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Utilization and Outcomes of Postcardiotomy Mechanical Circulatory Support
  • Nicholas Hess,
  • Yisi Wang,
  • Arman Kilic
Nicholas Hess
University of Pittsburgh Medical Center

Corresponding Author:[email protected]

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Yisi Wang
University of Pittsburgh Medical Center Health System
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Arman Kilic
Medical University of South Carolina
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Background: This study evaluated the utilization and outcomes of postcardiotomy mechanical circulatory support (MCS). Methods: This was a retrospective, single institution analysis of adult cardiac surgery cases that required de novo MCS following surgery from 2011-2018. Patients that were bridged with MCS to surgery were excluded. The primary outcomes were early operative mortality and longitudinal survival. Secondary outcomes included postoperative complications, and five-year all-cause readmission. Results: 533 patients required de novo postcardiotomy MCS, with the most commonly performed procedure being isolated coronary artery bypass grafting (29.8%). Median cardiopulmonary bypass and cross clamp times were 185 (IQR 123-260) minutes and 122 (IQR 81-179) minutes, respectively. A total of 442 (82.9%) of patients were supported with intra-aortic balloon pump counterpulsation, 23 (4.3%) with an Impella device, and 115 (21.6%) with extracorporeal membrane oxygenation. Three (0.6%) patients had an unplanned ventricular assist device placed. Operative mortality was 29.8%. Longitudinal survival was 56.1% and 43.0% at 1- and 5-years, respectively. Survival was lowest in those supported with ECMO and highest with those supported with an Impella (P<0.001). Freedom from readmission was 61.4% at 5-years. Postoperative ECMO was an independent predictor of mortality (HR 5.1, 95% CI 2.0-12.9, P<0.001), but none of the MCS types predicted long-term hospital readmission after risk adjustment. Conclusions: Postcardiotomy MCS is associated with high operative mortality. Even patients that survive to discharge have compromised longitudinal survival, with nearly only half surviving to 1-year. Close follow-up and early referral to advanced heart failure specialists may be prudent in improving these outcomes.
16 Jul 2021Submitted to Journal of Cardiac Surgery
17 Jul 2021Assigned to Editor
17 Jul 2021Submission Checks Completed
31 Jul 2021Review(s) Completed, Editorial Evaluation Pending
01 Aug 2021Editorial Decision: Accept
Nov 2021Published in Journal of Cardiac Surgery volume 36 issue 11 on pages 4030-4037. 10.1111/jocs.15908