Cardiologist National Institute of Cardiology Ignacio Chavez Tlalpan, Mexico City, Mexico
Disclosure(s):
Guadalupe L. Hernandez Gonzalez, MD: No financial relationships to disclose
Background: Postcardiotomy cardiogenic shock (PCS) is a rare but highly lethal complication after cardiac surgery. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an established rescue therapy, outcomes vary widely and depend on patient selection, timing, and procedural factors; data from Latin American centers remain scarce.
Methods: We performed a retrospective observational cohort study including adult patients with refractory PCS supported with VA-ECMO between 2014 and 2024 at a tertiary cardiovascular referral center. Clinical, surgical, and ECMO-related variables were collected. In-hospital mortality was the primary outcome. Univariate logistic regression and age- and sex-adjusted models were used to identify factors associated with mortality.
Outcome: Forty-eight patients were analyzed, with an overall in-hospital survival of 43.8%. In adjusted analysis, body mass index < 25 kg/m² and surgical left ventricular unloading through the pulmonary veins were independently associated with increased mortality, while the Bentall and Bono procedure was associated with improved survival. Non-survivors had shorter ECMO duration and ICU stay, reflecting early fatal progression. Survivors demonstrated excellent functional recovery, with most achieving NYHA class I and full independence at follow-up.
Conclusion: VA-ECMO for PCS achieved survival comparable to international benchmarks with favorable long-term functional outcomes among survivors. Mortality was primarily driven by early refractory shock and specific clinical and procedural factors, underscoring the importance of careful patient selection to optimize the benefit of VA-ECMO.
