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Ann Thorac Surg 2001;71:S60-S66
© 2001 The Society of Thoracic Surgeons

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Session 1: acute heart failure

Postcardiotomy mechanical support: risk factors and outcomes

^a Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Address reprint requests to Dr Smedira, Department of Thoracic and Cardiovascular Surgery, 9500 Euclid Ave, Desk F25, Cleveland, OH 44195
e-mail: smedirn{at}ccf.org

Presented at the Fifth International Conference on Circulatory Support Devices for Severe Cardiac Failure, New York, NY, Sept 15–17, 2000.

Abstract

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.

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