AI Article Synopsis
- The study focuses on the incidence and outcomes of prosthetic valve thrombosis in patients who received peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO) after valve replacement surgery for postcardiotomy cardiogenic shock (PCCS).
- It involved a retrospective analysis of 549 patients, with 152 having valve replacements, and found that 9 developed thrombosis, resulting in a 30-day thrombosis incidence of approximately 7.5%.
- The findings suggest that using an intra-aortic balloon pump (IABP) in conjunction with pVA-ECMO significantly reduces the risk of valve thrombosis and is linked to lower hospital mortality rates.
Article Abstract
Objectives: In the context of postcardiotomy cardiogenic shock (PCCS) following valve replacement surgery, it may be necessary to implant a peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO). This procedure, however, carries a risk of prosthetic valve thrombosis. The aim of this retrospective study was to describe the incidence and outcomes of prosthetic valve thrombosis after VA-ECMO support for PCCS and to report the associated risk factors.
Methods: All consecutive adult patients who received pVA-ECMO for PCCS following a valve replacement procedure between January 2015 and October 2019 in our institution were included in this retrospective study. Outcome variables were prosthetic valve thrombosis, 30-day and hospital survival, pVA-ECMO-associated adverse events and surgery-related adverse events.
Results: During the 4-year study period, 549 patients received pVA-ECMO for PCCS. Among them, 152 had undergone a valve replacement procedure and 9 of these developed prosthetic valve thrombosis. The incidence of valve thrombosis at 30 days was 7.5 ± 2%. The cumulative incidence of prosthetic valve thrombosis was significantly lower with pVA-ECMO + intra-aortic balloon pump versus VA-ECMO alone (1.4 ± 1.4% vs 13.7 ± 4.7%, P = 0.021, respectively). Intra-aortic balloon pump use associated with pVA-ECMO (versus pVA-ECMO alone) was an independent protective factor against hospital death [odds ratio = 0.180 (0.068-0.478), P = 0.001].
Conclusions: After PCCS following valve replacement surgery, peripheral femoro-femoral VA-ECMO is associated with a low risk of acute valve thrombosis especially when associated with an intra-aortic balloon pump.
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| http://dx.doi.org/10.1093/ejcts/ezae321 | DOI Listing |
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