Central extracorporeal membrane oxygenation as a bridge to recovery in patients with myocardial stunning after coronary artery bypass grafting
Background: The role of central extracorporeal membrane oxygenation (ECMO) post coronary artery bypass grafting (CABG) in older patients is debatable. The objectives of our study were to investigate the role of central veno-arterial (V-A) ECMO as a bridge to recovery in patients with myocardial stunning after CABG and its effect on mortality in this group of patients.
Methods: Seventy-five patients had central ECMO as a bridge to recovery after CABG because of myocardial stunning; 45 of them (60%) had survived (group 1), and mortality occurred in 30 patients (40%) (group 2). Preoperative risk factors such as hypertension, stroke, and renal failure were comparable between groups. In non-survivors, left main disease was more common (19 (63.3%) vs. 13 (28.9%); p= 0.003) and SYNTAX score was higher (Median 33 (25th- 75th percentiles); 33 (29- 35) vs. 26 (25- 32); p< 0.001).
Results: Cross-clamp time was shorter in group 1 (58 minutes; (52-62) vs 115.5 minutes; (84- 161) in group 2; p< 0.001). Cardiopulmonary bypass time was shorter in group 1 compared to group 2 (83; (70-90) vs. 155.5; (60 -120) minutes; p< 0.001). ECMO duration was longer in group 2 (6 days; (6-7) vs. 3 days; (3-4); p<0.001). Stroke occurred in 10 patients (33.33%) in group 2 vs. 1 patient (2.22%) in groups 1; p< 0.001. Longer cross-clamp (OR: 1.61, 95% CI: 1.11- 2.31, p= 0.011) and bypass time (OR: 1.76; 95% CI: 1.57- 1.99; p= 0.048) predicted postoperative mortality.
Conclusion: Central ven-arterial extramembrane oxygenation can be used as a bridge to recovery in patients with stunned myocardium post coronary bypass grafting, especially in centers where heart transplantation and ventricular assist devices are not available.