Korean J Thorac Cardiovasc Surg.  2019 Apr;52(2):70-77. 10.5090/kjtcs.2019.52.2.70.

Outcomes of Coronary Artery Bypass Grafting after Extracorporeal Life Support in Patients with Cardiac Arrest or Cardiogenic Shock

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. wooksung.kim@samsung.com
  • 2Department of Thoracic and Cardiovascular Surgery, Sejong Hospital, Bucheon, Korea.
  • 3Extracorporeal Perfusion Team, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND
Extracorporeal life support (ECLS) is used as a bridge to revascularization in high-risk patients with ischemic heart disease. We reviewed our experiences of coronary artery bypass grafting (CABG) after ECLS in patients with cardiac arrest or refractory cardiogenic shock.
METHODS
We retrospectively reviewed 4,616 patients who underwent CABG at our institution between May 2006 and February 2017. We identified patients who underwent CABG following ECLS for cardiogenic shock or cardiac arrest. Twenty-three patients (0.5% of all CABG cases) were enrolled in the analysis. Their median age was 65 years (Q1-Q3, 58-77 years). Nine patients (39.1%) were diagnosed with ST-elevation myocardial infarction. Mechanical complications after acute myocardial infarction, including acute mitral regurgitation, left ventricular rupture, and ventricular septal defect, occurred in 9 patients (39.1%).
RESULTS
The median time from cardiopulmonary resuscitation to ECLS initiation was 25 minutes (Q1-Q3, 18.5-28.5 minutes). Conventional CABG was performed in 10 patients (43.5%) who underwent concomitant intracardiac procedures. Postoperative ECLS was required in 16 patients (69.5%). The rate of successful ECLS weaning was 91.3% (n=21). There were 6 early mortalities (26.1%).
CONCLUSION
CABG after ECLS was very rare in real-world circumstances. Although the early mortality rate was high, the risk of mortality may be acceptable under such devastating circumstances.

Keyword

Extracorporeal membrane oxygenation; Coronary artery bypass surgery

MeSH Terms

Cardiopulmonary Resuscitation
Coronary Artery Bypass*
Coronary Vessels*
Extracorporeal Membrane Oxygenation
Heart Arrest*
Heart Septal Defects, Ventricular
Humans
Mitral Valve Insufficiency
Mortality
Myocardial Infarction
Myocardial Ischemia
Retrospective Studies
Rupture
Shock, Cardiogenic*
Weaning
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