Features and outcomes of female and male patients requiring postcardiotomy extracorporeal life support

Silvia Mariani; Justine Mafalda Ravaux; Bas C.T. van Bussel; Maria Elena De Piero; Sander M.J. van Kruijk; Anne Kristin Schaefer; Dominik Wiedemann; Diyar Saeed; Matteo Pozzi; Antonio Loforte; Udo Boeken; Robertas Samalavicius; Karl Bounader; Xiaotong Hou; Jeroen J.H. Bunge; Hergen Buscher; Leonardo Salazar; Bart Meyns; Michael A. Mazzeffi; Sacha Matteucci; Sandro Sponga; Vitaly Sorokin; Claudio Russo; Francesco Formica; Pranya Sakiyalak; Antonio Fiore; Daniele Camboni; Giuseppe Maria Raffa; Rodrigo Diaz; I. wen Wang; Jae Seung Jung; Jan Belohlavek; Vin Pellegrino; Giacomo Bianchi; Matteo Pettinari; Alessandro Barbone; José P. Garcia; Kiran Shekar; Glenn J.R. Whitman; Roberto Lorusso; Samuel Heuts; Luca Conci; Philipp Szalkiewicz; Sven Lehmann; Jawad Khalil; Jean Francois Obadia; Nikolaos Kalampokas; Agne Jankuviene; Erwan Flecher; Dinis Dos Reis Miranda; Kogulan Sriranjan; Daniel Herr; Nazli Vedadi; Marco Di Eusanio; Graeme MacLaren; Kollengode Ramanathan; Alessandro Costetti; Chistof Schmid; Roberto Castillo; Tomas Grus; Vladimir Mikulenka; Marco Solinas

doi:10.1016/j.jtcvs.2024.04.033

Features and outcomes of female and male patients requiring postcardiotomy extracorporeal life support

Silvia Mariani^*, Justine Mafalda Ravaux, Bas C.T. van Bussel, Maria Elena De Piero, Sander M.J. van Kruijk, Anne Kristin Schaefer, Dominik Wiedemann, Diyar Saeed, Matteo Pozzi, Antonio Loforte, Udo Boeken, Robertas Samalavicius, Karl Bounader, Xiaotong Hou, Jeroen J.H. Bunge, Hergen Buscher, Leonardo Salazar, Bart Meyns, Michael A. Mazzeffi, Sacha MatteucciSandro Sponga, Vitaly Sorokin, Claudio Russo, Francesco Formica, Pranya Sakiyalak, Antonio Fiore, Daniele Camboni, Giuseppe Maria Raffa, Rodrigo Diaz, I. wen Wang, Jae Seung Jung, Jan Belohlavek, Vin Pellegrino, Giacomo Bianchi, Matteo Pettinari, Alessandro Barbone, José P. Garcia, Kiran Shekar, Glenn J.R. Whitman, Roberto Lorusso, Samuel Heuts, Luca Conci, Philipp Szalkiewicz, Sven Lehmann, Jawad Khalil, Jean Francois Obadia, Nikolaos Kalampokas, Agne Jankuviene, Erwan Flecher, Dinis Dos Reis Miranda, Kogulan Sriranjan, Daniel Herr, Nazli Vedadi, Marco Di Eusanio, Graeme MacLaren, Kollengode Ramanathan, Alessandro Costetti, Chistof Schmid, Roberto Castillo, Tomas Grus, Vladimir Mikulenka, Marco Solinas

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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.

Original language	English
Pages (from-to)	1701-1711.e30
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	168
Issue number	6
DOIs	https://doi.org/10.1016/j.jtcvs.2024.04.033
Publication status	Published - Dec 2024

Bibliographical note

Publisher Copyright:
© 2024 The Authors

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Features and outcomes of female and male patients requiring postcardiotomy extracorporeal life supportFinal published version, 3.97 MBLicence: CC BY

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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., ... Solinas, M. (2024). Features and outcomes of female and male patients requiring postcardiotomy extracorporeal life support. Journal of Thoracic and Cardiovascular Surgery, 168(6), 1701-1711.e30. https://doi.org/10.1016/j.jtcvs.2024.04.033

@article{005a50ceacb24d93ad80b2fa7a223159,

title = "Features and outcomes of female and male patients requiring postcardiotomy extracorporeal life support",

abstract = "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.",

author = "Silvia Mariani and Ravaux, {Justine Mafalda} and {van Bussel}, {Bas C.T.} and {De Piero}, {Maria Elena} and {van Kruijk}, {Sander M.J.} and Schaefer, {Anne Kristin} and Dominik Wiedemann and Diyar Saeed and Matteo Pozzi and Antonio Loforte and Udo Boeken and Robertas Samalavicius and Karl Bounader and Xiaotong Hou and Bunge, {Jeroen J.H.} and Hergen Buscher and Leonardo Salazar and Bart Meyns and Mazzeffi, {Michael A.} and Sacha Matteucci and Sandro Sponga and Vitaly Sorokin and Claudio Russo and Francesco Formica and Pranya Sakiyalak and Antonio Fiore and Daniele Camboni and Raffa, {Giuseppe Maria} and Rodrigo Diaz and Wang, {I. wen} and Jung, {Jae Seung} and Jan Belohlavek and Vin Pellegrino and Giacomo Bianchi and Matteo Pettinari and Alessandro Barbone and Garcia, {Jos{\'e} P.} and Kiran Shekar and Whitman, {Glenn J.R.} and Roberto Lorusso and Samuel Heuts and Luca Conci and Philipp Szalkiewicz and Sven Lehmann and Jawad Khalil and Obadia, {Jean Francois} and Nikolaos Kalampokas and Agne Jankuviene and Erwan Flecher and {Reis Miranda}, {Dinis Dos} and Kogulan Sriranjan and Daniel Herr and Nazli Vedadi and {Di Eusanio}, Marco and Graeme MacLaren and Kollengode Ramanathan and Alessandro Costetti and Chistof Schmid and Roberto Castillo and Tomas Grus and Vladimir Mikulenka and Marco Solinas",

note = "Publisher Copyright: {\textcopyright} 2024 The Authors",

year = "2024",

month = dec,

doi = "10.1016/j.jtcvs.2024.04.033",

language = "English",

volume = "168",

pages = "1701--1711.e30",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Elsevier Inc.",

number = "6",

}

Mariani, S, Ravaux, JM, van Bussel, BCT, De Piero, ME, van Kruijk, SMJ, Schaefer, AK, Wiedemann, D, Saeed, D, Pozzi, M, Loforte, A, Boeken, U, Samalavicius, R, Bounader, K, Hou, X, Bunge, JJH, Buscher, H, Salazar, L, Meyns, B, Mazzeffi, MA, Matteucci, S, Sponga, S, Sorokin, V, Russo, C, Formica, F, Sakiyalak, P, Fiore, A, Camboni, D, Raffa, GM, Diaz, R, Wang, IW, Jung, JS, Belohlavek, J, Pellegrino, V, Bianchi, G, Pettinari, M, Barbone, A, Garcia, JP, Shekar, K, Whitman, GJR, Lorusso, R, Heuts, S, Conci, L, Szalkiewicz, P, Lehmann, S, Khalil, J, Obadia, JF, Kalampokas, N, Jankuviene, A, Flecher, E, Reis Miranda, DD, 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 2024, 'Features and outcomes of female and male patients requiring postcardiotomy extracorporeal life support', Journal of Thoracic and Cardiovascular Surgery, vol. 168, no. 6, pp. 1701-1711.e30. https://doi.org/10.1016/j.jtcvs.2024.04.033

TY - JOUR

T1 - Features and outcomes of female and male patients requiring postcardiotomy extracorporeal life support

AU - Mariani, Silvia

AU - Ravaux, Justine Mafalda

AU - van Bussel, Bas C.T.

AU - De Piero, Maria Elena

AU - van Kruijk, Sander M.J.

AU - Schaefer, Anne Kristin

AU - Wiedemann, Dominik

AU - Saeed, Diyar

AU - Pozzi, Matteo

AU - Loforte, Antonio

AU - Boeken, Udo

AU - Samalavicius, Robertas

AU - Bounader, Karl

AU - Hou, Xiaotong

AU - Bunge, Jeroen J.H.

AU - Buscher, Hergen

AU - Salazar, Leonardo

AU - Meyns, Bart

AU - Mazzeffi, Michael A.

AU - Matteucci, Sacha

AU - Sponga, Sandro

AU - Sorokin, Vitaly

AU - Russo, Claudio

AU - Formica, Francesco

AU - Sakiyalak, Pranya

AU - Fiore, Antonio

AU - Camboni, Daniele

AU - Raffa, Giuseppe Maria

AU - Diaz, Rodrigo

AU - Wang, I. wen

AU - Jung, Jae Seung

AU - Belohlavek, Jan

AU - Pellegrino, Vin

AU - Bianchi, Giacomo

AU - Pettinari, Matteo

AU - Barbone, Alessandro

AU - Garcia, José P.

AU - Shekar, Kiran

AU - Whitman, Glenn J.R.

AU - Lorusso, Roberto

AU - Heuts, Samuel

AU - Conci, Luca

AU - Szalkiewicz, Philipp

AU - Lehmann, Sven

AU - Khalil, Jawad

AU - Obadia, Jean Francois

AU - Kalampokas, Nikolaos

AU - Jankuviene, Agne

AU - Flecher, Erwan

AU - Reis Miranda, Dinis Dos

AU - Sriranjan, Kogulan

AU - Herr, Daniel

AU - Vedadi, Nazli

AU - Di Eusanio, Marco

AU - MacLaren, Graeme

AU - Ramanathan, Kollengode

AU - Costetti, Alessandro

AU - Schmid, Chistof

AU - Castillo, Roberto

AU - Grus, Tomas

AU - Mikulenka, Vladimir

AU - Solinas, Marco

PY - 2024/12

Y1 - 2024/12

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85196638421&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2024.04.033

DO - 10.1016/j.jtcvs.2024.04.033

M3 - Article

C2 - 38762034

AN - SCOPUS:85196638421

SN - 0022-5223

VL - 168

SP - 1701-1711.e30

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

IS - 6

ER -

Features and outcomes of female and male patients requiring postcardiotomy extracorporeal life support

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