Extracorporeal Life Support for Post-Cardiotomy Acute Right Ventricular Failure: A Retrospective Observational Multicenter Study

초록

Background: Post-cardiotomy acute right ventricular failure (aRVF) constitutes a complex clinical challenge that might necessitate escalating interventions, including extracorporeal life support (ECLS). This study evaluated outcomes of adults requiring ECLS for post-cardiotomy aRVF compared with other post-cardiotomy indications. Methods: In this multicenter, international, retrospective study, we analyzed patients undergoing post-cardiotomy ECLS from January 2000 to December 2020 and compared patients' characteristics and in-hospital mortality between aRVF and other indications. Results: Of 2010 patients, 240 (12%) had aRVF and 1770 (88%) had other indications for ECLS. Demographics were similar between groups; median age was 65 (55-72) years (P = .217), and 60% were male (P = .675). The aRVF group showed higher preoperative right-sided cardiac dysfunction, including preexisting right ventricular failure (aRVF, 22%; other indications, 8%; P < .001) and biventricular failure (aRVF, 12%; other indications, 7%; P = .013). Patients with aRVF more frequently underwent tricuspid valve surgery (aRVF, 20%; other indications, 13%; P = .003) and aortic root procedures (aRVF, 24%; other indications, 13%). They also required longer ECLS support (aRVF, 135 [70-221] hours; other indications, 116 [58-192] hours; P = .025) and longer intensive care unit stay (aRVF, 15 [7-29] days; other indications, 13 [6-25] days; P = .042). Despite more complications, including nonsurgical bleeding (aRVF, 31%; other indications, 25%; P = .042) and persistent right-sided heart failure (aRVF, 50%; other indications, 17%; P < .001), both in-hospital survival (aRVF, 59%; other indications, 61%; P = .526) and long-term survival were comparable (log-rank P = .17). Conclusions: Patients requiring ECLS for post-cardiotomy aRVF, despite higher preoperative risks and complex clinical courses, achieve survival rates comparable to those of patients with other indications. (c) 2026 by The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

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