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Outcomes after postcardiotomy venoarterial extracorporeal membrane oxygenation in young patients : An individual patient data meta-analysis

Giambuzzi, Ilaria ; Biancari, Fausto ; Mastroiacovo, Giorgio ; Kaserer, Alexander ; L'Acqua, Camilla ; Ruggieri, Vito G. ; Cho, Sung Min ; Dalén, Magnus ; Welp, Henryk and Jónsson, Kristján , et al. (2025) In JTCVS Open 28. p.278-295
Abstract

Objective We aimed to evaluate the early and midterm mortality of young patients treated for cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO) after adult cardiac surgery. Methods Studies reporting the outcome after postcardiotomy VA-ECMO in adult patients were identified through a systematic review of the literature. Individual patient-level data were provided by the authors of 10 studies. Results Data on 1268 patients treated at 25 hospitals were included in this study. Adjusted analysis identified 40 years of age as a cutoff value for in-hospital and mid-term mortality. Patients aged >40 years had significantly greater in-hospital mortality (1129 patients, crude rates 68.8% vs 43.1%, adjusted odds... (More)

Objective We aimed to evaluate the early and midterm mortality of young patients treated for cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO) after adult cardiac surgery. Methods Studies reporting the outcome after postcardiotomy VA-ECMO in adult patients were identified through a systematic review of the literature. Individual patient-level data were provided by the authors of 10 studies. Results Data on 1268 patients treated at 25 hospitals were included in this study. Adjusted analysis identified 40 years of age as a cutoff value for in-hospital and mid-term mortality. Patients aged >40 years had significantly greater in-hospital mortality (1129 patients, crude rates 68.8% vs 43.1%, adjusted odds ratio, 3.267; 95% confidence interval, 1.970-5.425) and mortality at 24-month (109 patients, crude rates 73.7% vs 45.0%, adjusted hazard ratio, 3.530, 95% confidence interval, 2.571-4.844). Twelve (11.0%) patients aged ≤40 years received a ventricular assist device and heart transplantation, whereas this strategy was adopted in 33 (2.9%) patients aged >40 years (P < .001). Eventually, 7 (6.4%) patients aged ≤40 years and 12 (1.1%) patients aged >40 years underwent heart transplantation (P < .001). Heart transplantation tended to decrease in-hospital mortality in patients aged ≤40 years (14.3% vs 45.1%, P = .138), whereas this difference reached statistical significance in patients aged >40 years (25.0% vs 69.3%, P = .002). Conclusions The present findings suggest that early and midterm mortality after postcardiotomy VA-ECMO is significantly lower in patients aged ≤40 years compared to older patients. However, mortality remains substantial also among these young patients and heart-replacement therapies are infrequently performed in this subset of patients likely because of severe perioperative complications.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
age, cardiac surgery postcardiotomy, ECLS, ECMO, extracorporeal membrane oxygenation, heart transplant, LVAD
in
JTCVS Open
volume
28
pages
18 pages
publisher
Elsevier
external identifiers
  • scopus:105024088598
  • pmid:41473066
ISSN
2666-2736
DOI
10.1016/j.xjon.2025.09.046
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 The Author(s).
id
c92ff54f-0c19-4fc4-9a71-8a28efeebdc3
date added to LUP
2026-02-13 13:32:56
date last changed
2026-02-14 03:00:02
@article{c92ff54f-0c19-4fc4-9a71-8a28efeebdc3,
  abstract     = {{<p>Objective We aimed to evaluate the early and midterm mortality of young patients treated for cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO) after adult cardiac surgery. Methods Studies reporting the outcome after postcardiotomy VA-ECMO in adult patients were identified through a systematic review of the literature. Individual patient-level data were provided by the authors of 10 studies. Results Data on 1268 patients treated at 25 hospitals were included in this study. Adjusted analysis identified 40 years of age as a cutoff value for in-hospital and mid-term mortality. Patients aged &gt;40 years had significantly greater in-hospital mortality (1129 patients, crude rates 68.8% vs 43.1%, adjusted odds ratio, 3.267; 95% confidence interval, 1.970-5.425) and mortality at 24-month (109 patients, crude rates 73.7% vs 45.0%, adjusted hazard ratio, 3.530, 95% confidence interval, 2.571-4.844). Twelve (11.0%) patients aged ≤40 years received a ventricular assist device and heart transplantation, whereas this strategy was adopted in 33 (2.9%) patients aged &gt;40 years (P &lt; .001). Eventually, 7 (6.4%) patients aged ≤40 years and 12 (1.1%) patients aged &gt;40 years underwent heart transplantation (P &lt; .001). Heart transplantation tended to decrease in-hospital mortality in patients aged ≤40 years (14.3% vs 45.1%, P = .138), whereas this difference reached statistical significance in patients aged &gt;40 years (25.0% vs 69.3%, P = .002). Conclusions The present findings suggest that early and midterm mortality after postcardiotomy VA-ECMO is significantly lower in patients aged ≤40 years compared to older patients. However, mortality remains substantial also among these young patients and heart-replacement therapies are infrequently performed in this subset of patients likely because of severe perioperative complications.</p>}},
  author       = {{Giambuzzi, Ilaria and Biancari, Fausto and Mastroiacovo, Giorgio and Kaserer, Alexander and L'Acqua, Camilla and Ruggieri, Vito G. and Cho, Sung Min and Dalén, Magnus and Welp, Henryk and Jónsson, Kristján and Ragnarsson, Sigurdur and Hernández Pérez, Francisco J. and Gatti, Giuseppe and Alkhamees, Khalid and Loforte, Antonio and Lechiancole, Andrea and D'Errigo, Paola and Rosato, Stefano and Spadaccio, Cristiano and Pettinari, Matteo and Fiore, Antonio and Mariscalco, Giovanni and Perrotti, Andrea and Bouchot, Olivier and Arafat, Amr A. and Albabtain, Monirah A. and Albarrak, Mohammed M. and Laimoud, Mohamed and Djordjevic, Ilija and Samalavicius, Robertas and Alonso-Fernandez-Gatta, Marta and Wilhelm, Markus J. and Dzemali, Omer and Juvonen, Tatu and Mäkikallio, Timo and Bonalumi, Giorgia}},
  issn         = {{2666-2736}},
  keywords     = {{age; cardiac surgery postcardiotomy; ECLS; ECMO; extracorporeal membrane oxygenation; heart transplant; LVAD}},
  language     = {{eng}},
  pages        = {{278--295}},
  publisher    = {{Elsevier}},
  series       = {{JTCVS Open}},
  title        = {{Outcomes after postcardiotomy venoarterial extracorporeal membrane oxygenation in young patients : An individual patient data meta-analysis}},
  url          = {{http://dx.doi.org/10.1016/j.xjon.2025.09.046}},
  doi          = {{10.1016/j.xjon.2025.09.046}},
  volume       = {{28}},
  year         = {{2025}},
}