Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery
(1) Alkaline phosphatase (AP) is consumed during cardiopulmonary bypass (CPB). A high AP depletion leads to an impaired outcome after cardiac surgery. However, data is scarce on the postoperative course of AP under venoarterial ECMO (VA-ECMO) support. (2) A total of 239 patients with VA-ECMO support...
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| Format: | Article |
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MDPI AG
2021-05-01
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| Series: | Biomolecules |
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| Online Access: | https://www.mdpi.com/2218-273X/11/5/748 |
| _version_ | 1797533761899855872 |
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| author | Thomas Poschner Anne-Kristin Schaefer Doris Hutschala Georg Goliasch Julia Riebandt Klaus Distelmaier Martin H. Bernardi Martin Andreas Ruud Brands Tandis Aref Günther Laufer Dominik Wiedemann |
| author_facet | Thomas Poschner Anne-Kristin Schaefer Doris Hutschala Georg Goliasch Julia Riebandt Klaus Distelmaier Martin H. Bernardi Martin Andreas Ruud Brands Tandis Aref Günther Laufer Dominik Wiedemann |
| author_sort | Thomas Poschner |
| collection | DOAJ |
| description | (1) Alkaline phosphatase (AP) is consumed during cardiopulmonary bypass (CPB). A high AP depletion leads to an impaired outcome after cardiac surgery. However, data is scarce on the postoperative course of AP under venoarterial ECMO (VA-ECMO) support. (2) A total of 239 patients with VA-ECMO support between 2000 and 2019 at the Department of Cardiac Surgery (Vienna General Hospital, Austria) were included in this retrospective analysis. Blood samples were collected at several timepoints (baseline, postoperative day (POD) 1–7, POD 14 and 30). Patients were categorized according to the relative AP drop (<60% vs. ≥60%) and ECMO duration (<5 days vs. ≥5 days). (3) Overall, 44.4% reached the baseline AP values within 5 days—this was only the case for 28.6% with a higher AP drop (compared to 62.7% with a lower drop; <i>p</i> = 0.000). A greater AP drop was associated with a significantly higher need for renal replacement therapy (40.9% vs. 61.9%; <i>p</i> = 0.002) and an impaired 1-year survival (51.4% vs. 66.0%; <i>p</i> = 0.031). (4) CPB exceeds the negative impact of VA-ECMO; still, ECMO seems to delay alkaline phosphatase recovery. A greater initial AP drop bears the risk of higher morbidity and mortality. |
| first_indexed | 2024-03-10T11:20:10Z |
| format | Article |
| id | doaj.art-97d55580cc4f40b8b36f55055d9891af |
| institution | Directory Open Access Journal |
| issn | 2218-273X |
| language | English |
| last_indexed | 2024-03-10T11:20:10Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomolecules |
| spelling | doaj.art-97d55580cc4f40b8b36f55055d9891af2023-11-21T20:08:08ZengMDPI AGBiomolecules2218-273X2021-05-0111574810.3390/biom11050748Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac SurgeryThomas Poschner0Anne-Kristin Schaefer1Doris Hutschala2Georg Goliasch3Julia Riebandt4Klaus Distelmaier5Martin H. Bernardi6Martin Andreas7Ruud Brands8Tandis Aref9Günther Laufer10Dominik Wiedemann11Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, AustriaAlloksys Life Sciences BV, 6708 PW Wageningen, The NetherlandsDepartment of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, AustriaDepartment of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria(1) Alkaline phosphatase (AP) is consumed during cardiopulmonary bypass (CPB). A high AP depletion leads to an impaired outcome after cardiac surgery. However, data is scarce on the postoperative course of AP under venoarterial ECMO (VA-ECMO) support. (2) A total of 239 patients with VA-ECMO support between 2000 and 2019 at the Department of Cardiac Surgery (Vienna General Hospital, Austria) were included in this retrospective analysis. Blood samples were collected at several timepoints (baseline, postoperative day (POD) 1–7, POD 14 and 30). Patients were categorized according to the relative AP drop (<60% vs. ≥60%) and ECMO duration (<5 days vs. ≥5 days). (3) Overall, 44.4% reached the baseline AP values within 5 days—this was only the case for 28.6% with a higher AP drop (compared to 62.7% with a lower drop; <i>p</i> = 0.000). A greater AP drop was associated with a significantly higher need for renal replacement therapy (40.9% vs. 61.9%; <i>p</i> = 0.002) and an impaired 1-year survival (51.4% vs. 66.0%; <i>p</i> = 0.031). (4) CPB exceeds the negative impact of VA-ECMO; still, ECMO seems to delay alkaline phosphatase recovery. A greater initial AP drop bears the risk of higher morbidity and mortality.https://www.mdpi.com/2218-273X/11/5/748alkaline phosphatasecardiac surgerycardiopulmonary bypassinflammationSIRSVA-ECMO |
| spellingShingle | Thomas Poschner Anne-Kristin Schaefer Doris Hutschala Georg Goliasch Julia Riebandt Klaus Distelmaier Martin H. Bernardi Martin Andreas Ruud Brands Tandis Aref Günther Laufer Dominik Wiedemann Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery Biomolecules alkaline phosphatase cardiac surgery cardiopulmonary bypass inflammation SIRS VA-ECMO |
| title | Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery |
| title_full | Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery |
| title_fullStr | Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery |
| title_full_unstemmed | Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery |
| title_short | Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery |
| title_sort | impact of venoarterial extracorporeal membrane oxygenation on alkaline phosphatase metabolism after cardiac surgery |
| topic | alkaline phosphatase cardiac surgery cardiopulmonary bypass inflammation SIRS VA-ECMO |
| url | https://www.mdpi.com/2218-273X/11/5/748 |
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