Background: Post-acute myocardial infarction papillary muscle rupture (post-AMI PMR) may present variable clinical scenarios and degree of emergency due to result of cardiogenic shock. Veno-arterial extracorporeal life support (V-A ECLS) has been proposed to improve extremely poor pre- or postoperative conditions. Information in this respect is scarce.Methods: From the CAUTION (meChanical complicAtion of acUte myocardial infarcTion: an InternatiOnal multiceNter cohort study) database (16 different Centers, data from 2001 to 2018), we extracted adult patients who were surgically treated for post-AMI PMR and underwent pre- or/and postoperative V-A ECLS support. The end-points of this study were in-hospital survival and ECLS complications.Results: From a total of 214 post-AMI PMR patients submitted to surgery, V-A ECLS was instituted in 23 (11%) patients. The median age was 61.7 years (range 46-81 years). Preoperatively, ECLS was commenced in 10 patients (43.5%), whereas intra/postoperative in the remaining 13. The most common V-A ECLS indication was post-cardiotomy shock, followed by preoperative cardiogenic shock and cardiac arrest. The median duration of V-A ECLS was 4 days. V-A ECLS complications occurred in more than half of the patients. Overall, in-hospital mortality was 39.2% (9/23), compared to 22% (42/219) for the non-ECLS group.Conclusions: In post-AMI PMR patients, V-A ECLS was used in almost 10% of the patients either to promote bridge to surgery or as postoperative support. Further investigations are required to better evaluate a potential for increased use and its effects of V-A ECLS in such a context based on the still high perioperative mortality.
Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study / Massimi, Giulio; Matteucci, Matteo; De Bonis, Michele; Kowalewski, Mariusz; Formica, Francesco; Russo, Claudio Francesco; Sponga, Sandro; Vendramin, Igor; Colli, Andrea; Falcetta, Giosuè; Trumello, Cinzia; Carrozzini, Massimiliano; Fischlein, Theodor; Troise, Giovanni; Actis Dato, Guglielmo; D'Alessandro, Stefano; Nia, Peyman Sardari; Lodo, Vittoria; Villa, Emmanuel; Shah, Shabir Hussain; Scrofani, Roberto; Binaco, Irene; Kalisnik, Jurij Matija; Pettinari, Matteo; Thielmann, Matthias; Meyns, Bart; Khouqeer, Fareed A; Fino, Carlo; Simon, Caterina; Severgnini, Paolo; Kowalowka, Adam; Deja, Marek A; Ronco, Daniele; Lorusso, Roberto. - In: ARTIFICIAL ORGANS. - ISSN 0160-564X. - 47:8(2023), pp. 1386-1394. [10.1111/aor.14541]
Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study
De Bonis, Michele;
2023-01-01
Abstract
Background: Post-acute myocardial infarction papillary muscle rupture (post-AMI PMR) may present variable clinical scenarios and degree of emergency due to result of cardiogenic shock. Veno-arterial extracorporeal life support (V-A ECLS) has been proposed to improve extremely poor pre- or postoperative conditions. Information in this respect is scarce.Methods: From the CAUTION (meChanical complicAtion of acUte myocardial infarcTion: an InternatiOnal multiceNter cohort study) database (16 different Centers, data from 2001 to 2018), we extracted adult patients who were surgically treated for post-AMI PMR and underwent pre- or/and postoperative V-A ECLS support. The end-points of this study were in-hospital survival and ECLS complications.Results: From a total of 214 post-AMI PMR patients submitted to surgery, V-A ECLS was instituted in 23 (11%) patients. The median age was 61.7 years (range 46-81 years). Preoperatively, ECLS was commenced in 10 patients (43.5%), whereas intra/postoperative in the remaining 13. The most common V-A ECLS indication was post-cardiotomy shock, followed by preoperative cardiogenic shock and cardiac arrest. The median duration of V-A ECLS was 4 days. V-A ECLS complications occurred in more than half of the patients. Overall, in-hospital mortality was 39.2% (9/23), compared to 22% (42/219) for the non-ECLS group.Conclusions: In post-AMI PMR patients, V-A ECLS was used in almost 10% of the patients either to promote bridge to surgery or as postoperative support. Further investigations are required to better evaluate a potential for increased use and its effects of V-A ECLS in such a context based on the still high perioperative mortality.File | Dimensione | Formato | |
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