Gender and the Outcome of Postcardiotomy Veno-Arterial Extracorporeal Membrane Oxygenation

Structured Abstract Objective: There is a paucity of sex-specific data on patients postcardiotomy venoarterial extracorporeal membrane oxygenation (VA-ECMO). The present study sought to assess this issue in a multicenter study. Design: Retrospective, propensity score matched analysis of an international registry. Setting: Multicenter study, tertiary university hospitals. Participants: Data on adult patients receiving postcardiotomy VA-ECMO. Measurements and Main Results: Between January 2010 and March 2018, patients treated with postcardiotomy VA-ECMO at 17 cardiac surgery centers were analysed. Index procedures considered were coronary artery bypass graft surgery, isolated valve surgery, their combination, and proximal aortic root surgery. Hospital and 5-year mortality constituted the endpoints of interest. Propensity score matching was adopted with logistic regression. A total of 358 patients (mean age: 63.3 ± 12.3 years; 29.6% female) were identified. Among 94 propensity score matched pairs, females had a higher hospital mortality (70.5% vs. 56.4%, P=0.049) compared to males. Logistic regression analysis showed that females (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.10 to 3.16), age (OR, 1.06; 95%CI 1.04 to 1.08) and pre-ECMO arterial lactate (OR, 1.09; 95%CI 1.04 to 1.16) were independent predictors of hospital mortality. No differences between female and male patients were observed for other outcomes. Among propensity score matched pairs, 1-, 3-, and 5-year mortality were 60.6%, 65.0% and 65.0% among men, and 71.3%, 71.3%, and 74.0% among women, respectively (P=0.110, adjusted hazard ratio, 1.27; 95%CI 0.96 to 1.66). Conclusions: In postcardiotomy VA-ECMO, female patients demonstrated higher hospital mortality than males. Morbidity and late mortality were similar between the two groups.