Preoperative Venoarterial Extracorporeal Membrane Oxygenation improves mortality in Advanced Structural Heart Disease

Introduction: Cardiac surgery for structural heart disease has poor outcomes in the presence of cardiogenic shock or advanced heart failure. We applied venoarterial extracorporeal membrane oxygenation (ECMO) to restore end-organ function and resuscitate patients before high-risk cardiac operation.

Methods: We reviewed all patients with structural heart disease and cardiogenic shocked who have been admitted to our institute during one-year period (2018) and have been resuscitated by ECMO preoperatively. Seven patients were included in to research. Before surgery, patients were placed on ECMO for 3.7 days in average (2-7 days). Follow, patients were undergoing different surgical procedures: AVR for severe aortic stenosis (n=1), MVR for severe mitral regurgitation (n=4), TVR+PFO closure (n=1) and closure of acute post-infarct ventricular septal defect (n=1).

Results: Mean age was 52 ± 17 years. Comorbidities included acute renal failure (n=3), inotrope requirement (n= 5), intra-aortic balloon pump (n= 5) and acute liver injury (n=3). With ECMO support, vasopressor requirement, central venous pressure, creatinine, lactate, pH and pulmonary hypertension all improved significantly. Average length of follow-up is 4 months, with 2 patient deaths at 12 and 7 days and the rest of the patients survived. Complications included acute kidney injury - yet no patients required dialysis at discharge- and one patient was underwent above knee amputation as a result of lower limb ischemia.

Conclusion: ECMO can be used as a bridge to heart valve or septal defect surgery in severely decompensated patients, suffered from cardiogenic shock. Through recovery of end-organ function, ECMO may allow surgical correction of structural heart disease in patients considered inoperable or convert a salvage situation to an elective operation.