Features and Outcomes of Females and Males Requiring Postcardiotomy Extracorporeal Life Support.

Acute Heart Failure Cardiac Surgery Extracorporeal Life Support Mechanical Circulatory Support Post-cardiotomy Cardiogenic Shock Sex differences

Journal

The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343

Informations de publication

Date de publication:
16 May 2024
Historique:
received: 18 12 2023
revised: 08 04 2024
accepted: 30 04 2024
medline: 19 5 2024
pubmed: 19 5 2024
entrez: 18 5 2024
Statut: aheadofprint

Résumé

Although cardiogenic shock requiring extracorporeal life support (ECLS) after cardiac surgery is associated with high mortality, the impact of sex on outcomes of post-cardiotomy ECLS remains unclear with conflicting results in literature. We compare patient characteristics, in-hospital outcomes, and overall survival between females and males requiring post-cardiotomy ECLS. This retrospective, multicentre (34 centres), observational study included adults requiring post-cardiotomy ECLS between 2000 and 2020. Pre-operative, procedural, and ECLS characteristics, complications, and survival were compared between females and males. Association between sex and in-hospital survival was investigated through mixed-Cox proportional hazards models. This analysis included 1823 patients [females:40.8%; median age:66.0 (interquartile range:56.2-73.0 years)]. Females underwent more mitral (females:38.4%, males:33.1%, p=0.019) and tricuspid (females:18%, males:12.4%, p<0.001) valve surgery, while males had more coronary artery surgery (females:45.9%, males:52.4%, p=0.007). ECLS implantation was more common intra-operatively in females (females:64.1%, males:59.1%) and post-operatively in males (females:35.9%, males:40.9%, p=0.036). Ventricular unloading (females:25.1%, males:36.2%, p<0.001) and intra-aortic balloon pump (females: 25.8%, males:36.8%, p<0.001) were most frequently used in males. Females suffered more post-operative right ventricular failure (females:24.1%, males:19.1%, p=0.016) and limb ischemia (females:12.3%, males:8.8%, p=0.23). In-hospital mortality was 64.9% in females and 61.9% in males (p=0.199) with no differences in 5-year survival (females:20%, 95%CI:17-23; males:24%, 95%CI:21-28;p=0.069). Crude hazard ratio for in-hospital mortality in females was 1.12 (95%CI: 0.99-1.27,p=0.069) and did not change after adjustments. This study demonstrates that females and males requiring post-cardiotomy ECLS have different pre-operative and ECLS characteristics, as well as complications, without a statistical difference in in-hospital and 5-year survival.

Sections du résumé

BACKGROUND BACKGROUND
Although cardiogenic shock requiring extracorporeal life support (ECLS) after cardiac surgery is associated with high mortality, the impact of sex on outcomes of post-cardiotomy ECLS remains unclear with conflicting results in literature. We compare patient characteristics, in-hospital outcomes, and overall survival between females and males requiring post-cardiotomy ECLS.
METHODS METHODS
This retrospective, multicentre (34 centres), observational study included adults requiring post-cardiotomy ECLS between 2000 and 2020. Pre-operative, procedural, and ECLS characteristics, complications, and survival were compared between females and males. Association between sex and in-hospital survival was investigated through mixed-Cox proportional hazards models.
RESULTS RESULTS
This analysis included 1823 patients [females:40.8%; median age:66.0 (interquartile range:56.2-73.0 years)]. Females underwent more mitral (females:38.4%, males:33.1%, p=0.019) and tricuspid (females:18%, males:12.4%, p<0.001) valve surgery, while males had more coronary artery surgery (females:45.9%, males:52.4%, p=0.007). ECLS implantation was more common intra-operatively in females (females:64.1%, males:59.1%) and post-operatively in males (females:35.9%, males:40.9%, p=0.036). Ventricular unloading (females:25.1%, males:36.2%, p<0.001) and intra-aortic balloon pump (females: 25.8%, males:36.8%, p<0.001) were most frequently used in males. Females suffered more post-operative right ventricular failure (females:24.1%, males:19.1%, p=0.016) and limb ischemia (females:12.3%, males:8.8%, p=0.23). In-hospital mortality was 64.9% in females and 61.9% in males (p=0.199) with no differences in 5-year survival (females:20%, 95%CI:17-23; males:24%, 95%CI:21-28;p=0.069). Crude hazard ratio for in-hospital mortality in females was 1.12 (95%CI: 0.99-1.27,p=0.069) and did not change after adjustments.
CONCLUSIONS CONCLUSIONS
This study demonstrates that females and males requiring post-cardiotomy ECLS have different pre-operative and ECLS characteristics, as well as complications, without a statistical difference in in-hospital and 5-year survival.

Identifiants

DOI: 10.1016/j.jtcvs.2024.04.033 PMID: 38762034
pubmed: 38762034
pii: S0022-5223(24)00435-5
doi: 10.1016/j.jtcvs.2024.04.033
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Investigateurs

Samuel Heuts (S)
Luca Conci (L)
Philipp Szalkiewicz (P)
Sven Lehmann (S)
Jawad Khalil (J)
Jean-Francois Obadia (JF)
Nikolaos Kalampokas (N)
Agne Jankuviene (A)
Erwan Flecher (E)
Dinis Dos Reis Miranda (D)
Kogulan Sriranjan (K)
Daniel Herr (D)
Nazli Vedadi (N)
Marco Di Eusanio (M)
Graeme MacLaren (G)
Kollengode Ramanathan (K)
Alessandro Costetti (A)
Chistof Schmid (C)
Roberto Castillo (R)
Tomas Grus (T)
Vladimir Mikulenka (V)
Marco Solinas (M)

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.

Auteurs

Silvia Mariani (S)

Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, Netherlands; Cardiac Surgery Unit, Fondazione IRCCS San Gerardo, Monza, Italy. Electronic address: s.mariani1985@gmail.com.

Justine Mafalda Ravaux (JM)

Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, Netherlands; Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.

Bas C T van Bussel (BCT)

Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, Netherlands; Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.

Maria Elena De Piero (ME)

Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, Netherlands.

Sander M J van Kruijk (SMJ)

Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands.

Anne-Kristin Schaefer (AK)

Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.

Dominik Wiedemann (D)

Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.

Diyar Saeed (D)

Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

Matteo Pozzi (M)

Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France.

Antonio Loforte (A)

Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; University of Turin, Turin, Italy.

Udo Boeken (U)

Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany.

Robertas Samalavicius (R)

II Department of Anesthesiology, Centre of Anesthesia, Intensive Care and Pain management, Vilnius University Hospital Santariskiu Klinikos, Vilnius, Lithuania.

Karl Bounader (K)

Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.

Xiaotong Hou (X)

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 (JJH)

Department of Intensive Care Adults, Erasmus MC, Rotterdam, The Netherlands; Deparment of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.

Hergen Buscher (H)

Department of Intensive Care Medicine, Center of Applied Medical Research, St Vincent's Hospital, Darlinghurs, NSW, and University of New South Wales, Sidney, Australia.

Leonardo Salazar (L)

Department of Cardiology, Fundación Cardiovascular de Colombia,Bucaramanga,Colombia.

Bart Meyns (B)

Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.

Michael A Mazzeffi (MA)

Departments of Medicine and Surgery, University of Maryland, Baltimore, USA.

Sacha Matteucci (S)

SOD Cardiochirurgia Ospedali Riuniti 'Umberto I - Lancisi - Salesi' Università Politecnica delle Marche, Ancona, Italy.

Sandro Sponga (S)

Division of Cardiac Surgery, Cardiothoracic Department, University Hospital of Udine, Udine, Italy.

Vitaly Sorokin (V)

Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore.

Claudio Russo (C)

Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy.

Francesco Formica (F)

Cardiac Surgery Unit, Fondazione IRCCS San Gerardo, Monza, Italy; Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy.

Pranya Sakiyalak (P)

Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Antonio Fiore (A)

Department of Cardio-Thoracic Surgery, University Hospital Henri-Mondor, Créteil, Paris, France.

Daniele Camboni (D)

Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany.

Giuseppe Maria Raffa (GM)

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 (R)

ECMO Unit, Departamento de Anestesia, Clínica Las Condes, Las Condes, Santiago, Chile.

I-Wen Wang (IW)

Division of Cardiac Surgery, Memorial Healthcare System, Hollywood, FL 33021, USA.

Jae-Seung Jung (JS)

Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, South Korea.

Jan Belohlavek (J)

2nd Department of Internal Medicine, Cardiovascular Medicine General Teaching Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.

Vin Pellegrino (V)

Intensive Care Unit, The Alfred Hospital, Melbourne, VIC, Australia.

Giacomo Bianchi (G)

Ospedale del Cuore Fondazione Toscana "G. Monasterio", Massa, Italy.

Matteo Pettinari (M)

Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.

Alessandro Barbone (A)

Cardiac Surgery Unit, IRCCS Humanitas Research Hospital - Rozzano (MI) - Italy.

José P Garcia (JP)

IU Health Advanced Heart & Lung Care, Indiana University Methodist Hospital, Indianapolis, IN, USA.

Kiran Shekar (K)

Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.

Glenn J R Whitman (GJR)

Cardiac Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Maryland, USA.

Roberto Lorusso (R)

Cardiovascular Research Institute Maastricht, University of Maastricht, Maastricht, Netherlands; Cardio-Thoracic Surgery Department, Maastricht University medical Centre, Maastricht, The Netherlands.

Classifications MeSH