Postcardiotomy extracorporeal life support after isolated or valve-concomitant coronary artery bypass grafting: An observational multicenter study

Objectives: Data on outcomes of patients undergoing isolated coronary artery bypass grafting (isolated CABG) versus CABG and concomitant left heart valve (LHV-CABG) surgery are conflicting, especially in extracorporeal life support (ECLS) settings. We compared characteristics, in-hospital outcomes, and overall survival between patients undergoing isolated-CABG and concomitant LHVCABG requiring postcardiotomy ECLS from a large multicenter study. Methods: This retrospective, multicenter (34 centers), observational study included adults requiring postcardiotomy ECLS between 2000 and 2020. Clinical characteristics and outcomes were compared between patients who underwent isolated CABG with those who underwent LHV-CABG. Association between type of surgery and in-hospital survival was investigated through mixed-Cox proportional hazards models. Results: This study included 639 patients comprising 58.8% (n = 376) isolated CABG and 41.1% (n = 263) LHV-CABG, including 46.7% (n = 123) aortic, 38.8% (n = 102) mitral, and 14.5% (n = 38) combined aortic-mitral valve procedures. The LHV-CABG patients were older (P = .001), more frequently experienced preoperative pulmonary artery hypertension (P < .001), and 6.5% (n = 17) had active endocarditis. They required longer cardiopulmonary bypass times (P < .001) and cardiac surgery reoperations (P = .002). In-hospital mortality was 54.8% (n = 206) and 63.1% (n = 166) in the isolated CABG and LHV-CABG groups (P = .036), respectively. Crude hazard ratio for in-hospital mortality in LHV-CABG was 1.28 (95% CI, 1.03-1.58, P = .023) and did not change after adjustments. The 5-year postdischarge survival probabilities were 71.1% (95% CI, 61.0-82.2) and 69.3% (95% CI, 57.7-83.2; P = .210) for isolated CABG and LHV-CABG groups, respectively. Conclusions: LHV-CABG surgery, compared with isolated CABG, was associated with higher in-hospital mortality in patients requiring ECLS, whereas no midterm postdischarge survival differences could be detected. Early identification of patients in need for ECLS following LHV-CABG may improve outcomes.