Abstract
ObjectiveTo assess the influence of primary arterial access in patients receiving peripheral postcardiotomy extracorporeal life support on associated complications and outcome. MethodsOf 573 consecutive patients requiring PC-ECLS between 2000 and 2019 at a single center, 436 were included in a retrospective analysis and grouped according to primary arterial extracorporeal life support access site. Survival and rate of access-site–related complications with special emphasis on fatal/disabling stroke were compared. ResultsThe axillary artery was cannulated in 250 patients (57.3%), whereas the femoral artery was used as primary arterial access in 186 patients (42.6%). There was no significant difference in 30-day (axillary: 62%; femoral: 64.7%; P = .561) and 1-year survival (axillary: 42.5%; femoral: 44.8%; P = .657). Cerebral computed tomography-confirmed stroke with a modified ranking scale ≥4 was significantly more frequent in the axillary group (axillary: n = 28, 11.2%; femoral: n = 4, 2.2%; P = .0003). Stroke localization was right hemispheric (n = 20; 62.5%); left hemispheric (n = 5; 15.6%), bilateral (n = 5; 15.6%), or infratentorial (n = 2; 6.25%). Although no difference in major cannulation site bleeding was observed, cannulation site change for bleeding was more frequent in the axillary group (axillary: n = 13; 5.2%; femoral: n = 2; 1.1%; P = .03). Clinically apparent limb ischemia was significantly more frequent in the femoral group (axillary: n = 12, 4.8%; femoral: n = 31, 16.7%; P < .0001). ConclusionsAlthough survival did not differ, surgeons should be aware of access–site-specific complications when choosing peripheral PC-ECLS access. Although lower rates of limb ischemia and the advantage of antegrade flow seem beneficial for axillary cannulation, the high incidence of right hemispheric strokes in axillary artery cannulation should be considered.
Highlights
MethodsOf 573 consecutive patients requiring postcardiotomy temporary extracorporeal life support (PC-ECLS) between 2000 and 2019 at a single center, 436 were included in a retrospective analysis and grouped according to primary arterial extracorporeal life support access site
Several complications of postcardiotomy temporary extracorporeal life support (PC-ECLS) are related to the vascular access site
Operative Data and ECLS Indication Procedure duration, cardiopulmonary bypass (CPB) and aortic crossclamp (Xclamp) time were significantly longer in the axillary group, and the rate of surgery for type-A aortic dissection was higher in the axillary group
Summary
Of 573 consecutive patients requiring PC-ECLS between 2000 and 2019 at a single center, 436 were included in a retrospective analysis and grouped according to primary arterial extracorporeal life support access site. All consecutive patients who received PC-ECLS from 2000 to 2019 (N 1⁄4 573) at the Department of Cardiac Surgery at the Medical University of Vienna were screened for the inclusion and exclusion criteria stated below. Older patients are less likely to be eligible candidates for durable MCS or heart transplantation (HTX) and therapy may be withdrawn in the case the patient cannot be weaned from ECLS. In this case, a weaning attempt is made and ECLS explanted. In cases when we anticipate that the patient will not be weanable from ECLS because of an underlying structural cardiac defect, we are more restrictive with ECLS implementation when the patient is no candidate for ventricular assist device (VAD)/HTX
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More From: The Journal of Thoracic and Cardiovascular Surgery
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