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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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Settepani F, Cappai A, Cannata A, Merlanti B, Carrozzini M, Olivieri G, Costetti A, Russo C. P44 PREDICTORS OF MORTALITY AFTER ACUTE TYPE A AORTIC DISSECTION REPAIR IN PATIENTS OF 70 YEARS OF AGE OR OLDER. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Objectives
The impact of age on outcomes of acute type A aortic dissection remains controversial. We sought to investigate 30–day and follow–up outcomes of acute type A aortic dissection repair in elderly patients. Survival anlysis was performed and independent risk factors for mortality were searched.
Methods
During a 21–year period (2000–2021), 102 patients of 70 years of age or older were emergently treated for acute type A aortic dissection at our institution. (mean age 75.1 ± 3.8 years, 53.9% male) Preoperative characteristics are displayed in Table I.
Results
Overall 30–day mortality (including operative mortality) was 21.6%. Mortality increased among patients presenting with atrial fibrillation (adjusted odds ratio 10.33, P = 0.02) and visceral malperfution (adjusted odds ratio 70.88, P = 0.005). Survival at 1, 5 and 10 years was 70.2 ± 4.6%, 50.9 ± 5.6% and 24.1 ± 5.6%, respectively (Figure 1). The need to perform concomitant coronary artery bypass grafting was the only independent risk factor for mortality during follow–up. (adjusted odds ratio 2.21, P = 0.04)
Conclusions
Thirty –day and follow–up mortality were extremely satisfactory in elderly patients undergoing acute type A dissection repair. We could detect significant disease and surgery–related risk factors for death. Patients presenting with atrial fibrillation or visceral malperfusion had the poorest 30–day outcome. The need to perform concomitant coronary artery bypass grafting, significantly increased the mortality during follow–up.
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Affiliation(s)
- F Settepani
- ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO
| | - A Cappai
- ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO
| | - A Cannata
- ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO
| | - B Merlanti
- ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO
| | - M Carrozzini
- ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO
| | - G Olivieri
- ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO
| | - A Costetti
- ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO
| | - C Russo
- ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA, MILANO
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Botta L, De Chiara B, Macera F, Cannata A, Costetti A, Voltolini A, Moreo A, Cipriani M, Frigerio M, Russo CF. HeartWare-HVAD for end-stage heart failure: a review of clinical experiences with ≥50 patients. Expert Rev Med Devices 2017; 14:423-437. [DOI: 10.1080/17434440.2017.1325318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Luca Botta
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Benedetta De Chiara
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Francesca Macera
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Aldo Cannata
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Alessandro Costetti
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Alessandra Voltolini
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Antonella Moreo
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Manlio Cipriani
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
| | - Maria Frigerio
- Cardiology Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milano, Italy
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