Postcardiotomy extracorporeal membrane oxygenation in patients older than 70 years: Characteristics, outcomes, and variables associated with mortality
Issued Date
2025-01-01
Resource Type
eISSN
26662736
Scopus ID
2-s2.0-105004271609
Journal Title
JTCVS Open
Rights Holder(s)
SCOPUS
Bibliographic Citation
JTCVS Open (2025)
Suggested Citation
Makhoul M., Mariani S., van Bussel B.C.T., Wiedeman D., Saeed D., Di Mauro M., Pozzi M., Botta L., Boeken U., Samalavicius R., Bounader K., Hou X., Bunge J.J.H., Buscher H., Salazar L., Meyns B., Mazzeffi M.A., Sacha Matteucci M.L., Sponga S., MacLaren G., 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., Bolotin G., Lorusso R. Postcardiotomy extracorporeal membrane oxygenation in patients older than 70 years: Characteristics, outcomes, and variables associated with mortality. JTCVS Open (2025). doi:10.1016/j.xjon.2025.04.004 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/110095
Title
Postcardiotomy extracorporeal membrane oxygenation in patients older than 70 years: Characteristics, outcomes, and variables associated with mortality
Author(s)
Makhoul M.
Mariani S.
van Bussel B.C.T.
Wiedeman D.
Saeed D.
Di Mauro M.
Pozzi M.
Botta L.
Boeken U.
Samalavicius R.
Bounader K.
Hou X.
Bunge J.J.H.
Buscher H.
Salazar L.
Meyns B.
Mazzeffi M.A.
Sacha Matteucci M.L.
Sponga S.
MacLaren G.
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.
Bolotin G.
Lorusso R.
Mariani S.
van Bussel B.C.T.
Wiedeman D.
Saeed D.
Di Mauro M.
Pozzi M.
Botta L.
Boeken U.
Samalavicius R.
Bounader K.
Hou X.
Bunge J.J.H.
Buscher H.
Salazar L.
Meyns B.
Mazzeffi M.A.
Sacha Matteucci M.L.
Sponga S.
MacLaren G.
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.
Bolotin G.
Lorusso R.
Author's Affiliation
Korea University Anam Hospital
Siriraj Hospital
Departement Cardiovasculaire Wetenschappen
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Fundación Cardiovascular de Colombia
Beijing Anzhen Hospital, Capital Medical University
CARIM School for Cardiovascular Disease
Ziekenhuis Oost-Limburg
Vilniaus Universitetas
Erasmus MC
National University Hospital
The University of Queensland
Hôpital Pontchaillou
St. Vincent's Hospital Sydney
Humanitas Research Hospital
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Hôpital Henri Mondor
Rambam Health Care Campus Israel
Klinikum der Universität Regensburg und Medizinische Fakultät
Universiteit Maastricht
Clínica Las Condes
Università degli Studi di Palermo
Charles University
Asst Grande Ospedale Metropolitano Niguarda
Policlinico Universitario, Udine
University of Maryland, Baltimore (UMB)
Fondazione IRCCS San Gerardo dei Tintori
Medizinische Universität Wien
The Alfred
Memorial Healthcare System
Università di Parma
The Johns Hopkins Hospital
Methodist Hospital Indianapolis
Karl Landsteiner University
Ospedale del Cuore Fondazione Toscana “G. Monasterio”
Louis Pradel Cardiologic Hospital
Helios Hospital Krefeld
Siriraj Hospital
Departement Cardiovasculaire Wetenschappen
Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione
Heinrich-Heine-Universität Düsseldorf Medizinische Fakultät
Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona
Fundación Cardiovascular de Colombia
Beijing Anzhen Hospital, Capital Medical University
CARIM School for Cardiovascular Disease
Ziekenhuis Oost-Limburg
Vilniaus Universitetas
Erasmus MC
National University Hospital
The University of Queensland
Hôpital Pontchaillou
St. Vincent's Hospital Sydney
Humanitas Research Hospital
IRCCS Azienda Ospedaliero-Universitaria di Bologna
Hôpital Henri Mondor
Rambam Health Care Campus Israel
Klinikum der Universität Regensburg und Medizinische Fakultät
Universiteit Maastricht
Clínica Las Condes
Università degli Studi di Palermo
Charles University
Asst Grande Ospedale Metropolitano Niguarda
Policlinico Universitario, Udine
University of Maryland, Baltimore (UMB)
Fondazione IRCCS San Gerardo dei Tintori
Medizinische Universität Wien
The Alfred
Memorial Healthcare System
Università di Parma
The Johns Hopkins Hospital
Methodist Hospital Indianapolis
Karl Landsteiner University
Ospedale del Cuore Fondazione Toscana “G. Monasterio”
Louis Pradel Cardiologic Hospital
Helios Hospital Krefeld
Corresponding Author(s)
Other Contributor(s)
Abstract
Objectives: Age is the main determinant for mortality in patients requiring postcardiotomy extracorporeal membrane oxygenation (PC-ECMO), but strategies to reverse this trend are unknown. This study investigates PC-ECMO outcomes in older patients (≥70 years) compared with younger patients (<70 years). Methods: This retrospective study included patients who required PC-ECMO between 2000 and 2020. Variables independently associated with in-hospital mortality were identified using mixed Cox proportional hazards models. Results: The study included 2057 patients (mean age: 62.3 [first and third quartile: 19-94]; male patients: n = 1213 [59%]): 1376 (67%) were <70 years and 680 (33%) were ≥70 years old. Older patients had more preoperative comorbidities, whereas younger patients had lower cardiac function and more preoperative intubation and vasopressor use. In-hospital mortality was 56.3% (n = 775) and 68.8% (n = 468) in the <70 year and ≥70 year groups, respectively (P < .001). The 7-year postdischarge survival rate was greater for the younger patient group (P < .001). Variables associated with in-hospital mortality in older patients were previous stroke (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.05-1.84), preoperative right ventricular failure (HR, 1.45; 95% CI, 1-2.1), aortic surgery (HR 1.65; 95% CI, 1.2-2.2), and postoperative complications including bleeding (HR 1.24; 95% CI, 1.0-1.5), cardiac arrest (HR, 1.65; 95% CI, 1.3-2.1), and right ventricular failure (HR, 1.29; 95% CI, 1.0-1.6). Conclusions: PC-ECMO mortality is high in older patients. Preoperative factors including previous stroke and right ventricular failure and postoperative factors including bleeding, cardiac arrest, and right ventricular failure should be targeted to reduce in-hospital mortality after appropriate initial selection in older patients.