Extracorporeal Life Support Associated with Cardiac Procedures in Patients with Malignancy

Abstract

Abstract Background With an aged population, cardiac surgery in oncologic patients is no longer uncommon. The use of postcardiotomy extracorporeal life support has increased, but its utility in oncologic patients is not clear. This study aims to define the role of postcardiotomy extracorporeal life support in patients with malignancy. Methods The Extracorporeal Life Support Organization registry was queried for patients older than 18 years with an International Classification of Diseases codes of hematologic and solid malignancy over the last decade (2010–2019). Among them, patients who underwent cardiac surgery or transcatheter valve intervention were selected. Outcomes and clinical data including types of procedure and cancer subtypes were analyzed. Results One hundred and sixty-two patients met inclusion criteria: 17 pulmonary support, 119 cardiac support, and 26 extracorporeal cardiopulmonary resuscitation. Sixty-two patients (38.3%) survived to discharge. Low survival was seen with hematologic (35.5%), soft tissue (25.0%) and breast malignancies (15.4%) though none of them were statistically significant. Coronary artery bypass grafting (n = 56) and surgical valve procedure (n = 54) were dominant types of procedures with a survival of 44.6% and 33.3%, respectively. Ventricular assist device procedure (n = 48) and cardiac transplant (n = 21) were also commonly performed with a survival of 37.5% and 33.3%, respectively. Conclusions Postcardiotomy extracorporeal life support in patients with malignancy was associated with a low but acceptable survival rate given the high mortality with postcardiotomy extracorporeal life support in the general population. The impact of a cancer diagnosis appeared to be small, but gathering a detailed history of cardiotoxic treatments could be crucial.