Extracorporeal Life Support for Post-Cardiotomy Acute Right Ventricular Failure: a Retrospective Observational Multicenter Study

Background: Post-cardiotomy acute right ventricular failure (aRVF) constitutes a complex clinical challenge that might necessitate escalating interventions, including extracorporeal life support (ECLS). This study evaluates outcomes of adults requiring ECLS for post-cardiotomy acute right ventricular failure (aRVF) compared to other post-cardiotomy indications. Methods: In this multicenter, international, retrospective study, we analyzed patients undergoing post-cardiotomy ECLS from January 2000 to December 2020 and compared patients' characteristics and in-hospital mortality between aRVF and other indications groups. Results: Of 2010 patients, 240 (12%) had aRVF and 1770 (88%) had other indication for ECLS. Demographics were similar between groups (median age: 65 years [55-72]; p=0.217; males 60%; p=0.675). The aRVF group showed higher pre-operative right-sided cardiac dysfunction, including pre-existing right ventricular failure (aRVF: 22%; other indications: 8%; p<0.001) and biventricular failure (aRVF: 12%; other indications: 7%; p=0.013). aRVF patients more frequently underwent tricuspid valve surgery (aRVF: 20%; other indications: 13%; p=0.003) and aortic root procedures (aRVF: 24%; other indications: 13%). They also required longer ECLS support (aRVF: 135 hours [70-221]; other indications:116 hours [58-192]; p=0.025) and longer intensive care unit stay (aRVF: 15 days [7-291]; other indications: 13 days [6-25]; p=0.042). Despite more complications, including non-surgical bleeding (aRVF: 31%; other indications: 25%; p=0.042) and persistent right heart failure (aRVF: 50%; other indications: 17%; p<0.001), both in-hospital survival (aRVF: 59%; other indications: 61%; p=0.526) and long-term survival were comparable (log-rank p=0.17). Conclusions: Patients requiring ECLS for post-cardiotomy aRVF, despite higher pre-operative risks and complex clinical courses, achieve survival rates comparable to other indications patients.