Post-Cardiotomy Extracorporeal Life Support Following Aortic Surgery

Aortic surgery carries high risks and complication rates, particularly when extracorporeal life support (ECLS) is required. We compared outcomes of patients receiving post-cardiotomy ECLS after surgeries involving or not involving the thoracic aorta, with a focus on emergency operations. This retrospective multicenter study included adults requiring veno-arterial (V-A) ECLS for post-cardiotomy shock. In-hospital outcomes and long-term survival were analyzed. Among 2,058 patients, 382 (18.6%) underwent aortic and 1,676 (81.4%) non-aortic surgery. Patients undergoing aortic operations were younger (63.0, interquartile range [IQR]: 54.4-70 years; non-aortic: 65.0, IQR: 55-72 years; p = 0.020), with more emergencies (n = 126, 33.1%; non-aortic: n = 402, 24.3%; p < 0.001), longer cross-clamp times (148, IQR: 101-203 mins; non-aortic: 90, IQR: 59-133 mins; p < 0.001) and more postoperative bleeding events (n = 234, 62.4%; non-aortic: n = 922, 56.0%; p = 0.024). Stroke was more frequent after aortic surgery (n = 60, 15.8%; non-aortic: n = 157, 9.4%; p < 0.001), especially in emergency cases (n = 27, 21.6%; p = 0.034). In-hospital mortality was greater after aortic surgery (n = 258, 67.5%; non-aortic: n = 986, 58.8%; p = 0.002), with 49.9% (n = 189) on-ECLS mortality. Neurological injury caused death in 8.9% (n = 22) of patients undergoing aortic and 4.0% (n = 36) non-aortic operations. Post-discharge survival was similar ( p = 0.32), and emergency status did not affect mortality in the aortic group ( p = 0.643). Veno-arterial extracorporeal life support after aortic surgery is associated with higher bleeding, stroke, and in-hospital mortality compared with non-aortic surgery, independent of emergency status.

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Journal
ASAIO Journal
Published
2025-12-17
DOI
https://doi.org/10.1097/mat.0000000000002619
Primary Topic
Mechanical Circulatory Support Devices
Type
article
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article

Post-Cardiotomy Extracorporeal Life Support Following Aortic Surgery

Michele Di Mauro, Jeroen J. H. Bunge, Gábor Bari, Antonio Loforte et al.
ASAIO Journal
Mechanical Circulatory Support Devices
article

Post-Cardiotomy Extracorporeal Life Support Following Aortic Surgery

Michele Di Mauro, Jeroen J. H. Bunge, Gábor Bari, Antonio Loforte, Sandro Sponga, Daniele Camboni, Jae Seung Jung, Robertas Samalavičius, Giuseppe Maria Raffa, Silvia Mariani, Hergen Buscher, Antonio Fiore, Bas C. T. van Bussel, Matteo Pettinari, Matteo Pozzi, Pranya Sakiyalak, Alessandro Barbone, Francesco Formica, Karl Bounader, Bart Meyns, I.-wen Wang, Luca Conci, Sacha Matteucci, Rodrigo Díaz Flores, José P. Garcia, Xiaotong Hou, В В Сорокин, Claudio Russo, Leonardo Salazar, Glenn J.R. Whitman, Roberto Lorusso, Kiran Shekar, Vin Pellegrino, Diyar Saeed, Jan Belohlavek, Udo Boeken, Giacomo Bianchi, Michael A. Mazzeffi
article en

Abstract

Aortic surgery carries high risks and complication rates, particularly when extracorporeal life support (ECLS) is required. We compared outcomes of patients receiving post-cardiotomy ECLS after surgeries involving or not involving the thoracic aorta, with a focus on emergency operations. This retrospective multicenter study included adults requiring veno-arterial (V-A) ECLS for post-cardiotomy shock. In-hospital outcomes and long-term survival were analyzed. Among 2,058 patients, 382 (18.6%) underwent aortic and 1,676 (81.4%) non-aortic surgery. Patients undergoing aortic operations were younger (63.0, interquartile range [IQR]: 54.4-70 years; non-aortic: 65.0, IQR: 55-72 years; p = 0.020), with more emergencies (n = 126, 33.1%; non-aortic: n = 402, 24.3%; p < 0.001), longer cross-clamp times (148, IQR: 101-203 mins; non-aortic: 90, IQR: 59-133 mins; p < 0.001) and more postoperative bleeding events (n = 234, 62.4%; non-aortic: n = 922, 56.0%; p = 0.024). Stroke was more frequent after aortic surgery (n = 60, 15.8%; non-aortic: n = 157, 9.4%; p < 0.001), especially in emergency cases (n = 27, 21.6%; p = 0.034). In-hospital mortality was greater after aortic surgery (n = 258, 67.5%; non-aortic: n = 986, 58.8%; p = 0.002), with 49.9% (n = 189) on-ECLS mortality. Neurological injury caused death in 8.9% (n = 22) of patients undergoing aortic and 4.0% (n = 36) non-aortic operations. Post-discharge survival was similar ( p = 0.32), and emergency status did not affect mortality in the aortic group ( p = 0.643). Veno-arterial extracorporeal life support after aortic surgery is associated with higher bleeding, stroke, and in-hospital mortality compared with non-aortic surgery, independent of emergency status.

ASAIO Journal
University of Foggia (IT), University of Maryland, Baltimore (US), Indiana University Health (US), University of Udine (IT), Siriraj Hospital (TH), University of Salento (IT), University of Szeged (HU), Korea University Medical Center (KR), Maastricht University Medical Centre (NL), The Alfred Hospital (AU), University Hospital Regensburg (DE), Maastricht University (NL), Clínica Las Condes (CL), St Vincent's Hospital Sydney (AU), Methodist Hospital (US), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Fundación Cardiovascular de Colombia (CO), Memorial Healthcare System (US), Leipzig Heart Institute (DE), Beijing Anzhen Hospital (CN), Hôpital Pontchaillou (FR), Prince Charles Hospital (AU), Hôpitaux Universitaires Henri-Mondor (FR), Hôpital Louis Pradel (FR), National University Hospital (SG), Ziekenhuis Oost-Limburg (BE), Johns Hopkins Hospital (US), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Fondazione Toscana Gabriele Monasterio (IT), Vilnius University Hospital Santariskiu Klinikos (LT), General University Hospital in Prague (CZ), IRCCS Humanitas Research Hospital (IT), Ospedali Riuniti Umberto I (IT), Heinrich Heine University Düsseldorf (DE), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IT), University of Turin (IT), Indiana University – Purdue University Indianapolis (US), Medical University of Vienna (AT), University of Palermo (IT), Erasmus University Rotterdam (NL), KU Leuven (BE)
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Mechanical Circulatory Support Devices
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