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Preoperative Venoarterial Extracorporeal Membrane Oxygenation Reduces Mortality in Advanced Structural Heart Disease
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  • Tamer Gamal,
  • Eilon Ram,
  • David Volvovitch,
  • Yigal Kassif,
  • Ehud Raanani,
  • Leonid Sternik,
  • Alexander Kogan
Tamer Gamal
Sheba Medical Center at Tel Hashomer
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Eilon Ram
Sheba Medical Center at Tel Hashomer
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David Volvovitch
Sheba Medical Center at Tel Hashomer
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Yigal Kassif
Sheba Medical Center at Tel Hashomer
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Ehud Raanani
Sheba Medical Center at Tel Hashomer
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Leonid Sternik
Sheba Medical Center at Tel Hashomer
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Alexander Kogan
Sheba Medical Center at Tel Hashomer
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Abstract

Introduction: Cardiac surgery for structural heart disease in the presence of cardiogenic shock or advanced heart failure has poor outcomes. We applied venoarterial extracorporeal membrane oxygenation (ECMO) to restore end-organ function and resuscitate patients prior to high-risk cardiac surgery. Methods: During a 2-year period (1/2018-12/2019) we reviewed all patients admitted to our Medical Centre with structural heart disease and cardiogenic shock, who had been resuscitated preoperatively by ECMO. Of these patients, 11 were included in the study. Patients were placed on ECMO preoperatively for 69 hours (range, 36-136 hours). Eight patients underwent valvular surgeries and 3 patients had ventricular septal defect repairs. Results: Mean age was 54± 15 years. Nine patients presented with cardiogenic shock, and two with advanced heart failure. Nine patients needed inotropes and four needed IABP support. Seven patients were admitted with acute kidney injury and five presented with metabolic acidosis. Average calculated EUROSCORE I was 56±23% and mean calculated APACHE II score was 17.18±6.26. The mean ECMO total time was 126±93 hours. Of the four postoperative deaths, three died within 10 days of surgery and one 2 months post-surgery. Conclusion: ECMO can be used as a bridge to heart valve or septal defect surgery in severely decompensated patients suffering from cardiogenic shock. Through recovery of end-organ function, ECMO may facilitate surgical correction of structural heart disease in patients in a very high risk for surgery.