- Journal
- JTCVS OPEN
- Année
- 2025
- Volume
- 28
- Pages
- 278-295
- Mois
- DEC
- DOI
- 10.1016/j.xjon.2025.09.046
Abstract
Objective: We aimed to evaluate the early and midterm mortality of young patients treated for cardiogenic shock with venoarterial extracorporeal membrane oxygenation (VA-ECMO) after adult cardiac surgery. Methods: Studies reporting the outcome after postcardiotomy VA-ECMO in adult patients were identified through a systematic review of the literature. Individual patient-level data were provided by the authors of 10 studies. Results: Data on 1268 patients treated at 25 hospitals were included in this study. Adjusted analysis identified 40 years of age as a cutoff value for in-hospital and mid-term mortality. Patients aged >40 years had significantly greater in-hospital mortality (1129 patients, crude rates 68.8% vs 43.1%, adjusted odds ratio, 3.267; 95% confidence interval, 1.970-5.425) and mortality at 24-month (109 patients, crude rates 73.7% vs 45.0%, adjusted hazard ratio, 3.530, 95% confidence interval, 2.571-4.844). Twelve (11.0%) patients aged <= 40 years received a ventricular assist device and heart transplantation, whereas this strategy was adopted in 33 (2.9%) patients aged >40 years (P < .001). Eventually, 7 (6.4%) patients aged <= 40 years and 12 (1.1%) patients aged >40 years underwent heart transplantation (P < .001). Heart transplantation tended to decrease in-hospital mortality in patients aged <= 40 years (14.3% vs 45.1%, P = .138), whereas this difference reached statistical significance in patients aged >40 years (25.0% vs 69.3%, P = .002). Conclusions: The present findings suggest that early and midterm mortality after postcardiotomy VA-ECMO is significantly lower in patients aged <= 40 years compared to older patients. However, mortality remains substantial also among these young patients and heart-replacement therapies are infrequently performed in this subset of patients likely because of severe perioperative complications.