P244. Outcomes of Post Cardiotomy Veno-Arterial Extra-Corporeal Membrane Oxygenation For Repair of Acute Aortic Syndrome Compared to Other Cardiac Operations
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Royal Papworth Hospital
London, London
United Kingdom - Contact Me
I am a Cardiothoracic Surgical Trainee at Royal Papworth Hospital.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objectives:
Cardiac surgery has seen a shift in the patient population with increasing disease severity. Some patients are unable to wean from cardiopulmonary bypass safely following surgery. The increased availability and reliability of ECMO has allowed mechanical circulatory support (MCS) to become a viable option for selected patients in this situation. Our objectives were to assess the outcomes of Post Cardiotomy Veno-Arterial Extra-Corporeal Membrane Oxygenation (PC VA-ECMO) at our institution following repair of acute aortic syndrome compared to other cardiac operations.
Methods:
This was a retrospective study of all patients that underwent cardiac surgery at our institution from January 2008 until July 2023. Patients initiated on ECMO prior to surgery, placed on VV-ECMO or VAD were excluded. Patients initiated onto VA-ECMO post cardiotomy were identified and their records analysed further. Categoric variables were presented as numbers and percentages and compared with two tailed chi-square tests. Continuous variables were expressed as median and standard deviation and compare with an unpaired t-test.
Results:
28310 general adult cardiac operations were performed, of which 172 (0.61%) patients fulfilled inclusion criteria, with a median age of 66.5years. A total of 22 (12.8%) of patient had repair of an acute aortic syndrome (Group A) and 150 (87.2%) patients underwent other cardiac operations (Group B). There was no significant difference in relation to gender; 12/22 males in group A vs 99/150 in group B (p=0.2943), or in the age of the two groups the mean age in group A was 62.3 ±11.75 vs 64.9 ±12.01 in group B (p=0.3434), with a mean EuroScore of 12.4% ± 3.1% vs 9.9% ±4.6% (p=0.0131)
Pre-operatively, there was no significant differences between the two groups with regards to redo-sternotomy 3/22 vs 25/150 (p= 0.7192), LVEF<30% 9/22 vs 50/150 (p=0.4845), pre-operative cardiogenic shock 5/22 vs 27/150 (p= 0.8432), pre-operative intubation 3/22 vs 25/150 (p= 0.7192), and pre-operative inotropes 4/22 vs 23/150 (p=0.7344).
The urgency of the index procedure was elective in 29.1% (50/172), urgent in 29.1% (50/1972) and emergency/salvage in 41.8% (72/172). VA-ECMO was instituted at the index operation in 20/22 in group A vs 87/150 in group B (p= 0.0029) with the mean number of days on ECMO in group A of 7.5 ± 8.2 vs 5.9 ± 6 in group B (p=0.2685). A total of 10 patients underwent further mechanical circulatory support, 3 in group A (2x RVAD and 1x BiVAD) and 7 in group B (1x LVAD, 4x RVAD and 2x BiVAD). Table 1 shows other complications, mortality, and survival outcomes.
Conclusion:
Post cardiotomy ECMO is a useful method of support following cardiac surgery, although utilised in a small percentage of patients. The use of PC VA-ECMO following repair of acute aortic syndrome has comparable outcomes to its use following other cardiac operations. In-hospital mortality was significantly lower in the acute aortic syndrome group, with a significantly higher number of patients discharged from hospital. Survival outcomes between the two groups was similar. Our results demonstrate that VA-ECMO can be utilised in patients following repair of acute aortic syndromes with similar outcomes compared to other cardiac operations.
Authors
Ahmed Mohamed Abdel Shafi (1), Jason Ali (1), Narain Moorjani (1), David Jenkins (1), Alain Vuylsteke (1), Stephen Large (1), Ismail Vokshi (1), Choo Ng (1), Muhammad Rafiq (1), Fouad Taghavi (1), Shakil Farid (1), Pradeep Kaul (1), Jo-Anne Fowles (1), Francis Wells (1), Marius Berman (1), STEVEN TSUI (1), Hassiba Smail (1), RAVI DE SILVA (1)
Institutions
(1) Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
Cardiac surgery has seen a shift in the patient population with increasing disease severity. Some patients are unable to wean from cardiopulmonary bypass safely following surgery. The increased availability and reliability of ECMO has allowed mechanical circulatory support (MCS) to become a viable option for selected patients in this situation. Our objectives were to assess the outcomes of Post Cardiotomy Veno-Arterial Extra-Corporeal Membrane Oxygenation (PC VA-ECMO) at our institution following repair of acute aortic syndrome compared to other cardiac operations.
Methods:
This was a retrospective study of all patients that underwent cardiac surgery at our institution from January 2008 until July 2023. Patients initiated on ECMO prior to surgery, placed on VV-ECMO or VAD were excluded. Patients initiated onto VA-ECMO post cardiotomy were identified and their records analysed further. Categoric variables were presented as numbers and percentages and compared with two tailed chi-square tests. Continuous variables were expressed as median and standard deviation and compare with an unpaired t-test.
Results:
28310 general adult cardiac operations were performed, of which 172 (0.61%) patients fulfilled inclusion criteria, with a median age of 66.5years. A total of 22 (12.8%) of patient had repair of an acute aortic syndrome (Group A) and 150 (87.2%) patients underwent other cardiac operations (Group B). There was no significant difference in relation to gender; 12/22 males in group A vs 99/150 in group B (p=0.2943), or in the age of the two groups the mean age in group A was 62.3 ±11.75 vs 64.9 ±12.01 in group B (p=0.3434), with a mean EuroScore of 12.4% ± 3.1% vs 9.9% ±4.6% (p=0.0131)
Pre-operatively, there was no significant differences between the two groups with regards to redo-sternotomy 3/22 vs 25/150 (p= 0.7192), LVEF<30% 9/22 vs 50/150 (p=0.4845), pre-operative cardiogenic shock 5/22 vs 27/150 (p= 0.8432), pre-operative intubation 3/22 vs 25/150 (p= 0.7192), and pre-operative inotropes 4/22 vs 23/150 (p=0.7344).
The urgency of the index procedure was elective in 29.1% (50/172), urgent in 29.1% (50/1972) and emergency/salvage in 41.8% (72/172). VA-ECMO was instituted at the index operation in 20/22 in group A vs 87/150 in group B (p= 0.0029) with the mean number of days on ECMO in group A of 7.5 ± 8.2 vs 5.9 ± 6 in group B (p=0.2685). A total of 10 patients underwent further mechanical circulatory support, 3 in group A (2x RVAD and 1x BiVAD) and 7 in group B (1x LVAD, 4x RVAD and 2x BiVAD). Table 1 shows other complications, mortality, and survival outcomes.
Conclusion:
Post cardiotomy ECMO is a useful method of support following cardiac surgery, although utilised in a small percentage of patients. The use of PC VA-ECMO following repair of acute aortic syndrome has comparable outcomes to its use following other cardiac operations. In-hospital mortality was significantly lower in the acute aortic syndrome group, with a significantly higher number of patients discharged from hospital. Survival outcomes between the two groups was similar. Our results demonstrate that VA-ECMO can be utilised in patients following repair of acute aortic syndromes with similar outcomes compared to other cardiac operations.
Authors
Ahmed Mohamed Abdel Shafi (1), Jason Ali (1), Narain Moorjani (1), David Jenkins (1), Alain Vuylsteke (1), Stephen Large (1), Ismail Vokshi (1), Choo Ng (1), Muhammad Rafiq (1), Fouad Taghavi (1), Shakil Farid (1), Pradeep Kaul (1), Jo-Anne Fowles (1), Francis Wells (1), Marius Berman (1), STEVEN TSUI (1), Hassiba Smail (1), RAVI DE SILVA (1)
Institutions
(1) Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
Presentation Duration
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