patient was hypotensive with signs of hypoperfusion and pulmonary congestion: systemic blood pressure (SBP) 80/60 mmHg despite inotropic drugs, blood lactates 4 mmol/l, urine output of last 6 hours 0,4 ml/kg/h (INTERMACS 2). Echocardiography showed severe left ventricle disfunction with LVEF 15%, severe mitral regurgitation (MR) and sPAP 45 mmHg. Therefore, IABP was implanted. Right heart catheterization (RHC) showed pulmonary hypertension and high filling pressure with reduced cardiac output and increased pulmonary vascular resistance (mPAP 39 mmHg, CPWP 28 mmHg, CO 3 l/min, PVR 3.7 uW, PAPi 2.8); X-ray chest showed persistence of pulmonary congestion. After 9 days on IABP, patient underwent Impella 5.0 implant through right axillary artery as bridge to durable LVAD. Pulmonary artery catheter (PAC) monitoring showed reduction of pulmonary hypertension with mPAP 35 mmHg and CPWP 17 mmHg and chest X-ray documented improvement of lung congestion. Bedside rehabilitation was started. Two weeks later patient underwent LVAD HM3 implantation as destination therapy. The patient was discharge home on post-operative day 55. B) After subacute myocardial infarction with three-vessels disease, a 53 y.o. man developed severe congestive HF with severe left ventricular disfunction and was referred to our institution for evaluation. RHC showed pulmonary hypertension with pre-capillary component not reversible after enoximone test, contraindicating heart transplantation. Therefore, patient was candidate to receive LVAD as bridge strategy. Echocardiography at admission showed dilated and hypokinetic left ventricle (EDV 200 ml, LVEF 17% severe MR, sPAP 60 mmHg) and dilated and hypokinetic RV. During hospitalization the patient experienced CS with SBP 62/45 mmHg, 6-hours urine output of 1,4 ml/kg/h and blood lactates 8.3 mmol/l (INTERMACS 1) so femoral IABP was implanted. RHC was repeated both without IABP support (mPAP 37 mmHg, PCWP 28 mmHg, CO 1.4 l/min, CI 0.9 l/min/m2) and with IABP support (mPAP 32 mmHg, PCWP 18 mmHg, CO 2.15 l/min, CI 1.4 l/min/m2). During the following stay he developed S. Aureus sepsis requiring prolonged antibiotic therapy. Expecting a long time before LVAD, axillary Impella 5.0 was implanted in order to unload the LV and allow early patient mobilization. Subsequent PAC monitoring showed improvement of pulmonary hypertension and cardiac index (mPAP 24 mmHg, PCWP 9 mmHg, CO 5.1 l/min with Impella flow 4.2 l/min, CI 3.2 l/min/m2). After 11 days, patient received LVAD HVAD with uneventful course and was discharged on post-operative day 22.
Conclusions
Impella 5.0 is a surgically implanted intravascular microaxial blood pump that delivers up to 5 l/min of blood from LV to aorta, leading to improved perfusion and more efficient LV unloading. In patients with CS this can help to obtain better decongestion, RV recovery, and favorable preconditioning before LVAD implant. Moreover, axillary access allows better patient mobilization preventing cachexia after long time hospitalization.
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Biancari F, Kaserer A, Perrotti A, Ruggieri VG, Cho SM, Kang JK, Dalén M, Welp H, Jónsson K, Ragnarsson S, Hernández Pérez FJ, Gatti G, Alkhamees K, Loforte A, Lechiancole A, Rosato S, Spadaccio C, Pettinari M, Fiore A, Mäkikallio T, Sahli SD, L’Acqua C, Arafat AA, Albabtain MA, AlBarak MM, Laimoud M, Djordjevic I, Krasivskyi I, Samalavicius R, Puodziukaite L, Alonso-Fernandez-Gatta M, Wilhelm MJ, Mariscalco G. Central versus Peripheral Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation: Systematic Review and Individual Patient Data Meta-Analysis. J Clin Med 2022; 11:jcm11247406. [PMID: 36556021 PMCID: PMC9785985 DOI: 10.3390/jcm11247406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is unclear whether peripheral arterial cannulation is superior to central arterial cannulation for postcardiotomy veno-arterial extracorporeal membrane oxygenation (VA-ECMO). METHODS A systematic review was conducted using PubMed, Scopus, and Google Scholar to identify studies on postcardiotomy VA-ECMO for the present individual patient data (IPD) meta-analysis. Analysis was performed according to the intention-to-treat principle. RESULTS The investigators of 10 studies agreed to participate in the present IPD meta-analysis. Overall, 1269 patients were included in the analysis. Crude rates of in-hospital mortality after central versus peripheral arterial cannulation for VA-ECMO were 70.7% vs. 63.7%, respectively (adjusted OR 1.38, 95% CI 1.08-1.75). Propensity score matching yielded 538 pairs of patients with balanced baseline characteristics and operative variables. Among these matched cohorts, central arterial cannulation VA-ECMO was associated with significantly higher in-hospital mortality compared to peripheral arterial cannulation VA-ECMO (64.5% vs. 70.8%, p = 0.027). These findings were confirmed by aggregate data meta-analysis, which showed that central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation (OR 1.35, 95% CI 1.04-1.76, I2 21%). CONCLUSIONS Among patients requiring postcardiotomy VA-ECMO, central arterial cannulation was associated with an increased risk of in-hospital mortality compared to peripheral arterial cannulation. This increased risk is of limited magnitude, and further studies are needed to confirm the present findings and to identify the mechanisms underlying the potential beneficial effects of peripheral VA-ECMO.
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Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Haartmaninkatu 4, P.O. Box 340, 00029 Helsinki, Finland
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland
- Correspondence:
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Andrea Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, 25030 Besançon, France
| | - Vito G. Ruggieri
- Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, 51100 Reims, France
| | - Sung-Min Cho
- Divisions of Neurosciences, Critical Care and Cardiac Surgery, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21201, USA
| | - Jin Kook Kang
- Divisions of Neurosciences, Critical Care and Cardiac Surgery, Departments of Neurology, Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21201, USA
| | - Magnus Dalén
- Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Henryk Welp
- Department of Cardiothoracic Surgery, Münster University Hospital, 48149 Münster, Germany
| | - Kristján Jónsson
- Department of Cardiac Surgery, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Sigurdur Ragnarsson
- Department of Cardiothoracic Surgery, University of Lund, 10392 Lund, Sweden
| | | | - Giuseppe Gatti
- Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, University Hospital of Trieste, 34128 Trieste, Italy
| | | | - Antonio Loforte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, 40138 Bologna, Italy
| | - Andrea Lechiancole
- Cardiothoracic Department, University Hospital of Udine, 33100 Udine, Italy
| | - Stefano Rosato
- Center for Global Health, Italian National Institute, 00161 Rome, Italy
| | | | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France
| | - Timo Mäkikallio
- Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland
| | - Sebastian D. Sahli
- Institute of Anesthesiology, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Camilla L’Acqua
- Anesthesia and Intensive Care Unit, Centro Cardiologico Monzino, 20138 Milan, Italy
- Anesthesia and Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Amr A. Arafat
- Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh 12611, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta 31527, Egypt
| | - Monirah A. Albabtain
- Cardiology Clinical Pharmacy, Prince Sultan Cardiac Center, Riyadh 12611, Saudi Arabia
| | - Mohammed M. AlBarak
- Intensive Care Department, Prince Sultan Cardiac Center, Riyadh 12611, Saudi Arabia
| | - Mohamed Laimoud
- Cardiac Surgical Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia
- Critical Care Medicine Department, Cairo University, Cairo 12613, Egypt
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Ihor Krasivskyi
- Department of Cardiothoracic Surgery, University Hospital Cologne, 50937 Cologne, Germany
| | - Robertas Samalavicius
- 2nd Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
- Clinic of Emergency Medicine, Medical Faculty, Vilnius University, 03101 Vilnius, Lithuania
| | - Lina Puodziukaite
- 2nd Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
| | - Marta Alonso-Fernandez-Gatta
- Cardiology Department, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca, 37007 Salamanca, Spain
- CIBER-CV Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Markus J. Wilhelm
- Clinic for Cardiac Surgery, University Heart Center, University and University Hospital Zurich, 8091 Zurich, Switzerland
| | - Giovanni Mariscalco
- Department of Intensive Care Medicine and Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester LE2 9QP, UK
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Loforte A, Gliozzi G, Nersesian G, Votano D, Potapov E, Pacini D. Mechanical recovery plug for left ventricular assist device explantation. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 36315037 DOI: 10.1510/mmcts.2022.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Myocardial recovery occurs in approximately 5% of left ventricular assist device recipients. In selected patients, it is possible to electively perform left ventricular assist device explantation after accurate myocardial function recovery assessment. Several surgical approaches and techniques have been reported in the literature that focus on left ventricular assist device removal and preservation of left ventricular geometry. We provide a detailed step-by-step tutorial for continuous-flow left ventricular assist device explantation facilitated by the use of a manufactured titanium apical recovery plug.
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Affiliation(s)
- Antonio Loforte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, ALMA Mater Studiorum, University of Bologna, Via Massarenti n.9, 40138 Bologna, Italy
| | - Gregorio Gliozzi
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, ALMA Mater Studiorum, University of Bologna, Via Massarenti n.9, 40138 Bologna, Italy
| | - Gaik Nersesian
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Daniela Votano
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany
| | - Davide Pacini
- Department of Cardiovascular Surgery S. Orsola-Malpighi Hospital Alma Mater Studiorum - University of Bologna Bologna Italy
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de By TMMH, Schweiger M, Hussain H, Amodeo A, Martens T, Bogers AJJC, Damman K, Gollmnan-Tepeköylü C, Hulman M, Iacovoni A, Krämer U, Loforte A, Napoleone CP, Němec P, Netuka I, Özbaran M, Polo L, Pya Y, Ramjankhan F, Sandica E, Sliwka J, Stiller B, Kadner A, Franceschini A, Thiruchelvam T, Zimpfer D, Meyns B, Berger F, Miera O. The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): third Paediatric (Paedi-EUROMACS) report. Eur J Cardiothorac Surg 2022; 62:6618527. [PMID: 35758622 DOI: 10.1093/ejcts/ezac355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/23/2022] [Accepted: 06/25/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Martin Schweiger
- Department of Congenital Pediatric Surgery, Children's Hospital Zürich, Zürich, Switzerland
| | | | | | | | - Ad J J C Bogers
- Department of Cardio-thoracic surgery, Erasmus MC, Rotterdam, Netherlands
| | - Kevin Damman
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | | | | | - Ulrike Krämer
- Department of Pediatric Intensive Care, Erasmus MC, Rotterdam, Netherlands
| | | | - Carlo Pace Napoleone
- Pediatric Cardiac Surgery Department, Regina Margherita Children's Hospital, Torino, Italy
| | - Petr Němec
- Center for Cardiovascular and Transplant Surgery Brno
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | | | - Luz Polo
- La Paz University Hospital, Madrid, Spain
| | - Yuri Pya
- National Research Cardiac Surgery Center, Astana, Kazakhstan
| | | | - Eugen Sandica
- Clinic for Pediatric Cardiac Surgery and Congenital Heart Defects, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Germany
| | - Joanna Sliwka
- Department of Cardiac Surgery, Transplantology and Vascular Surgery, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Brigitte Stiller
- Department of Congenital Heart Defects and Pediatric Cardiology, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Germany
| | - Alexander Kadner
- Department of Herz- und Gefässchirurgie, University Hospital Bern, Switzerland
| | | | | | | | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Oliver Miera
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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Lechiancole A, Loforte A, Scandroglio M, Comisso M, Iacovoni A, Maiani M, Gliozzi G, De Bonis M, Musumeci F, Terzi A, Pacini D, Livi U. Does the distance between residency and implanting center affect the outcome of patients supported by left ventricular assist devices? A multicenter Italian study on radial mechanically assisted circulatory support (MIRAMACS) analysis. Artif Organs 2022; 46:1932-1936. [PMID: 35718933 DOI: 10.1111/aor.14343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/16/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with LVAD require continuous monitoring and care, and since Implanting Centers (ICs) are more experienced in managing LVAD patients than other healthcare facilities, the distance between patient residency and IC could negatively affect the outcomes. METHODS Data of patients discharged after receiving an LVAD implantation between 2010 and 2021 collected from the MIRAMACS database were retrospectively analyzed. The population was divided into two groups: A (n = 175) and B (n = 141), according to the distance between patient residency and IC ≤ or >90 miles. The primary endpoint was freedom from Adverse Events (AEs), a composite outcome composed of death, cerebrovascular accident, hospital admission because of GI bleeding, infection, pump thrombosis, and right ventricular failure. Secondary endpoints were incidences of mortality and complications. All patients were followed-up regularly, according to participating center protocols. RESULTS Baseline clinical characteristics and indications for LVAD did not differ between the two groups. The mean duration of support was 25.5 ± 21 months for Group A and 25.7 ± 20 months for Group B (p = 0.79). At 3 years, freedom from AEs was similar between Group A and Group B (p = 0.36), and there were no differences in rates of mortality and LVAD-related complications. CONCLUSIONS Distance from the IC does not represent a barrier to successful outcomes as long as regular and continuous follow-up is provided.
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Affiliation(s)
- Andrea Lechiancole
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, S. Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Bologna, Italy
| | - Mara Scandroglio
- Division of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Marina Comisso
- Cardiothoracic Department, San Camillo Forlanini Hospital, Rome, Italy
| | - Attilio Iacovoni
- Cardiothoracic Department, Papa Giovanni XXII Hospital of Bergamo, Bergamo, Italy
| | - Massimo Maiani
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, S. Maria della Misericordia University Hospital of Udine, Udine, Italy
| | - Gregorio Gliozzi
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Bologna, Italy
| | - Michele De Bonis
- Division of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Amedeo Terzi
- Cardiothoracic Department, Papa Giovanni XXII Hospital of Bergamo, Bergamo, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Bologna, Italy
| | - Ugolino Livi
- Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, S. Maria della Misericordia University Hospital of Udine, Udine, Italy
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Loforte A. Thromboelastography and multiplate tests for current rotational left ventricular assist device management. J Card Surg 2022; 37:2629-2632. [PMID: 35610499 DOI: 10.1111/jocs.16647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Bologna, Italy
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Lechiancole A, Loforte A, Trumello C, Scandroglio M, Gliozzi G, Comisso M, Iacovoni A, Terzi A, Maiani M, Musumeci F, De Bonis M, Pacini D, Livi U. C15 DOES THE DISTANCE BETWEEN RESIDENCY AND IMPLANTING CENTER AFFECT THE OUTCOME OF PATIENTS SUPPORTED BY LEFT VENTRICULAR ASSIST DEVICE? A MULTICENTER ITALIAN STUDY ON RADIAL MECHANICALLY ASSISTED CIRCULATORY SUPPORT (MIRAMACS) ANALYSIS. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Patients with LVAD require continuous monitoring and care, and since Implanting Centers (IC) are more experienced in managing LVAD patients than other health care facilities, the distance between patient residency and IC could negatively affect the outcomes.
Methods
Data of patients discharged after receiving a LVAD implantation between 2010 and 2021 collected into the MIRAMACS database were retrospectively analyzed. The population was divided into two groups: A (n = 175) and B (n = 141), according to a distance between patient residency and IC ≤ or >of 90 miles. The primary end–point was freedom form Adverse Events (AEs), a composite outcome composed by death, cerebrovascular accident, hospital admission because of GI bleeding, infection, pump thrombosis or right ventricular failure. Secondary end–points were incidences of mortality and complications. All patients were followed–up regularly, according to participating centers protocols, by means of clinical visits, telemonitoring and local care–sharing.
Results
Baseline clinical characteristics and indications for LVAD did not differ between the two groups (Figure 1). Mean duration of support was 25.5±21 months for Group A and 25.7±20 months for Group B (p = 0.79). At 3 years, freedom from AEs was similar between Group A and B (p = 0.32, Figure 2), and there were no differences in rates of mortality and LVAD–related complications (Figure 2).
Conclusions
Distance from the IC does not represent a barrier to successful outcome, as long as regular and continuous follow–up is provided. Telemonitoring could offer several benefits, including early detection of complications and continuous evaluation of patient conditions and data of the pump. Moreover, it seemed to reduce the patient anxiety related to the device, increasing direct communication with the VAD–team. On the other hand, shared health programs with local facilities remains an attractive way to follow–up patient, provided that LVAD specific resources and trained staff are available. The dissemination of LVAD–specific care knowledge is also important to face urgent or emergent needs in the rapidly enlarging population of LVAD patients, by empowering local healthcare facilities.
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Affiliation(s)
- A Lechiancole
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - A Loforte
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - C Trumello
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - M Scandroglio
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - G Gliozzi
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - M Comisso
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - A Iacovoni
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - A Terzi
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - M Maiani
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - F Musumeci
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - M De Bonis
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - D Pacini
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
| | - U Livi
- AZIENDA SANITARIA UNIVERSITARIA FRIULI CENTRALE – OSPEDALE S. MARIA DELLA MISERICORDIA, UDINE; S. ORSOLA UNIVERSITY HOSPITAL, BOLOGNA; SAN RAFFAELE UNIVERSITY HOSPITAL, MILANO; SAN CAMILLO HOSPITAL, ROMA; PAPA GIOVANNI XXII HOSPITAL OF BERGAMO, BERGAMO
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Polastri M, Loforte A, Swol J. "Racing team" or "orchestra" approach? Two different perspectives on providing care in emergency and critical settings. Artif Organs 2022; 46:1722-1724. [PMID: 35490353 DOI: 10.1111/aor.14274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/02/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola University Hospital, Bologna, Italy
| | - Antonio Loforte
- Department of Cardiac-Thoracic and Vascular Diseases, Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola University Hospital, Bologna, Italy
| | - Justyna Swol
- Department of Respiratory Medicine, Allergology and Sleep Medicine, Paracelsus Medical University General Hospital, Nuremberg, Germany
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Loforte A. Web-based health education in medicine and surgery. J Card Surg 2022; 37:2006-2008. [PMID: 35442521 DOI: 10.1111/jocs.16532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/28/2022]
Abstract
The Internet is transforming health care and has the potential to combine existing health information sources. The general public increasingly uses the Internet as a complementary resource for health information. With the rapid development of the Internet and broadband worldwide, the web has become a major means of health information dissemination and proactive use of the Internet for health promotion is possible. Health professionals need to be more responsive to the use of the Internet to deliver better healthcare for consumers. In this editorial comment, I tried to address the issue and even explore the navigational needs of consumers for finding online health information and identifying consumer barriers to online health information-seeking behavior.
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Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Bologna, Italy
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Masetti M, Scuppa F, Sabatino M, Suarez SM, Loforte A, Russo A, Prestinenzi P, Leone O, Potena L. Using Hemodynamics to Define Graft Function: Do We Need It? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Loforte A, de By T, Gliozzi G, Schoenrath F, Cavalli G, Netuka I, Pya Y, Zimpfer D, Boschi S, Gummert J, Meyns B, Pacini D, Potapov E. Impact of Concomitant Cardiac Valvular Surgery During Implantation of Continuous-Flow Left Ventricular Assist Devices: A European Registry for Patients with Mechanical Circulatory Support (EUROMACS) Analysis. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Lechiancole A, Loforte A, De Bonis M, Iacovoni A, Musumeci F, Cavalli G, Maiani M, Comisso M, Trumello C, Terzi A, Pacini D, Livi U. Living at Distance from the Implanting Center: Any Impact on LVAD Patients Outcome? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Wert L, Stewart G, Mehra M, Milwidsky A, Jorde U, Goldstein D, Selzman C, Stehlik J, Alshamdin F, Khaliel F, Gustafsson F, Boschi S, Loforte A, Ajello S, Scandroglio A, Tučanová Z, Netuka I, Schlöglhofer T, Zimpfer D, Dogan G, Schmitto J, Maier S, Schibilsky D, Jawad K, Saeed D, Faerber G, Morshuis M, Hanuna M, Müller C, Mulzer J, Kempfert J, Falk V, Potapov E. A Multi-Center Evaluation of Outflow Graft Obstruction with a Fully Magnetically Levitated Left Ventricular Assist Device. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Suarez SM, Fiorentino M, Murana G, Botta L, Loforte A, Santamaria V, Pagano V, Prestinenzi P, Sabatino M, Bombardini A, Sangiorgi G, Potena L, Pacini D. Medium-Long Term Results of Cardiac Transplantation from Donors Assessed with the “Aged Donor Heart Rescue by Stress Echo” (ADONHERS) Protocol. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Loforte A, Fiorentino F, Gliozzi G, Santamaria V, Cavalli G, Murana G, Mariani C, Botta L, Sabatino M, Masetti M, Potena L, Martin Suarez S, Pacini D. Impact of Recipients Pre-Operative Right Ventricular Dysfunction on Heart Transplantation Outcomes. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fiorentino M, Suarez SM, Botta L, Loforte A, Murana G, Amodio C, Costantino A, Cavalli G, Tassi S, Russo A, Masetti M, Potena L, Pacini D. Cardiac Transplantation Italian Allocation System Analysis: Single Center Results. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Dardi F, Manes A, Guarino D, Suarez SM, Loforte A, Rotunno M, Pacini D, Galiѐ N, Palazzini M. Long-term outcomes after pulmonary endarterectomy. Ann Cardiothorac Surg 2022; 11:172-174. [PMID: 35433360 PMCID: PMC9012203 DOI: 10.21037/acs-2021-pte-179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/21/2021] [Indexed: 09/08/2023]
Affiliation(s)
- Fabio Dardi
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Alessandra Manes
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Daniele Guarino
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Sofia Martin Suarez
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Antonio Loforte
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Mariangela Rotunno
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Davide Pacini
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Nazzareno Galiѐ
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
| | - Massimiliano Palazzini
- Alma Mater Studiorum, University of Bologna and IRCCS Sant'Orsola University Hospital, Bologna, Italy
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Loforte A, Comentale G, Gliozzi G, Cavalli GG, Pacini D, Martin-Suarez S. Mechanical circulatory supports after pulmonary thrombo-endarterectomy: why, when and how. Ann Cardiothorac Surg 2022; 11:169-171. [PMID: 35433365 PMCID: PMC9012191 DOI: 10.21037/acs-2021-pte-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/26/2021] [Indexed: 08/30/2023]
Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Giuseppe Comentale
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
- Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples “Federico II”, Naples, Italy
| | - Gregorio Gliozzi
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Sofia Martin-Suarez
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
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Brookes JDL, Li C, Chung STW, Brookes EM, Williams ML, McNamara N, Martin-Suarez S, Loforte A. Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension: a systematic review. Ann Cardiothorac Surg 2022; 11:68-81. [PMID: 35433363 PMCID: PMC9012194 DOI: 10.21037/acs-2021-pte-25] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/28/2022] [Indexed: 07/26/2023]
Abstract
BACKGROUND Pulmonary thromboendarterectomy (PTE) is the gold standard treatment for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, the results are poorly quantified outside a few registry reports and several individual centers. METHODS A systematic review was performed searching five electronic databases assessing the outcomes for adult patients undergoing PTE for CTEPH. All articles that reported mortality data were included. Primary outcome measures were early/inpatient mortality; secondary outcomes were survival, pulmonary haemodynamics, morbidity and functional status following PTE for CTEPH. Results were pooled via a meta-analysis of proportions and meta-regression. RESULTS A total of 5,717 studies were identified, yielding sixty-one relevant papers. Thirty-day mortality ranged from 0.8% to 24.4%, and on meta-analysis was 8.4% [95% confidence interval (CI): 7.2-9.6%]. Mortality was noted to decrease with increasing center volume of PTE cases (P<0.01). Residual pulmonary hypertension was reported in 8.2% to 44.5% of patients. CONCLUSIONS CTEPH is associated with acceptable short-term mortality and an improvement in pulmonary hemodynamics. With increasing volume of experience and ongoing developments over time peri-operative mortality continues to decrease.
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Affiliation(s)
- John D. L. Brookes
- Department of Cardiothoracic Surgery, University Hospital Geelong, Barwon Health, Geelong, Australia
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Crystal Li
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
- Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Sally T. W. Chung
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
- School of Medicine, University of New South Wales, Sydney, Australia
| | | | - Michael L. Williams
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
| | - Nicholas McNamara
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sofia Martin-Suarez
- S. Orsola University Hospital, IRCCS Bologna, Division of Cardiac Surgery, Bologna, Italy
| | - Antonio Loforte
- S. Orsola University Hospital, IRCCS Bologna, Division of Cardiac Surgery, Bologna, Italy
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Martin-Suarez S, Loforte A, Cavalli GG, Gliozzi G, Botta L, Mariani C, Orioli V, Votano D, Costantino A, Santamaria V, Tassi S, Fiaschini C, Campanini F, Palazzini M, Rossi B, Barbera NA, Niro F, Manes A, Saia F, Dardi F, Galiè N, Pacini D. Therapeutic alternatives in chronic thromboembolic pulmonary hypertension: from pulmonary endarterectomy to balloon pulmonary angioplasty to medical therapy. State of the art from a multidisciplinary team. Ann Cardiothorac Surg 2022; 11:120-127. [PMID: 35433353 PMCID: PMC9012190 DOI: 10.21037/acs-2021-pte-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/02/2022] [Indexed: 08/26/2023]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease with a very complex pathophysiology differing from other causes of pulmonary hypertension (PH). It is an infrequent consequence of acute pulmonary embolism that is frequently misdiagnosed. Pathogenesis has been related to coagulation abnormalities, infection or inflammation, although these disturbances can be absent in many cases. The hallmarks of CTEPH are thrombotic occlusion of pulmonary vessels, variable degree of ventricular dysfunction and secondary microvascular arteriopathy. The definition of CTEPH also includes an increase in mean pulmonary arterial pressure of more than 25 mmHg with a normal pulmonary capillary wedge of less than 15 mmHg. It is classified as World Health Organization group 4 PH, and is the only type that can be surgically cured by pulmonary endarterectomy (PEA). This operation needs to be carried out by a team with strong expertise, from the diagnostic and decisional pathway to the operation itself. However, because the disease has a very heterogeneous phenotype in terms of anatomy, degree of PH and the lack of a standard patient profile, not all cases of CTEPH can be treated by PEA. As a result, PH-directed medical therapy traditionally used for the other types of PH has been proposed and is utilized in CTEPH patients. Since 2015, we have been witnessing the rebirth of balloon pulmonary angioplasty, a technique first performed in 2001 but has since fallen out fashion due to major complications. The refinement of such techniques has allowed its safe utilization as a salvage therapy in inoperable patients. In the present keynote lecture, we will describe these therapeutic approaches and results.
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Affiliation(s)
- Sofia Martin-Suarez
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Antonio Loforte
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Giulio Giovanni Cavalli
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Gregorio Gliozzi
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Luca Botta
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Carlo Mariani
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Valentina Orioli
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Daniela Votano
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Antonino Costantino
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Valeria Santamaria
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Sara Tassi
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Costanza Fiaschini
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Francesco Campanini
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Massimiliano Palazzini
- Cardiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Barbara Rossi
- Cardiac Anaesthesia Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Nicolò Antonino Barbera
- Cardiac Anaesthesia Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Fabio Niro
- Cardiovascular Radiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Alessandra Manes
- Cardiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Francesco Saia
- Cardiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Fabio Dardi
- Cardiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Nazzareno Galiè
- Cardiology Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
| | - Davide Pacini
- Cardiac Surgery Unit, Cardio Thoracic and Vascular Department, S.Orsola Hospital IRCCS, Bologna University, Bologna, Italy
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Gliozzi G, Loforte A, Mariani C, Cavalli GG, Botta L, Santamaria V, Tassi S, Martìn-Suarez S, Potena L, Pacini D. Impact of Predicted Heart Mass–Based Donor-Recipient Size Matching on Transplant Outcomes. Transplant Proc 2022; 54:774-781. [DOI: 10.1016/j.transproceed.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/01/2022] [Indexed: 10/18/2022]
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Björnsdóttir B, Biancari F, Dalén M, Dell'Aquila AM, Jónsson K, Fiore A, Mariscalco G, El-Dean Z, Gatti G, Zipfel S, Perrotti A, Bounader K, Alkhamees K, Loforte A, Lechiancole A, Pol M, Spadaccio C, Pettinari M, De Keyzer D, Welp H, Speziale G, Lichtenberg A, Ruggieri VG, Yusuf H, Ragnarsson S. Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation With and Without Intra-Aortic Balloon Pump. J Cardiothorac Vasc Anesth 2022; 36:2876-2883. [PMID: 35304046 DOI: 10.1053/j.jvca.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To compare the outcomes of patients with postcardiotomy shock treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO) only compared with VA-ECMO and intra-aortic balloon pump (IABP). DESIGN A retrospective multicenter registry study. SETTING At 19 cardiac surgery units. PARTICIPANTS A total of 615 adult patients who required VA-ECMO from 2010 to 2018. The patients were divided into 2 groups depending on whether they received VA-ECMO only (ECMO only group) or VA-ECMO plus IABP (ECMO-IABP group). MEASUREMENTS AND MAIN RESULTS The overall series mean age was 63 ± 13 years, and 33% were female. The ECMO-only group included 499 patients, and 116 patients were in the ECMO-IABP group. Urgent and/or emergent procedures were more common in the ECMO-only group. Central cannulation was performed in 47% (n = 54) in the ECMO-IABP group compared to 27% (n = 132) in the ECMO-only group. In the ECMO-IABP group, 58% (n = 67) were successfully weaned from ECMO, compared to 46% (n = 231) in the ECMO-only group (p = 0.026). However, in-hospital mortality was 63% in the ECMO-IABP group compared to 65% in the ECMO-only group (p = 0.66). Among 114 propensity score-matched pairs, ECMO-IABP group had comparable weaning rates (57% v 53%, p = 0.51) and in-hospital mortality (64% v 58%, p = 0.78). CONCLUSIONS This multicenter study showed that adjunctive IABP did not translate into better outcomes in patients treated with VA-ECMO for postcardiotomy shock.
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Affiliation(s)
- Björk Björnsdóttir
- Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Magnus Dalén
- Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Angelo M Dell'Aquila
- Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany
| | - Kristján Jónsson
- Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Antonio Fiore
- Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France
| | - Giovanni Mariscalco
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Zein El-Dean
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Giuseppe Gatti
- Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
| | | | - Andrea Perrotti
- Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Karl Bounader
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | | | - Antonio Loforte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Marek Pol
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Cristiano Spadaccio
- Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom; Department of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Matteo Pettinari
- Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Dieter De Keyzer
- Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Henryk Welp
- Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany
| | - Giuseppe Speziale
- Division of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vito G Ruggieri
- Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
| | - Hakeem Yusuf
- Department of Cardiac Anesthesia and Intensive Care, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Sigurdur Ragnarsson
- Department of Cardiothoracic Surgery, Skane University Hospital and Lund University, Lund, Sweden.
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Polastri M, Boschi S, Tchantchaleishvili V, Loforte A. Hand grip strength in patients with
LVADs
: A scoping review. Artif Organs 2022; 46:747-754. [DOI: 10.1111/aor.14180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/11/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation IRCCS Azienda Ospedaliero‐Universitaria di Bologna, St. Orsola University Hospital Bologna Italy
| | - Silvia Boschi
- Department of Cardiac‐Thoracic and Vascular Diseases, Cardiac Surgery and Transplantation IRCCS Azienda Ospedaliero‐Universitaria di Bologna, St. Orsola University Hospital Bologna Italy
| | | | - Antonio Loforte
- Department of Cardiac‐Thoracic and Vascular Diseases, Cardiac Surgery and Transplantation IRCCS Azienda Ospedaliero‐Universitaria di Bologna, St. Orsola University Hospital Bologna Italy
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Loforte A. Tricuspid valve repair and mechanical right ventricular support in rescue left ventricular assist device implantations: Still a relevant issue. J Card Surg 2022; 37:1118-1120. [DOI: 10.1111/jocs.16275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna Bologna Italy
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Mariani C, Loforte A, Gliozzi G, Cavalli GG, Botta L, Martìn Suarez S, Potena L, Pacini D. Impact of prior sternotomy on survival and allograft function after heart transplantation: A single center matched analysis. J Card Surg 2022; 37:868-879. [PMID: 35032070 DOI: 10.1111/jocs.16224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/25/2021] [Accepted: 11/16/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Orthotopic heart transplantation (OHT) remains the gold standard for the treatment of end-stage heart failure. The number of patients who have had at least one prior sternotomy while awaiting transplantation has increased over the years reaching 50% in the last ISHLT registry report. We analysed our institutional transplant activity focusing on prior-sternotomy setting to identify the real burden of this preoperative variable and its potential consequences. METHODS Between 2000 and 2020, a total of 512 consecutive adult patients underwent OHT. We divided them into two groups according to the previous sternotomy variable: a prior sternotomy group (PS-group, n = 131, 25.6%) and a heart transplant as first sternotomy group (FS-group, n = 381, 74.4%). After propensity score matching, a total of 106 matched-pairs were identified for the final analysis. RESULTS The overall 30-day mortality was similar in the two groups (7.5% vs. 5.7%, p = .58). The prior sternotomy was not an independent risk factor for 90-day mortality (odds ratio: 0.89, p = .81). In the matched sample, prior cardiac surgery was not predictive for any major postoperative complication: primary graft failure, AKI, bleeding, acute respiratory insufficiency, need for extra-corporeal life support (p > .05). The log-rank test revealed no significant difference between the two groups in the unmatched and matched pools (p = .93 and 0.69 respectively. At univariable analysis prior sternotomy was not associated with an increased risk of posttransplant mortality (hazard ratio: 0.87, p = .599). CONCLUSIONS Despite it increases surgical complexity, the reoperation alone does not represent a proper risk factor and among different co-variates that may affect post-OHT outcomes.
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Affiliation(s)
- Carlo Mariani
- Division of Cardiac Surgery IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola Policlinic-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Antonio Loforte
- Division of Cardiac Surgery IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola Policlinic-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Gregorio Gliozzi
- Division of Cardiac Surgery IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola Policlinic-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giulio G Cavalli
- Division of Cardiac Surgery IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola Policlinic-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luca Botta
- Division of Cardiac Surgery IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola Policlinic-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sofia Martìn Suarez
- Division of Cardiac Surgery IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola Policlinic-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luciano Potena
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola Policlinic-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery IRCCS Azienda Ospedaliero-Universitaria di Bologna, St. Orsola Policlinic-Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Loforte A, Comentale G, Coppola G, Amodio C, Botta L, Saia F, Taglieri N, Marrozzini C, Savini C, Pacini D. A rescue transcatheter solution for early sutureless basal ring infolding. J Card Surg 2021; 37:697-699. [PMID: 34970780 DOI: 10.1111/jocs.16196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/13/2021] [Accepted: 12/08/2021] [Indexed: 12/01/2022]
Abstract
We report the case of an 83-year-old woman treated with a "rescue" valve-in-valve transcatheter aortic valve implantation because of an early basal ring partial collapse of a sutureless valve, probably due to septal hypertrophy.
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Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Giuseppe Comentale
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy.,Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuditta Coppola
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Ciro Amodio
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Luca Botta
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Francesco Saia
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Nevio Taglieri
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Cinzia Marrozzini
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Carlo Savini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
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Loforte A. Impact of renal function on heart replacement therapy. J Card Surg 2021; 37:600-601. [PMID: 34953082 DOI: 10.1111/jocs.16198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 12/11/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, S. Orsola University Hospital, ALMA Mater Studiorum University of Bologna, IRCCS Bologna, Bologna, Italy
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Loforte A, de By TMMH, Gliozzi G, Schönrath F, Mariani C, Netuka I, Pya Y, Zimpfer D, Cavalli GG, Gummert J, Meyns B, Pacini D, Potapov E. Impact of concomitant cardiac valvular surgery during implantation of continuous-flow left ventricular assist devices: A European registry for patients with mechanical circulatory support (EUROMACS) analysis. Artif Organs 2021; 46:813-826. [PMID: 34904255 DOI: 10.1111/aor.14143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/22/2021] [Accepted: 12/08/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND We investigated the clinical outcomes after cardiac valvular surgery procedures concomitant (CCPs) with left ventricular assist device (LVAD) implantation compared to propensity score (PS) matched controls using the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) data. METHODS Between 2006 and 2018, 2760 continuous-flow LVAD patients were identified. Of these, 533 underwent a CCP during the LVAD implant. RESULTS Cardiopulmonary bypass time (p < 0.001) and time for implant (p < 0.001) were both significantly longer in the LVAD+CCP group. Hospital mortality was comparable between the two groups from the unmatched population (15.7% vs. 14.1%, p = 0.073). Similarly, short-to-mid-term survival was similar in both groups, with 1-year, 3-year, and 5-year survival rates of 67.9%, 48.2%, and 27.7% versus 66.4%, 46.1%, and 26%, respectively (log-rank, p = 0.25). The results were similar in the PS-matched population. Hospital mortality was comparable between the two groups (18.9% vs. 17.4%, p = 0.074). The short-to-mid-term Kaplan-Meier survival analysis was similar for both groups, with 1-year, 3-year, and 5-year survival rates of 63.4%, 49.2%, and 24.7% versus 66.5%, 46%, and 25.1%, respectively (log-rank, p = 0.81). In the unmatched population, LVAD+CCP patients had longer intensive care unit (ICU) stays (p < 0.0001), longer mechanical ventilation time (p = 0.001), a higher rate of temporary right ventricular assist device (RVAD) support (p = 0.033), and a higher rate of renal replacement therapy (n = 35, 6.6% vs. n = 89, 4.0%, p = 0.014). In the PS-matched population, the LVAD+CCP patients had longer ICU stays (p = 0.019) and longer mechanical ventilation time (p = 0.002). CONCLUSIONS The effect of additive valvular procedures (CCPs) does not seem to affect short-term survival, significantly, based on our registry data analysis. However, the decision to perform CCPs should be balanced with the projected type of surgery and preoperative characteristics. LVAD+CCP patients remain a delicate population and adverse device-related events should be strictly monitored and managed.
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Affiliation(s)
- Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | | | - Gregorio Gliozzi
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | | | - Carlo Mariani
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Ivan Netuka
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Yuriy Pya
- National Research Cardiac Surgery Center, Astana Kazakhstan, Kazakhstan
| | | | - Giulio Giovanni Cavalli
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
| | - Jan Gummert
- Heart and Diabetes Center North-Rhine Westphalia, Ruhr-Un, Bad Oeynhausen, Germany
| | - Bart Meyns
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Davide Pacini
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, Bologna, Italy
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