TY - JOUR
T1 - Postcardiotomy extracorporeal life support after isolated or valve-concomitant coronary artery bypass grafting
T2 - An observational multicenter study
AU - Mariani, Silvia
AU - Matteucci, Sacha
AU - van Bussel, Bas C.T.
AU - Schaefer, Anne Kristin
AU - Saeed, Diyar
AU - Pozzi, Matteo
AU - Botta, Luca
AU - Kalampokas, Nikolaos
AU - Jankuviene, Agne
AU - Bounader, Karl
AU - Hou, Xiaotong
AU - Bunge, Jeroen J.H.
AU - Buscher, Hergen
AU - Salazar, Leonardo
AU - Meyns, Bart
AU - Mazzeffi, Michael A.
AU - Sponga, Sandro
AU - Sorokin, Vitaly
AU - Russo, Claudio
AU - Di Mauro, Michele
AU - Sakiyalak, Pranya
AU - Fiore, Antonio
AU - Camboni, Daniele
AU - Raffa, Giuseppe Maria
AU - Diaz, Rodrigo
AU - Wang, I. wen
AU - Jung, Jae Seung
AU - Belohlavek, Jan
AU - Pellegrino, Vin
AU - Bianchi, Giacomo
AU - Pettinari, Matteo
AU - Barbone, Alessandro
AU - Garcia, José P.
AU - Shekar, Kiran
AU - Whitman, Glenn
AU - Formica, Francesco
AU - Lorusso, Roberto
AU - Post-Cardiotomy Extracorporeal Life Support (PELS-1) Investigators
N1 - Publisher Copyright:
© 2026 The Author(s).
PY - 2026/8
Y1 - 2026/8
N2 - 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 LHV-CABG 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.
AB - 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 LHV-CABG 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.
KW - coronary-artery-bypass
KW - extracorporeal life support
KW - postcardiotomy cardiogenic shock
KW - valve surgery
U2 - 10.1016/j.xjon.2026.101875
DO - 10.1016/j.xjon.2026.101875
M3 - Article
SN - 2666-2736
VL - 32
JO - JTCVS open
JF - JTCVS open
M1 - 101875
ER -