Browsing by Author "Ravaux J.M."

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    Features and outcomes of female and male patients requiring postcardiotomy extracorporeal life support
    (2024-01-01) Mariani S.; Ravaux J.M.; van Bussel B.C.T.; De Piero M.E.; van Kruijk S.M.J.; Schaefer A.K.; Wiedemann D.; Saeed D.; Pozzi M.; Loforte A.; Boeken U.; Samalavicius R.; Bounader K.; Hou X.; Bunge J.J.H.; Buscher H.; Salazar L.; Meyns B.; Mazzeffi M.A.; Matteucci S.; Sponga S.; Sorokin V.; Russo C.; Formica F.; Sakiyalak P.; Fiore A.; Camboni D.; Raffa G.M.; Diaz R.; Wang I.w.; Jung J.S.; Belohlavek J.; Pellegrino V.; Bianchi G.; Pettinari M.; Barbone A.; Garcia J.P.; Shekar K.; Whitman G.J.R.; Lorusso R.; Heuts S.; Conci L.; Szalkiewicz P.; Lehmann S.; Khalil J.; Obadia J.F.; Kalampokas N.; Jankuviene A.; Flecher E.; Reis Miranda D.D.; Sriranjan K.; Herr D.; Vedadi N.; Di Eusanio M.; MacLaren G.; Ramanathan K.; Costetti A.; Schmid C.; Castillo R.; Grus T.; Mikulenka V.; Solinas M.; Mariani S.; Mahidol University
    Objectives: Although cardiogenic shock requiring extracorporeal life support after cardiac surgery is associated with high mortality, the impact of sex on outcomes of postcardiotomy extracorporeal life support remains unclear with conflicting results in the literature. We compare patient characteristics, in-hospital outcomes, and overall survival between females and males requiring postcardiotomy extracorporeal life support. Methods: This retrospective, multicenter (34 centers), observational study included adults requiring postcardiotomy extracorporeal life support between 2000 and 2020. Preoperative, procedural, and extracorporeal life support characteristics, complications, and survival were compared between females and males. Association between sex and in-hospital survival was investigated through mixed Cox proportional hazard models. Results: This analysis included 1823 patients (female: 40.8%; median age: 66.0 years [interquartile range, 56.2-73.0 years]). Females underwent more mitral valve surgery (females: 38.4%, males: 33.1%, P = .019) and tricuspid valve surgery (feamales: 18%, males: 12.4%, P < .001), whereas males underwent more coronary artery surgery (females: 45.9%, males: 52.4%, P = .007). Extracorporeal life support implantation was more common intraoperatively in feamales (females: 64.1%, females: 59.1%) and postoperatively in males (females: 35.9%, males: 40.9%, P = .036). Ventricular unloading (females: 25.1%, males: 36.2%, P < .001) and intra-aortic balloon pumps (females: 25.8%, males: 36.8%, P < .001) were most frequently used in males. Females had more postoperative right ventricular failure (females: 24.1%, males: 19.1%, P = .016) and limb ischemia (females: 12.3%, males: 8.8%, P = .23). In-hospital mortality was 64.9% in females and 61.9% in males (P = .199) with no differences in 5-year survival (females: 20%, 95% CI, 17-23; males: 24%, 95% CI, 21-28; P = .069). Crude hazard ratio for in-hospital mortality in females was 1.12 (95% CI, 0.99-1.27; P = .069) and did not change after adjustments. Conclusions: This study demonstrates that female and male patients requiring postcardiotomy extracorporeal life support have different preoperative and extracorporeal life support characteristics, as well as complications, without a statistical difference in in-hospital and 5-year survivals.
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    Heterogeneity in clinical practices for post-cardiotomy extracorporeal life support: A pilot survey from the PELS-1 multicenter study
    (2023-01-01) Mariani S.; Bari G.; Ravaux J.M.; van Bussel B.C.T.; De Piero M.E.; Schaefer A.K.; Jawad K.; Pozzi M.; Loforte A.; Kalampokas N.; Jankuviene A.; Flecher E.; Hou X.; Bunge J.J.H.; Sriranjan K.; Salazar L.; Meyns B.; Mazzeffi M.A.; Matteucci S.; Sponga S.; Ramanathan K.; Costetti A.; Formica F.; Sakiyalak P.; Fiore A.; Schmid C.; Raffa G.M.; Castillo R.; Wang I.w.; Jung J.S.; Grus T.; Pellegrino V.; Bianchi G.; Pettinari M.; Barbone A.; Garcia J.P.; Kowalewski M.; Shekar K.; Whitman G.; Lorusso R.; Mahidol University
    Background: High-quality evidence for post-cardiotomy extracorporeal life support (PC-ECLS) management is lacking. This study investigated real-world PC-ECLS clinical practices. Methods: This cross-sectional, multi-institutional, international pilot survey explored center organization, anticoagulation management, left ventricular unloading, distal limb perfusion, PC-ECLS monitoring, and transfusion practices. Twenty-nine questions were distributed among 34 hospitals participating in the Post-cardiotomy Extra-Corporeal Life Support Study. Results: Of the 32 centers [16 low-volume (50%); 16 high-volume (50%)] that responded, 16 (50%) had dedicated ECLS specialists. Twenty-six centers (81.3%) reported using additional mechanical circulatory supports. Anticoagulation practices were highly heterogeneous: 24 hospitals (75%) reported using patients bleeding status as a guide, without a specific threshold in 54.2% of cases. Transfusion targets ranged from 7 to 10 g/dL. Most centers used cardiac venting on a case-by-case basis (78.1%) and regular distal limb perfusion (84.4%). Nineteen (54.9%) centers reported dedicated monitoring protocols, including daily echocardiography (87.5%), Swan-Ganz catheterization (40.6%), cerebral near-infrared spectroscopy (53.1%), and multimodal assessment of limb ischemia. Inspection of the circuit (71.9%), oxygenator pressure drop (68.8%), plasma free hemoglobin (75%), d-dimer (59.4%), lactate dehydrogenase (56.3%), and fibrinogen (46.9%) are used to diagnose hemolysis and thrombosis. Conclusions: This study shows remarkable heterogeneity in clinical practices for PC-ECLS management. More standardized protocols and better implementation of the available evidence are recommended.