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Effect of venoarterial extracorporeal membrane oxygenation initiation timing on tricuspid valve surgery outcomes. | LitMetric

AI Article Synopsis

  • Tricuspid valve surgery can lead to high rates of shock and in-hospital mortality, and initiating venoarterial extracorporeal membrane oxygenation (VA-ECMO) early after surgery may improve survival outcomes.
  • A study evaluated 47 patients who required VA-ECMO for tricuspid valve surgery between 2010 and 2022, comparing those who received it early in the operating room versus later.
  • Results showed that in-hospital mortality was significantly lower in the Early group (35.5%) compared to the Late group (68.8%), indicating that the timing of VA-ECMO initiation is crucial for improving patient survival.

Article Abstract

Objectives: Tricuspid valve surgery is associated with high rates of shock and in-hospital mortality. Early initiation of venoarterial extracorporeal membrane oxygenation after surgery may provide right ventricular support and improve survival. We evaluated mortality in patients undergoing tricuspid valve surgery based on the timing of venoarterial extracorporeal membrane oxygenation.

Methods: All consecutive adult patients undergoing isolated or combined surgical tricuspid valve repair or replacement from 2010 to 2022 requiring venoarterial extracorporeal membrane oxygenation use were stratified by initiation in the operating room (Early) versus outside of the operating room (Late). Variables associated with in-hospital mortality were explored using logistic regression.

Results: There were 47 patients who required venoarterial extracorporeal membrane oxygenation: 31 Early and 16 Late. Mean age was 55.6 years (standard deviation, 16.8), 25 (54.3%) were in New York Heart Association class III/IV, 30 (60.8%) had left-sided valve disease, and 11 (23.4%) had undergone prior cardiac surgery. Median left ventricular ejection fraction was 60.0% (interquartile range, 45-65), right ventricular size was moderately to severely increased in 26 patients (60.5%), and right ventricular function was moderately to severely reduced in 24 patients (51.1%). Concomitant left-sided valve surgery was performed in 25 patients (53.2%). There were no differences in baseline characteristics or invasive measurements immediately before surgery between the Early and Late groups. Venoarterial extracorporeal membrane oxygenation was initiated 194 (23.0-840.0) minutes after cardiopulmonary bypass in the Late venoarterial extracorporeal membrane oxygenation group. In-hospital mortality was 35.5% (n = 11) in the Early group versus 68.8% (n = 11) in the Late group ( = .037). Late venoarterial extracorporeal membrane oxygenation was associated with in-hospital mortality (odds ratio, 4.00; 1.10-14.50;  = .035).

Conclusions: Early postoperative initiation of venoarterial extracorporeal membrane oxygenation after tricuspid valve surgery in high-risk patients may be associated with improvement in postoperative hemodynamics and in-hospital mortality.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10328813PMC
http://dx.doi.org/10.1016/j.xjon.2023.02.012DOI Listing

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