What Are the Survival Outcomes of Patients Requiring Postcardiotomy Temporary Mechanical Circulatory Support?

Postcardiotomy low cardiac output syndrome (PC-LCOS) remains a poorly characterized complication of cardiac surgery, often necessitating temporary mechanical circulatory support (tMCS) with resource utilization and variable outcomes. Evidence remains limited and heterogeneous, derived from retrospective, single-centre studies. Consequently, the prognosis of patients requiring postcardiotomy tMCS remains uncertain, representing a critical concern for clinicians initiating support. In-hospital survival after postcardiotomy tMCS remains ∼40% (range 15%-55%), with varying results based on clinical severity, extent and aetiology of ventricular dysfunction, type and timing of tMCS.1,2 On-support mortality accounts for ∼60% of in-hospital deaths, predominantly occurring within the first 3 days of support and associated with greater preoperative instability, severe postoperative haemometabolic compromise, cardiac arrest, bleeding, and delayed tMCS initiation.1,3 Conversely, post-weaning mortality accounts for ∼40% of deaths and is closely related to complications including re-thoracotomy, bowel ischaemia, acute kidney injury, and septic shock.1,2 Survival according to tMCS duration follows an inverted U-shaped pattern, with the highest values (49%) among patients supported for 4-7 days. Approximately 30% of patients requiring postcardiotomy tMCS remain on support for >7 days, with in-hospital survival falling to 33% and 27% beyond 7 and 10 days, respectively.4 Survival decreases in specific populations, including patients ≥70 years of age (24%-31%), those undergoing aortic surgery (26%-33%), receiving extracorporeal cardiopulmonary resuscitation (overall: 33%-35%; with favourable neurological outcome: 23%-29%),5 postoperative tMCS (36%), or central cannulation (28%-32%), although these findings should be interpreted cautiously given potential selection bias.1,4 Prophylactic, preoperatively planned tMCS initiation before cardiopulmonary bypass weaning in patients at high risk of PC-LCOS has yielded promising survival rates of up to 96%.3 Despite high early mortality, survivors to discharge have a favourable long-term prognosis, with an estimated 66% 10-year survival.1