Objectives: The aim of this study was to identify the risk factors associated with early mortality after postcardiotomy venoarterial extracorporeal membrane oxygenation. Methods: This is an analysis of the postcardiotomy extracorporeal membrane oxygenation registry, a retrospective multicenter cohort study including 781 patients aged more than 18 years who required venoarterial extracorporeal membrane oxygenation for cardiopulmonary failure after cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers.

Transcarotid vascular access for TAVR is feasible and is associated with encouraging short- and medium-term clinical outcomes. Prospective studies are required to ascertain if transcarotid TAVR yields equivalent results to other nonfemoral vascular access routes.

Background: There is uncertainty whether venoarterial extracorporeal membrane oxygenation (VA-ECMO) should be used in the elderly with cardiopulmonary failure after cardiac surgery.Methods: This is a retrospective multicenter study on 781 patients who required postcardiotomy VA-ECMO for cardiopulmonary failure after adult cardiac surgery from 2010 to 2018 at 19 cardiac surgery centers. A parallel systematic review and meta-analysis of the literature was performed. Results:The hospital mortality in the overall PC-ECMO series was 64.4%. Two-hundred and fifty-five patients were ≥70 years old (32.7%) and their hospital mortality was significantly higher than younger patients (76.1% vs. 58.7%, adjusted OR 2.199, 95%CI 1.536-3.149). Arterial lactate >6 mmol/L before starting VA-ECMO was the only predictor of hospital mortality among patients ≥70 years old in univariate analysis (82.6% vs. 70.4%, p=0.029). Meta-analysis of the current and prior studies showed that early mortality after postcardiotomy VA-ECMO was significantly higher in patients aged ≥70 years compared with younger patients (OR 2.09, 95%CI 1.59-2.75, five studies including 1547 patients, I 2 5.9%). The pooled early mortality rate among patients aged ≥70 years was 78.8% (95%CI 74.1-83.5, six studies including 617 patients, I 2 41.8%). Two studies reported 1-year mortality (including hospital mortality) of 79.9% and 75.6%, respectively, in patients ≥70 years old.Conclusions: Advanced age should not be considered a contraindication for postcardiotomy VA-ECMO. However, in view of the high risk of early mortality, a meaningful scrutiny is needed before using VA-ECMO after cardiac surgery in the elderly.

As opposed to LEF-LG patients, mid-term prognosis after TAVI procedure in PLFLG patients is similar to HGAS patients despite higher perioperative mortality.