Postcardiotomy mechanical support: risk factors and outcomes.
BACKGROUND
The need for postcardiotomy mechanical support is uncommon, with an incidence of 0.5%.


METHODS
Multivariable logistic regression analysis of factors associated with postcardiotomy extracorporeal membrane oxygenation (ECMO) support was investigated in 19,985 patients, of whom, 97 required ECMO.


RESULTS
Younger age, number of reoperations, emergency operation, higher creatinine, greater left ventricular dysfunction, and history of myocardial infarction were significant predictors. Overall survival was 35%, but significantly better (72%) in the subgroup converted to an implantable system and then bridged to transplantation.


CONCLUSIONS
Patients at increased risk for mechanical support can be identified preoperatively and patient management modified as indicated. Improvement in postcardiotomy survival has been realized by bridging to transplantation. In nontransplant candidates, permanent support may be the only option for increasing survival.
Smedira
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Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio, USA. smedirn@ccf.org
Blackstone
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EH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome