Outcomes after Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation in Young patients: an Individual Patient Data Meta-analysis

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.