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Vondran, Maximilian; Rylski, Bartosz; Berezowski, Mikolaj; Polycarpou, Andreas; Born, Frank; Guenther, Sabina; Lühr, Maximilian; Juchem, Gerd; Beyersdorf, Friedhelm; Hagl, Christian; Dashkevich, Alexey (2019): Preemptive Extracorporeal Life Support for Surgical Treatment of Severe Constrictive Pericarditis. In: Annals of Thoracic Surgery, Vol. 108, No. 5: pp. 1376-1382
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Abstract

Background. Surgical treatment of constrictive pericarditis (CP) is particularly challenging because of the increased risk of right heart failure. The necessity of postoperative extracorporeal life support (ECLS) can result in mortality rates of 100%. Preemptive implantation of ECLS may improve postoperative outcomes;however, no data are currently available on its use. We conducted a retrospective study to evaluate the feasibility of our strategy. Methods. Between September 2012 and June 2016, ECLS was established percutaneously through the groin vessels in 12 individually selected patients with high-risk CP immediately before pericardiectomy in the operating theater as part of the surgical strategy. Prolonged weaning was performed in the intensive care unit. Demographic characteristics, perioperative data, and survival were analyzed. Results. The median patient age was 61.5 years (first quartile, third quartile: 51.3, 68.5 years), with a preoperative central venous pressure of 24 mm Hg (first quartile, third quartile: 21, 28 mm Hg). Furthermore, the pulmonary artery pressure was greater than 60 mm Hg in 50% of patients and a dip plateau sign existed in 75% before surgery. The median duration of ECLS therapy was 132 hours (first quartile, third quartile: 96, 168 hours) with a length of stay on the intensive care unit of 10 days (first quartile, third quartile: 7.0, 16.8 days). There was no intraoperative death. The cumulative 30-day, 1-year, and 5-year survival rates were 83% +/- 11%, 75% +/- 13%, and 75% +/- 13%, respectively. Conclusions. From our real-world data, preemptive use of perioperative ECLS, assigned by individual team decision in selected patients with severe CP, is a feasible and safe strategy. (C) 2019 by The Society of Thoracic Surgeons