Abstract：
OBJECTIVE: Veno-arterial extracorporeal life support (V-A ECLS) is increasingly being utilized for postcardiotomy shock (PCS), though data describing the relationship between type of indexed operation and outcomes are limited. This study compared V-A ECLS outcomes across four major cardiovascular surgical procedures.
METHODS: This was a single-center retrospective study of patients who required V-A ECLS for PCS between 2015 and 2022. Patients were stratified by the type of indexed operation, which included aortic surgery (AoS), coronary artery bypass grafting (CABG), valve surgery (Valve), and combined CABG and valve surgery (CABG + Valve). Factors associated with postoperative outcomes were assessed using logistic regression.
RESULTS: Among 149 PCS patients who received V-A ECLS, there were 35 AoS patients (23.5%), 29 (19.5%) CABG patients, 59 (39.6%) Valve patients, and 26 (17.4%) CABG + Valve patients. Cardiopulmonary bypass times were longest in the AoS group (p < 0.01). Regarding causes of PCS, AoS patients had a greater incidence of ventricular failure, while the CABG group had a higher incidence of ventricular arrhythmia (p = 0.04). Left ventricular venting was most frequently utilized in the Valve group (p = 0.07). In-hospital mortality was worst among CABG + Valve patients (p < 0.01), and the incidence of acute kidney injury was highest in the AoS group (p = 0.03). In multivariable logistic regression, CABG + Valve surgery (odds ratio (OR) 4.20, 95% confidence interval 1.30-13.6, p = 0.02) and lactate level at ECLS initiation (OR, 1.17; 95% CI, 1.06-1.29; p < 0.01) were independently associated with mortality.
CONCLUSIONS: We demonstrate that indications, management, and outcomes of V-A ECLS for PCS vary by type of indexed cardiovascular surgery.
METHODS: This was a single-center retrospective study of patients who required V-A ECLS for PCS between 2015 and 2022. Patients were stratified by the type of indexed operation, which included aortic surgery (AoS), coronary artery bypass grafting (CABG), valve surgery (Valve), and combined CABG and valve surgery (CABG + Valve). Factors associated with postoperative outcomes were assessed using logistic regression.
RESULTS: Among 149 PCS patients who received V-A ECLS, there were 35 AoS patients (23.5%), 29 (19.5%) CABG patients, 59 (39.6%) Valve patients, and 26 (17.4%) CABG + Valve patients. Cardiopulmonary bypass times were longest in the AoS group (p < 0.01). Regarding causes of PCS, AoS patients had a greater incidence of ventricular failure, while the CABG group had a higher incidence of ventricular arrhythmia (p = 0.04). Left ventricular venting was most frequently utilized in the Valve group (p = 0.07). In-hospital mortality was worst among CABG + Valve patients (p < 0.01), and the incidence of acute kidney injury was highest in the AoS group (p = 0.03). In multivariable logistic regression, CABG + Valve surgery (odds ratio (OR) 4.20, 95% confidence interval 1.30-13.6, p = 0.02) and lactate level at ECLS initiation (OR, 1.17; 95% CI, 1.06-1.29; p < 0.01) were independently associated with mortality.
CONCLUSIONS: We demonstrate that indications, management, and outcomes of V-A ECLS for PCS vary by type of indexed cardiovascular surgery.
摘要：
目的：静脉动脉体外生命支持（V-AECLS）越来越多地用于心脏切开术后休克（PCS），尽管描述索引操作类型与结果之间关系的数据有限。这项研究比较了四种主要心血管外科手术的V-AECLS结果。
方法：这是一项单中心回顾性研究，研究对象是2015年至2022年之间需要为PCS进行V-AECLS的患者。根据指数化手术的类型对患者进行分层，其中包括主动脉手术（AoS），冠状动脉旁路移植术(CABG),瓣膜手术（瓣膜），联合CABG和瓣膜手术（CABG+瓣膜）。使用logistic回归评估与术后结果相关的因素。
结果：在149例接受V-AECLS的患者中，AoS患者35例（23.5%），29例（19.5%）CABG患者，59例（39.6%）瓣膜患者，26例（17.4%）CABG+瓣膜患者。AoS组体外循环时间最长(p<0.01)。关于PCS的原因，AoS患者的心室衰竭发生率更高，而CABG组的室性心律失常发生率较高(p=0.04)。左心室通气最常用于瓣膜组(p=0.07)。住院死亡率在CABG+瓣膜患者中最差(p<0.01),AoS组急性肾损伤发生率最高(p=0.03)。在多变量逻辑回归中，CABG+瓣膜手术（比值比（OR）4.20，95％置信区间1.30-13.6，p=0.02）和ECLS开始时的乳酸水平（OR，1.17；95%CI，1.06-1.29；p<0.01）与死亡率独立相关。
结论：我们证明适应症，管理,PCS的V-AECLS结果因指数化心血管手术类型而异。
方法：这是一项单中心回顾性研究，研究对象是2015年至2022年之间需要为PCS进行V-AECLS的患者。根据指数化手术的类型对患者进行分层，其中包括主动脉手术（AoS），冠状动脉旁路移植术(CABG),瓣膜手术（瓣膜），联合CABG和瓣膜手术（CABG+瓣膜）。使用logistic回归评估与术后结果相关的因素。
结果：在149例接受V-AECLS的患者中，AoS患者35例（23.5%），29例（19.5%）CABG患者，59例（39.6%）瓣膜患者，26例（17.4%）CABG+瓣膜患者。AoS组体外循环时间最长(p<0.01)。关于PCS的原因，AoS患者的心室衰竭发生率更高，而CABG组的室性心律失常发生率较高(p=0.04)。左心室通气最常用于瓣膜组(p=0.07)。住院死亡率在CABG+瓣膜患者中最差(p<0.01),AoS组急性肾损伤发生率最高(p=0.03)。在多变量逻辑回归中，CABG+瓣膜手术（比值比（OR）4.20，95％置信区间1.30-13.6，p=0.02）和ECLS开始时的乳酸水平（OR，1.17；95%CI，1.06-1.29；p<0.01）与死亡率独立相关。
结论：我们证明适应症，管理,PCS的V-AECLS结果因指数化心血管手术类型而异。
