Preoperative Venoarterial Extracorporeal Membrane Oxygenation Reduces
Mortality in Advanced Structural Heart Disease
Abstract
Introduction: Cardiac surgery for structural heart disease in the
presence of cardiogenic shock or advanced heart failure has poor
outcomes. We applied venoarterial extracorporeal membrane oxygenation
(ECMO) to restore end-organ function and resuscitate patients prior to
high-risk cardiac surgery. Methods: During a 2-year period
(1/2018-12/2019) we reviewed all patients admitted to our Medical Centre
with structural heart disease and cardiogenic shock, who had been
resuscitated preoperatively by ECMO. Of these patients, 11 were included
in the study. Patients were placed on ECMO preoperatively for 69 hours
(range, 36-136 hours). Eight patients underwent valvular surgeries and 3
patients had ventricular septal defect repairs. Results: Mean age was
54± 15 years. Nine patients presented with cardiogenic shock, and two
with advanced heart failure. Nine patients needed inotropes and four
needed IABP support. Seven patients were admitted with acute kidney
injury and five presented with metabolic acidosis. Average calculated
EUROSCORE I was 56±23% and mean calculated APACHE II score was
17.18±6.26. The mean ECMO total time was 126±93 hours. Of the four
postoperative deaths, three died within 10 days of surgery and one 2
months post-surgery. Conclusion: ECMO can be used as a bridge to heart
valve or septal defect surgery in severely decompensated patients
suffering from cardiogenic shock. Through recovery of end-organ
function, ECMO may facilitate surgical correction of structural heart
disease in patients in a very high risk for surgery.