The Relation Between Obesity and Mortality in Postcardiotomy Venoarterial Membrane Oxygenation

the PELS-1 Investigators, Samuel Heuts*, Silvia Mariani, Bas C.T. van Bussel, Udo Boeken, Robertas Samalavicius, Karl Bounader, Xiaotong Hou, Jeroen J.H. Bunge, Kogulan Sriranjan, Dominik Wiedemann, Diyar Saeed, Matteo Pozzi, Antonio Loforte, Leonardo Salazar, Bart Meyns, Michael A. Mazzeffi, Sacha Matteucci, Sandro Sponga, Vitaly SorokinClaudio 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 Whitman, Roberto Lorusso

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)


Background: Obesity is an important health problem in cardiac surgery and among patients requiring postcardiotomy venoarterial extracorporeal membrane oxygenation (V-A ECMO). Still, whether these patients are at risk for unfavorable outcomes after postcardiotomy V-A ECMO remains unclear. The current study evaluated the association between body mass index (BMI) and in-hospital outcomes in this setting. Methods: The Post-cardiotomy Extracorporeal Life Support (PELS-1) study is an international, multicenter study. Patients requiring postcardiotomy V-A ECMO in 36 centers from 16 countries between 2000 and 2020 were included. Patients were divided in 6 BMI categories (underweight, normal weight, overweight, class I, class II, and class III obesity) according to international recommendations. Primary outcome was in-hospital mortality, and secondary outcomes included major adverse events. Mixed logistic regression models were applied to evaluate associations between BMI and mortality. Results: The study cohort included 2046 patients (median age, 65 years; 838 women [41.0%]). In-hospital mortality was 60.3%, without statistically significant differences among BMI classes for in-hospital mortality (P = .225) or major adverse events (P = .126). The crude association between BMI and in-hospital mortality was not statistically significant after adjustment for comorbidities and intraoperative variables (class I: odds ratio [OR], 1.21; 95% CI, 0.88-1.65; class II: OR, 1.45; 95% CI, 0.86-2.45; class III: OR, 1.43; 95% CI, 0.62-3.33), which was confirmed in multiple sensitivity analyses. Conclusions: BMI is not associated to in-hospital outcomes after adjustment for confounders in patients undergoing postcardiotomy V-A ECMO. Therefore, BMI itself should not be incorporated in the risk stratification for postcardiotomy V-A ECMO.

Original languageEnglish
Pages (from-to)147-154
Number of pages8
JournalAnnals of Thoracic Surgery
Issue number1
Early online date2 Apr 2023
Publication statusPublished - Jul 2023

Bibliographical note

Funding Information:
PELS-1 Investigators: Justine Ravaux,1 Michele di Mauro,1 Ann-Kristin Schaefer,2 Luca Conci,2 Philipp Szalkiewicz,3 Jawad Khalil,3 Sven Lehmann,3 Jean-Francois Obadia,4 Nikolaos Kalampokas,5 Erwan Flecher,6 Dinis Dos Reis Miranda,7 Hergen Buscher,8 Daniel Herr,9 Nazli Vedadi,9 Marco Di Eusanio,10 Graeme Maclaren,11 Ram Ramanathan,11 Alessandro Costetti,12 Chistof Schmid,13 Roberto Castillo,14 Vladimir Mikulenka,15 and Marco Solinas16, 1Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; 2Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; 3Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; 4Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France; 5Department of Cardiac Surgery, Medical Faculty, Heinrich Heine University, Duesseldorf, Germany; 6Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France; 7Department of Intensive Care Adults, and Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands; 8Department of Intensive Care Medicine, Center of Applied Medical Research, St Vincent's Hospital, Darlinghurst, NSW, Australia; 9Departments of Medicine and Surgery, University of Maryland, Baltimore, USA; 10SOD Cardiochirurgia Ospedali Riuniti ‘Umberto I - Lancisi - Salesi’ Università Politecnica delle Marche, Ancona, Italy; 11Cardiothoracic Intensive Care Unit, National University Heart Centre, National University Hospital, Singapore, Singapore; 12Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy; 13Department of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany; 14ECMO Unit, Departamento de Anestesia, Clínica Las Condes, Las Condes, Santiago, Chile; 15Na Homolce Hospital, Prague, Czech Republic; and 16Ospedale del Cuore Fondazione Toscana “G. Monasterio”, Massa, Italy, The authors have no funding sources to disclose. Roberto Lorusso reports a relationship with Medtronic, Getinge, and LivaNova that includes: consulting; and is an Advisory Board Member of Eurosets (honoraria paid as research funding). Dominik Wiedemann reports a relationship with Abbott that includes: consulting/proctoring; and is a scientific advisor for Xenios. The other authors have no conflicts of interest to disclose.

Publisher Copyright:
© 2023 The Society of Thoracic Surgeons


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