Survival After Endocarditis Surgery Needing Venoarterial Extracorporeal Membrane Oxygenation Support: Results from the Netherlands Heart Registration

The incidence of venoarterial extracorporeal membrane oxygenation (VA-ECMO) support after cardiac surgery ranges from 0.4% to 3.7%, with in-hospital mortality rates reported at 60%. While the incidence of VA-ECMO after endocarditis (IE) surgery is unknown, these patients may face an even greater mortality risk due to additional IE-related complications. The primary objective of this study is to investigate the incidence and mortality rates of postoperative VA-ECMO following endocarditis surgery. The secondary objective is to compare clinical outcomes and to identify factors associated with in-hospital mortality in patients requiring and not requiring VA-ECMO support. Data were retrieved from the Netherlands Heart Registration. Of 3,468 IE surgeries performed between 2013 and 2022, 49 patients (1.4%) received postoperative VA-ECMO. The in-hospital mortality rate was 49% and the 1-year mortality rate was 60.9%. As expected, this was significantly higher compared to patients not requiring VA-ECMO support (49.0% vs 9.8% and 60.9% vs 15.2% respectively; p <0.001). At baseline, VA-ECMO patients had statistically higher rates of previous valve surgery, peripheral vascular disease and pulmonary hypertension, as well as lower renal and left ventricular functions compared to than patients not requiring VA-ECMO support. In addition, VA-ECMO patients more frequently underwent emergency surgeries and required aortic root surgery and coronary artery bypass grafting more often. While several comorbidities were associated with in-hospital mortality in patients not requiring VA-ECMO, no such associations were observed in VA-ECMO patients. In conclusion, while the incidence of VA-ECMO support after IE surgery is low, it comes with high mortality rates. However, mortality rates do not seem to differ from those reported for non-IE postcardiotomy VA-ECMO patients in current literature, and mortality after VA-ECMO support remains difficult to predict. Based on our data, postcardiotomy VA-ECMO should not be withheld from IE patients because of high-anticipated mortality risk.