Neurologic Complications in Patients Receiving Aortic vs Subclavian vs Femoral Arterial Cannulation for Post-cardiotomy Extracorporeal Life Support: Results of the PELS Observational Multicenter Study

Neurologic Complications in Patients Receiving Aortic vs Subclavian vs Femoral Arterial Cannulation for Post-cardiotomy Extracorporeal Life Support: Results of the PELS Observational Multicenter Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Neurologic Complications in Patients Receiving Aortic vs Subclavian vs Femoral Arterial Cannulation for Post-cardiotomy Extracorporeal Life Support: Results of the PELS Observational Multicenter Study Giovanni Chiarini, Silvia Mariani, Anne-Kristin Schaefer, Bas C.T. van Bussel, and 35 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4535505/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Aug, 2024 Read the published version in Critical Care → Version 1 posted 13 You are reading this latest preprint version Abstract Background: Cerebral perfusion may change depending on arterial cannulation site and may affect the incidence of neurologic adverse events in post-cardiotomy extracorporeal life support (ECLS). The current study compares patients' neurologic outcomes with three commonly used arterial cannulation strategies (aortic [A] vs. subclavian/axillary [SA] vs. femoral [F] artery) to evaluate if each ECLS configuration is associated with different rates of neurologic complications. Methods: This retrospective, multicenter (34 centers), observational study included adults requiring post-cardiotomy ECLS between January 2000 and December 2020 present in the Post-Cardiotomy Extracorporeal Life Support (PELS) Study database. Patients with Aortic, Subclavian/Axillary and Femoral cannulation were compared on the incidence of a composite neurological end-point (ischemic stroke, cerebral hemorrhage, brain edema). Secondary outcomes were overall in-hospital mortality, neurologic complications as cause of in-hospital death, and post-operative minor neurologic complications (seizures and vasospasm). Association between cannulation and neurological outcomes were investigated through mixed-Cox proportional hazards models. Results: This study included 1897 patients comprising 26.5% A (n=503), 20.9% SA (n=397) and 52.6% F (n=997) cannulations. The SA group featured a more frequent history of hypertension, smoking, diabetes, previous myocardial infarction, dialysis, peripheral artery disease and previous stroke. Neuro-monitoring was used infrequently in all groups. Major neurologic complications were more frequent in SA (A: n=79, 15.8%; SA: n=78, 19.6%,; F: n=118, 11.9%; p<0.001). Seizures were more common in SA (n=13, 3.4%) than A ( n=9, 1.8%) and F cannulation (n=12, 1.3%, p=0.036). In-hospital mortality was higher after A cannulation (A: n=344, 68.4%, SA: n=223, 56.2%, F: n=587, 58.9%, p<0.001), as shown by Kaplan-Meier curves, with more patients deceased during ECLS support. Anyhow, neurologic cause of death (A: n=12, 3.9%, SA: n=14, 6.6%, F: n=28, 5.0%, p=0.433) was similar. Conclusions: In this analysis of the PELS Study, SA was associated with higher rates of major neurologic complications and seizures. In-hospital mortality was higher after A cannulation, despite no significant differences in incidence of neurological cause of death in these patients. These results encourage vigilance for neurologic complications and neuromonitoring use in patients on ECLS, especially with SA cannulation. Extracorporeal Membrane Oxygenation Cardiac Surgery Neurologic Complications Cardiac arrest stroke ICH Figures Figure 1 Figure 2 Figure 3 Background Extracorporeal life support (ECLS) represents a strategy of temporary mechanical circulatory support for refractory post-cardiotomy (PC) cardiogenic shock(1, 2). ECLS has gained an important role in perioperative care, especially in patients with high-risk profiles undergoing complex cardiac surgical procedures(3). Nonetheless, morbidity and mortality in such patients are consistently high, with minimal evidence available on long-term and functional outcomes(3, 4). Particularly, data regarding patients’ neurological outcomes and association with different cannulation approaches in PC-ECLS are lacking and urgently needed to understand the pathophysiology of these complications, monitor and prevent them(5-7). Since cerebral perfusion patterns during ECLS may be different depending on the arterial cannulation site (antegrade vs. retrograde flow in ascending or descending aorta), as well as baseline vascular condition, the choice of the return site could potentially lead to a different likelihood of neurologic complications, although evidence on this topic is scarce(8). Moreover, little evidence addressing the relationship between the return cannulation site and neurologic injury exists to inform our cannulation strategy in PC-ECLS patients. In this study, we hypothesize that different ECLS cannulation strategies are associated with different rates of major neurological outcomes including stroke, cerebral bleeding and brain edema. We aim to compare patients' neurologic outcomes in three commonly used ECLS arterial cannulation sites: aortic [A] vs subclavian/axillary [SA] vs femoral [F] artery. Methods The multicenter, retrospective observational Post-cardiotomy Extracorporeal Life Support (PELS) study enrolled consecutive patients supported with ECLS in the post-operative phase (ClinicalTrials.gov: NCT03857217) in 34 centers from 16 countries. Adults (≥18 years old) were included if they underwent veno-arterial (V-A) ECLS implantation during or after cardiac surgery between January 2000 and December 2020. For the present analysis, we compared three cannulation strategies analyzing preoperative, intra-operative and post-operatory characteristics, neurologic complications and in-hospital mortality (Supplementary Table 1 and 2). Exclusion criteria were veno-venous configuration, mixed cannulations, pulmonary artery cannulation, and cannulation sites unknown (Supplementary Figure 1). The current study was conducted in accordance with the Declaration of Helsinki. Institutional Review Board (IRB) approval was acquired in all centers based on the IRB-approval of the coordinating center (METC-2018-0788). The need for informed consent was waived due to the observational character of the study, the emergency of the performed procedure, and the de-identification of shared data. Study was performed following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement (Appendix)(9). Data Collection and Outcomes Data were collected centrally according to data-sharing agreements between participating centers (3). Demographics, pre-operative clinical, procedural characteristics, ECLS details, in-hospital morbidity and mortality, and post-discharge survival were included in a dedicated form (data.castoredc.com). Follow-up data were collected through the review of the most recent medical records or contact with patients at discretion of the treating center. The primary outcome was a composite end-point of major neurologic complications (ischemic stroke, cerebral hemorrhage, brain edema). Secondary outcomes included seizures and vasospasm, all-cause in-hospital mortality, neurologic complication as cause of in-hospital mortality and mortality at follow-up after hospital discharge. Statistical Analysis The full cohort was categorized into three study groups based on arterial cannulation site (ascending aorta, subclavian/axillary artery, femoral artery). Missing data analysis (Supplementary Table 2) was conducted with the mice: Multivariate Imputation by Chained Equations R package(10). Missing data patterns were investigated and were identified as missing completely at random (MCAR). Descriptive statistics were conducted on available data only and no imputations were performed for this purpose. Normality was tested for continuous variables. Continuous variables were reported as median and interquartile range (IQR) and analyzed with Mann Whitney U-test. Chi-square Test and Fisher’s Exact Test were used to compare group differences for categorical variables expressed as count (percentage). In case of significant differences between groups, post-hoc comparisons were performed and adjusted by the Bonferroni correction for multiple tests (Supplementary Table 3). A p-value <0.05 was considered statistically significant. Survival was investigated with the Kaplan-Meier method and comparisons were performed with Log-rank test. Based on the possible variations in ECLS management over the study period and the confounding factors represented by cardiac arrest, previous stroke, previous transient ischemic attack, peripheral artery disease (PAD), two sensitivity analysis were performed after exclusion of patients who received post-cardiotomy ECLS before 2010 (2010-2020 cohort) and those with the abovementioned conditions. To estimate the associations between type of cannulation (reference group: femoral cannulation) and composite end-point of major neurological complications, we conducted a mixed-effects multivariable logistic regression, using the lme4: Linear Mixed-Effects Models using 'Eigen' and S4 R package (11). The random effect was used to account for dependency of observations due to clustering in centers and in years. We first estimated a crude model, which was subsequently adjusted for sets of variables deemed potential confounders for the association with the outcome: Model 1, crude model with variable “Arterial cannulation site”; Model 2, arterial cannulation site, peripheral artery disease; Model 3, arterial cannulation site, peripheral artery disease (PAD), stroke; Model 4, arterial cannulation site, peripheral artery disease, stroke, interaction stroke*PAD; Model 5, arterial cannulation site, peripheral artery disease, stroke, hypertension, dialysis, diabetes, preoperative cardiac arrest; Model 6, arterial cannulation site, peripheral artery disease, stroke, hypertension, dialysis, diabetes, preoperative cardiac arrest, coronary artery bypass graft (CABG), aortic surgery, cardiopulmonary bypass (CPB) time; Model 7, arterial cannulation site, peripheral artery disease, stroke, hypertension, dialysis, diabetes, preoperative cardiac arrest, CABG, aortic surgery, CPB time, implant timing, cardiac arrest as indication for ECLS. Data were merged and analyzed using SPSS 26.0 (IBM, New York, USA), and R 4.4.0 (R Foundation for Statistical Computing, Vienna, Austria). Results Baseline, Surgical, and ECLS Characteristics Overall, 1897 PC-ECLS patients were included in the current study: 503 patients (26.5%) underwent aortic, 397 (20.9%) subclavian/axillary and 997 (52.6%) femoral cannulation (Table 1). Each center enrolled a minimum of 1 and a maximum of 458 patients, with a median value of 24 patients per center. A history of hypertension (aortic: n=335, 66.6%; subclavian/axillary: n=298, 75.1%; femoral: n=590, 63.1%; p<0.001), smoking (aortic: n=116, 24.0%; subclavian/axillary: n=115, 29.0%; femoral: n=228, 22.9%; p=0.013), diabetes (aortic: n=144, 28.6%; subclavian/axillary: n=129, 32.5%; femoral: n=237, 23.8%; p=0.002), previous stroke (aortic: n=47, 9.3%; subclavian/axillary: n=62, 15.6%; femoral: n=145, 14.5%; p=0.007; Table 1 and Supplementary Table 3), previous myocardial infarction (aortic: n=146, 29.0%; subclavian/axillary: n=129, 32.5%; femoral: n=237, 23.8%; p=0.002), and dialysis (aortic: n=41, 8.5%; subclavian/axillary: n=44, 12.1%; femoral: n=76, 7.7%; p=0.041) was more frequent in the subclavian/axillary cannulation group. Peripheral artery disease was less frequent in femoral cannulation (n=99, 9.9%), compared to aortic (n=96, 19.1%) and subclavian/axillary cannulation (n=86, 21.7%; p<0.001; Table 1 and Supplementary Table 3). A higher rate of pre-operative cardiac arrest was observed in subclavian/axillary cannulation (aortic: n=50, 10.1%; subclavian/axillary: n=49, 12.7%; femoral: n=72, 7.3%; p=0.005). Emergency surgery occurred less frequently before femoral cannulation (aortic: n=162, 32.2%; subclavian/axillary: n=122, 32.5%; femoral: n=208, 20.9%; p<0.001) and CABG was more frequent in subclavian/axillary and aortic than femoral cannulation (aortic: n=238, 47.3%; subclavian/axillary: n=202, 50.9%; femoral: n=399, 40.0%; p<0.001, Table 2). Cardiopulmonary bypass (CPB) time was longer in aortic (215 min [IQR 143-294 min]) and subclavian/axillary (218 min [IQR 161-307 min]) groups, compared to femoral cannulation (192 min [IQR 129-272 min], p<0.001, Table 2 and Supplementary Table 3). Most common indication for ECLS was failure to wean from cardiopulmonary bypass which was more common in the subclavian/axillary group compared to others (aortic: n=204, 40.9%; subclavian/axillary: n=195, 52.0%; femoral: n=347, 35.0%). Other common indications were represented by cardiogenic shock (aortic: n=127, 25.5%; subclavian/axillary: n=71, 18.9%; femoral: n=281, 28.4%), and right ventricular failure (aortic: n=58, 11.6%; subclavian/axillary: n=41, 10.9%; femoral: n=114, 11.5%, Table 3). Active left ventricular unloading strategies were applied in 205 patients (49.6%) in aortic, 43 patients (15.0%) in subclavian/axillary and 237 patients (27.4%) in femoral cannulation (p<0.001). Patients were supported on ECLS for a median of 120 hours (IQR, 56–206 hours) in aortic, 116 hours (IQR, 69–182 hours) in subclavian/axillary and 116 hours (IQR, 52–192 hours) in femoral group (p=0.557). Neurological Outcomes and Associated Variables The composite end-point of major neurological complications was differently distributed between subclavian/axillary (n=78, 19.6%), aortic (n=79, 15.8%) and femoral cannulation (n=118, 11.9%, p<0.001) with subclavian/axillary cannulation showing a higher rate of events compared to femoral cannulation (p=0.001; Figure 1). Cerebral hemorrhage (aortic: n=16, 3.2%; subclavian/axillary: n=22, 5.9%; femoral: n=21, 2.3%, p=0.004) and stroke (aortic: n=59, 11.8%; subclavian/axillary: n=63, 15.9%; femoral: n=80, 8.1%, p<0.001) were more frequent in patients cannulated with subclavian/axillary approach. Seizures were more common in subclavian/axillary (n=13, 3.4%) compared to aortic (n=9, 1.8%) and femoral cannulation (n=12, 1.3%, p=0.036). No difference between groups was observed in cerebral hemorrhage severity (p=0.051) and stroke severity (p=0.197, Table 4). Neuro-monitoring was used very infrequently regardless of the monitoring system considered (Table 5). In a mixed-effects crude logistic regression model with random effects for centers and years, subclavian/axillary cannulation was associated with higher risk of neurological complications (OR 1.50 [95%CI 1.05-2.15], p=0.027), also after adjustment for peripheral artery disease, stroke, hypertension, dialysis, diabetes, preoperative cardiac arrest, CABG, aortic surgery, CPB time, implant timing, cardiac arrest as indication for ECLS (OR 1.57 [95%CI 1.06-2.34], p=0.026; Table 6). Secondary Outcomes Intensive care unit stay was longer in subclavian/axillary (16 days [IQR 8-33 days]) than aortic (12 days [IQR 5-25 days]) or femoral cannulation (13 days [IQR 6-24 days], p<0.001, Table 4), with a higher in-hospital mortality in the aortic group (aortic: n=344, 68.4%; subclavian/axillary : n=223, 56.2%; femoral: n=587, 58.9%; p<0.001, Figure 2 and Supplementary Table 3), also confirmed by Kaplan-Meier curves (Figure 3). More patients deceased during ECLS support in the aortic cannulation group (n=217, 43.8%) compared to subclavian/axillary (n=103, 29.9%) and femoral groups (n=360, 36.3%, p<0.001 Supplementary Table 3). No differences were found in main causes of in-hospital death between groups (p=0.433). Median Follow-up time was 11 days for in-hospital deaths (IQR: 4-22) and 885 days for hospital survivors (IQR: 91-1916). Sensitivity Analysis In the sensitivity analysis excluding patients supported before 2010 (Supplementary Tables 4-7), we confirmed the same distribution of the primary outcomes observed in the main analysis, particularly with more frequent composite end-point of neurological complications in subclavian/axillary patients (aortic: n=57, 14.4%; subclavian/axillary: n=68, 19.3%; femoral: n=99, 12.5%; p=0.011). In-hospital mortality was higher after aortic cannulation (aortic: n=274, 69.0%; subclavian/axillary: n=195, 55.2%; femoral: n=477, 59.4%; p<0.001, Supplementary Figure 2-3). In the sensitivity analysis excluding patients who suffered previous stroke, previous transient ischemic attack, peripheral vessel disease or with cardiac arrest during hospital stay (Supplementary Tables 8-11), the composite neurological end-point occurred more frequently in the subclavian/axillary group (aortic: n=48, 15.6%; subclavian/axillary: n=38, 18.0%; femoral: n=62, 9.2%; p=0.001; Supplementary Figure 5). In-hospital mortality remained higher in the aortic cannulation group (aortic: n=215, 69.8%; subclavian/axillary: n=103, 48.8%; femoral: n=370, 56.3%; p<0.001; Supplementary Figure 6-7). Discussion This study investigated neurological complications in one of the largest cohorts of PC-ECLS patients. The study has four main findings. First, femoral cannulation remains the most used cannulation approach (53%), while subclavian/axillary cannulation (21%) and aortic cannulation (26%) are less used. Second, we found that patients with subclavian/axillary cannulation had worse baseline vascular conditions as shown by higher prevalence of previous stroke, previous myocardial infarction, dialysis, preoperative cardiac arrest and peripheral artery disease. Third, we showed that the composite outcome of neurological complications occurred in almost 20% of patients cannulated with subclavian/axillary, compared to 12-16% of patients cannulated with femoral and aortic approach. Finally, we found higher in-hospital mortality in the aortic group, despite the lower incidence of neurological complications, confirmed by two sensitivity analyses after exclusion of patients supported before 2010 and those with cardiac arrest, stroke, previous transient ischemic attack, peripheral vessel disease. Overall neurological complications occur in almost 20% of veno-arterial ECLS patients as reported by literature(12). However, it is still difficult to identify which patient might develop such a complication, its predicted severity, or whether a specific ECLS setting may be related to more neurological events. Moreover, effective strategies to prevent such complications or monitor their early onset, are urgently needed to improve PC-ECLS outcomes. Literature supports the hypothesis that cerebral perfusion during ECLS might be influenced by the arterial cannulation site, but whether this could influence neurologic complications is still unknown(13, 14). Arterial cannulation approach may significantly vary, as demonstrated by this analysis of the PELS population, with femoral cannulation used in 52.6% of patients, subclavian/axillary cannulation in 20.9% and aortic cannulation used in 26.5% of patients. Femoral cannulation remains the preferred cannulation strategy in PC-ECLS(15), but its superiority in terms of fewer brain embolization events compared to the central aortic one is still debated, as mechanisms underlying the potential beneficial effects of peripheral cannulation have to be confirmed (16-19). The first step to understanding the association of neurological outcomes and cannulation strategy implies an analysis of patients’ characteristics to identify specific risk profiles for adverse events or best candidates for each cannulation strategy. This study showed that patients who were cannulated with subclavian/axillary approach were characterized by a worse vascular status compared to others. Moreover, a significant amount of them received emergency surgery and experienced cardiogenic shock or cardiac arrest before the operation. This observation suggests that the subclavian/axillary cannulation is preferred in case of worse patient’s vascular status, possibly because the subclavian/axillary artery is more often free from atheromatic disease compared to femoral vessels or ascending aorta(20, 21). Surprisingly, subclavian/axillary cannulation was not predominantly used in aortic surgery, even though the subclavian/axillary artery is often cannulated to initiate CPB during this type of operation(20). Aortic surgery is usually associated with higher neurological risks due to the possible disease involvement of neck vessels or the need for a circulatory arrest(16, 22), but interaction between disease extension and ECLS cannulation approach needs further investigations. Interestingly, CPB time was slightly longer in patients cannulated with subclavian/axillary and aortic approach compared to femoral approach. This could be explained by the higher surgical complexity that characterize the subclavian/axillary group, whose patients underwent two or more procedures in 28% of cases compared to the 16-18% of other groups. A longer CPB time might influence cerebral circulation and neurological outcomes. However, the interaction between CPB time and flow, intra-operative CPB cannulation and ECLS cannulation sites, hemodynamic parameters, and patient’s vascular status is still under-investigated and requires the development of dedicated studies. Observations from this study demonstrated that the composite neurological end-point including stroke, brain hemorrhage and brain oedema occurs more frequently in subclavian/axillary cannulation, with 6% of patients suffering cerebral hemorrhage and 16% of patients suffering ischemic stroke in the subclavian/axillary group. Also, clinical seizures were more common in subclavian/axillary patients. Although tracing the pathophysiological mechanism of these events was beyond the scope of this observational study, we can hypothesize an additive effect of baseline cerebral and vascular comorbidities, an intra-operative alteration of the cerebral blood flow, the lack of pulsatility due to ECLS and the flow pattern determined by the arterial cannulation site. Moreover, an autoregulatory dysfunction may contribute to neurological dysfunction, but how it interacts with ECLS and cannula flow is still unknown(13, 14, 23, 24) and mechanisms of cerebral autoregulation in the specific setting of non-pulsatile blood flow and after different cannulation strategies are still an active research area(8, 19, 21). To further investigate all these aspects and allow for an early detection of neurological complications, dedicated neurological monitoring strategies during ECLS are advised even if no specific guidelines still exist. PELS study demonstrated that neurologic monitoring (such as near-infrared spectroscopy, transcranial doppler, electroencephalogram and brain computed tomography) is still not routinely used. However, literature suggests that standardized neuromonitoring, when implemented, significantly improves the detection(25, 26) of acute brain injuries in ECLS patients; particularly lack of blood flow monitoring may be associated with increased stroke incidence (27-29). Several studies report in-hospital mortality of patients undergoing PC V-A ECLS around 60% with different variations, depending on weight of surgery, patient’s age and center’s expertise(3, 21, 27, 29-32). The current study showed a higher in-hospital mortality after aortic cannulation, but no differences in the distribution of neurological cause of death between groups. This finding opens the discussion on the fate of ECLS patients with neurological damage. Previous studies showed that patients on V-A ECLS support experiencing neurological complications had an increased in-hospital mortality, by a factor of 2-3(13, 33-35). Moreover, severe neurological damage could be a reason to withdraw the support. However, neurological complications remain limited in the ECLS population, and they seem not to be the main driver of mortality(33). Therefore, these complications, especially the "minor" ones, should not push toward support withdrawal. As clinical experience accumulates and ECLS becomes more widely used, focused research on neurological monitoring and management of neurological complications are imperative to improve early and long-term outcomes. Particularly, it is warranted to evaluate if improving neurological monitoring, neurological targeted therapy, prognostication, and follow-up, may mitigate incidence and severity of neurological complications in all patients, and especially in those with bad vascular status and/or subclavian cannulation. Since we included patients from different centers and countries, our results may be applicable to a large variety of patients treated with PC-ECLS. Strengths and Limitations PELS is observational by nature, so causal inference is not possible, and it was not designed to specifically investigate neurological outcomes with dedicated diagnostic tools(12, 16, 35). Details about CPB cannulation strategies during the index operation or timing (on ECLS, before or after ECLS) of neurological complications were not available, preventing any deeper causal investigation. Moreover, specific data on ECLS selection criteria, protocols, weaning strategies, cannulation technique (surgical vs percutaneous) are not captured by the database and could therefore not be included in this study, as well as intraoperative and postoperative hemodynamic parameters, anesthesia management protocols, reasons for withdrawal of ECLS support, post-discharge quality of life, functional status, and follow-up specific data. As previously mentioned, patients with compromised vascular status more frequently received subclavian/axillary. Therefore, we cannot rule out the effects of confounding by severity and indication. Since the observational nature of PELS study, we also cannot infer on relations between other complications (acute kidney injury, pneumonia, acute respiratory distress syndrome, embolism, and arrhythmia, etc.) more common after subclavian/axillary, and neurological complications(3). Furthermore, we had no access to long-term functional status of these patients, therefore additional studies are warranted in this respect. Finally, we encountered some missing data, especially regarding severity of stroke or cerebral hemorrhage and vasospasm (Supplementary Table 2). Conclusions In this cohort of the PELS Study, subclavian/axillary cannulation was used in patients with compromised vascular status and it was associated with higher rates of major neurologic complications and seizure, especially compared to femoral cannulation. In-hospital mortality was higher after aortic cannulation, despite no significant differences in incidence of neurological cause of death in these patients. These results focus attention on the application of preventive strategies in patients with impaired vascular status and/or subclavian/axillary cannulation, encouraging dedicated prospective trials. Eventually, this study suggests the need for an adequate neurologic monitoring of patients undergoing PC-ECLS, especially in subclavian/axillary cannulated patients. Abbreviations CABG Coronary artery bypass surgery CPB ECLS Cardiopulmonary bypass Extracorporeal Life Support IQR Interquartile range IRB NYHA PAD PELS Institutional Review Board New York Heart Association Peripheral Artery Disease Post-Cardiotomy Extracorporeal Life Support PC V-A Post-Cardiotomy Veno-Arterial Declarations Ethics approval and consent to participate Institutional Review Board (IRB) approval was required for all centers, based on the IRB-approval of the coordinating center (MUMC+, number: METC-2018-0788, date: December 19th, 2018). The study was registered at ClinicalTrials.gov (trial registration ID: NCT03857217). Need for informed consent was waived based on the retrospective nature of the study, the emergency of the performed procedure, and the pseudonymization of shared data. The current study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests DW: consultant/proctor for Abbott; scientific advisor for Xenios. RL: consultant for Medtronic, Getinge and LivaNova; Advisory Board Member of Eurosets (honoraria paid as research funding). KR: received honoraria from Baxter and Fresenius Ltd for educational lectures. Funding No financial support for this study was provided Author Contributions GC, AS, SM, RL conceived and designed the study. GC and SM conceived and performed the analysis. GC, AS, SM, RL drafted the manuscript. All authors interpreted the results, critically edited the manuscript, approved the final work, and agreed to be accountable for the accuracy and integrity of the work. 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Wang L, Yang F, Wang X, Xie H, Fan E, Ogino M, et al. Predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting: the REMEMBER score. Crit Care. 2019;23(1):11. Ong CS, Etchill E, Dong J, Shou BL, Shelley L, Giuliano K, et al. Neuromonitoring detects brain injury in patients receiving extracorporeal membrane oxygenation support. J Thorac Cardiovasc Surg. 2023;165(6):2104-10.e1. Hu RTC, Broad JD, Osawa EA, Ancona P, Iguchi Y, Miles LF, Bellomo R. 30-Day Outcomes Post Veno-Arterial Extra Corporeal Membrane Oxygenation (VA-ECMO) After Cardiac Surgery and Predictors of Survival. Heart Lung Circ. 2020;29(8):1217-25. Brewer JM, Tran A, Yu J, Ali MI, Poulos CM, Gates J, et al. ECMO after cardiac surgery: a single center study on survival and optimizing outcomes. J Cardiothorac Surg. 2021;16(1):264. Chen F, Wang L, Shao J, Wang H, Hou X, Jia M. Survival following venoarterial extracorporeal membrane oxygenation in postcardiotomy cardiogenic shock adults. Perfusion. 2020;35(8):747-55. Biancari F, Dalén M, Fiore A, Dell'Aquila AM, Jónsson K, Ragnarsson S, et al. Gender and the Outcome of Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth. 2022;36(6):1678-85. Cho SM, Farrokh S, Whitman G, Bleck TP, Geocadin RG. Neurocritical Care for Extracorporeal Membrane Oxygenation Patients. Crit Care Med. 2019;47(12):1773-81. Lorusso R, Gelsomino S, Parise O, Di Mauro M, Barili F, Geskes G, et al. Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: Findings From the Extracorporeal Life Support Organization Database. Crit Care Med. 2017;45(8):1389-97. Risnes I, Wagner K, Nome T, Sundet K, Jensen J, Hynås IA, et al. Cerebral outcome in adult patients treated with extracorporeal membrane oxygenation. Ann Thorac Surg. 2006;81(4):1401-6. Tables Table 1 – Pre-operative Characteristics of the Overall Population. Aorta (n=503) Subclavian/Axillary Artery (n=397) Femoral Artery (n=997) P-value Age (years) 65 (55-72) 67 (57-74) 64 (55-71) <0.001 Sex Female 197 (39.2%) 187 (47.1%) 391 (39.3%) 0.018 Male 306 (60.8%) 210 (52.9%) 605 (60.7%) Body Surface Area (m 2 ) 1.90 (1.73-2.04) 1.93 (1.79-2.07) 1.87 (1.73-2.023) 0.001 Comorbidities Hypertension 335 (66.6%) 298 (75.1%) 590 (63.1%) <0.001 Dialysis 41 (8.5%) 44 (12.1%) 76 (7.7%) 0.041 Previous Myocardial Infarction 146 (29.0%) 129 (32.5%) 237 (23.8%) 0.002 Previous Endocarditis 35 (7.0%) 46 (11.6%) 70 (7.0%) 0.011 Smoking 116 (24.0%) 105 (36.0%) 211 (25.3%) <0.001 Previous Stroke 47 (9.3%) 62 (15.6%) 145 (14.5%) 0.007 Atrial Fibrillation 129 (25.6%) 125 (31.6%) 251 (25.2%) 0.044 Previous Pulmonary Embolism 10 (2.0%) 11 (3.8%) 11 (1.2%) 0.016 Diabetes Mellitus 144 (28.6%) 115 (29.0%) 228 (22.9%) 0.013 Previous Transient Ischemic Attack 10 (2.1%) 6 (1.7%) 20 (2.4%) 0.718 Chronic Obstructive Pulmonary Disease 36 (7.2%) 50 (15.2%) 104 (10.5%) 0.001 Peripheral Artery Disease 96 (19.1%) 86 (21.7%) 99 (9.9%) <0.001 Left Ventricular Ejection Fraction (%) 47.0 (30-55) 40.0 (25-60) 48.00 (30-60) 0.002 Euroscore II 8.0 (3.2-18.1) 14.50 (6.4-29.6) 5.94 (2.4-16.0) <0.001 Preoperative Conditions NYHA Class Class I 32 (6.8%) 29 (7.5%) 73 (7.6%) <0.001 Class II 98 (20.9%) 64 (16.5%) 228 (23.7%) Class III 185 (39.5%) 128 (32.9%) 401 (41.7%) Class IV 153 (32.7%) 168 (43.2%) 260 (27.0%) Preoperative Cardiogenic Shock 128 (25.4%) 95 (25.5%) 177 (17.8%) <0.001 Preoperative Cardiac Arrest 50 (10.1%) 49 (12.7%) 72 (7.3%) 0.005 Preoperative Right Ventricular Failure 49 (10.1%) 41 (13.5%) 82 (9.4%) 0.125 Preoperative Biventricular Failure 33 (7.1%) 30 (11.8%) 50 (6.4%) 0.018 Emergency Surgery 162 (32.2%) 122 (32.4%) 208 (20.9%) <0.001 Data are reported as n (% as valid percentage excluding missing values) or median (interquartile range). NYHA, New York Heart Association. Table 2 - Procedural Characteristics Aorta (N=503) Subclavian/Axillary Artery (n=397) Femoral Artery (N=997) P-value Weight Of Surgery Unknown 4 (0.8%) 0 (0.0%) 7 (0.7%) <0.001 Isolated Coronary Artery Bypass Graft 93 (18.5%) 62 (15.6%) 177 (17.8%) Isolated Non Coronary Artery Bypass Graft 302 (60.0%) 159 (40.1%) 599 (60.1%) 2 Procedures 16 (3.2%) 64 (16.1%) 59 (5.9%) 3 Or More Procedures 88 (17.5%) 112 (28.2%) 155 (15.5%) Coronary Artery Bypass Graft 238 (47.3%) 202 (50.9%) 399 (40.0%) <0.001 Aortic Valve Surgery 171 (34.0%) 157 (39.5%) 338 (33.9%) 0.114 Aortic Valve Surgery Type Aortic Valve Repair 23 (17.2%) 41 (35.7%) 49 (20.3%) 0.006 Biological Prosthesis 79 (59.0%) 55 (47.8%) 134 (55.6%) Mechanical Prosthesis 32 (23.9%) 19 (16.5%) 58 (24.1%) Mitral Valve Surgery 158 (31.4%) 143 (36.0%) 306 (30.7%) 0.152 Mitral Valve Surgery Type Mitral Valve Repair 44 (38.6%) 53 (46.5%) 95 (41.7%) 0.537 Biological Prosthesis 42 (36.8%) 38 (33.3%) 71 (31.1%) Mechanical Prosthesis 28 (24.6%) 23 (20.2%) 62 (13.0%) Tricuspid Valve Surgery 63 (12.5%) 66 (16.6%) 126 (12.6%) 0.112 Aortic Surgery 98 (19.5%) 84 (21.2%) 182 (18.3%) 0.453 Aortic Surgery Type Aortic Root 13 (13.3%) 13 (15.9%) 27 (15.0%) 0.170 Ascending Aorta And Root 30 (30.6%) 23 (28.0%) 54 (30.0%) Ascending Aorta 27 (27.6%) 27 (32.9%) 41 (22.8%) Ascending Aorta And Arch 27 (27.6%) 16 (19.5%) 42 (23.3%) Aortic Arch And Descending Aorta 1 (1.0%) 3 (3.7%) 16 (8.9%) Left Ventricular Assist Device 6 (1.2%) 5 (1.3%) 11 (1.1%) 0.967 Right Ventricular Assist Device 5 (1.0%) 1 (0.3%) 0 (0.0%) 0.005 Heart Transplantation 38 (7.6%) 44 (11.1%) 102 (10.2%) 0.147 Off-Pump Surgery 15 (3.0%) 7 (1.8%) 50 (5.1%) 0.009 Conversion To Cardiopulmonary Bypass 6 (40.0%) 4 (57.1%) 11 (20.8%) 0.067 Cardiopulmonary Bypass Time (Min) 215 (143-294) 218 (161-307) 192 (129-272) <0.001 Crossclamp Time (Min) 102 (65-152) 102 (68-154) 97 (62-146) 0.196 Intraoperative Transfusions 209 (90.1%) 50 (100.0%) 437 (91.4%) 0.071 Data are reported as n (% as valid percentage excluding missing values) or median (interquartile range). Table 3 - Details on Extracorporeal Life Support. Aorta (n=503) Subclavian/Axillary Artery (n=397) Femoral Artery (N=997) P-value ECLS Indication Failure To Wean 204 (40.9%) 195 (52.0%) 347 (35.0%) <0.001 Acute Pulmonary Embolism 0 (0.0%) 0 (0.0%) 2 (0.2%) Arrhythmia 12 (2.4%) 4 (1.1%) 26 (2.6%) Cardiac Arrest 47 (9.4%) 12 (3.2%) 95 (9.6%) Cardiogenic Shock 127 (25.5%) 71 (18.9%) 281 (28.4%) Pulmonary Hemorrhage 3 (0.6%) 1 (0.3%) 3 (0.3%) Right Ventricular Failure 58 (11.6%) 41 (10.9%) 114 (11.5%) Respiratory Failure 7 (1.4%) 24 (6.4%) 24 (2.4%) Biventricular Failure 34 (6.8%) 23 (6.1%) 82 (8.3%) Other 7 (1.4%) 4 (1.1%) 17 (1.7%) Left Ventricular Unloading 205 (49.6%) 43 (15.0%) 237 (27.4%) <0.001 ECLS Duration (Hours) 120 (56-206) 116 (69-182) 116 (52-192) 0.557 Anticoagulation Regimen None 54 (11.1%) 20 (5.3%) 79 (8.2%) 0.010 Heparin 429 (87.9%) 355 (94.4%) 881 (91.0%) Bivalirudin 3 (0.6%) 0 (0.0%) 0 (0.0%) Argatroban 1 (0.2%) 0 (0.0%) 4 (0.4%) Data are reported as n (% as valid percentage excluding missing values) or median (interquartile range). ECLS, Extracorporeal Life Support. Table 4 – Post-operative Outcomes. Aorta (n=503) Subclavian/Axillary Artery (n=397) Femoral Artery (n=997) P-value Intensive Care Unit Stay (Days) 12 (5-25) 16 (8-33) 13 (6-24) <0.001 Hospital Stay (Days) 17 (6-35) 24 (10-46) 20 (8-39) <0.001 Postoperative Bleeding 339 (68.6%) 217 (54.9%) 526 (53.5%) <0.001 Requiring Rethoracotomy 234 (47.6%) 135 (43.7%) 347 (35.5%) <0.001 Cannulation Site Bleeding 58 (11.8%) 54 (13.8%) 110 (11.2%) 0.400 Diffuse No-Surgical Related Bleeding 165 (33.5%) 90 (28.3%) 194 (21.2%) <0.001 Composite Endpoint Of Neurological Outcomes 79 (15.8%) 78 (19.6%) 118 (11.9%) <0.001 Brain Edema 17 (3.4%) 22 (5.8%) 37 (4.0%) 0.098 Cerebral Hemorrhage 16 (3.2%) 22 (5.9%) 21 (2.3%) 0.004 Severity: Minor 7 (53.8%) 7 (43.8%) 4 (33.3%) 0.051 Disabling 2 (15.4%) 8 (50.0%) 2 (16.7%) Fatal 4 (30.8%) 1 (6.3%) 6 (50.0%) Seizure 9 (1.8%) 13 (3.4%) 12 (1.3%) 0.036 Stroke 59 (11.8%) 63 (15.9%) 80 (8.1%) <0.001 Severity: Minor 23 (45.1%) 28 (58.3%) 26 (38.8%) 0.197 Disabling 18 (35.3%) 14 (29.2%) 22 (32.8%) Fatal 10 (19.6%) 6 (12.5%) 19 (28.4%) Vasospasm 0 (0.0%) 0 (0.0%) 3 (0.4%) 0.237 Leg Ischemia* 4 4.1% 11 3.8% 123 13.7% <0.001 Distal Femoral Perfusion NA (NA) NA (NA) 653 74.7% NA Arrhythmia 163 (32.6%) 146 (45.5%) 289 (31.3%) <0.001 Cardiac Arrest 89 (17.8%) 56 (17.5%) 145 (15.7%) 0.540 Bowel Ischemia 24 (4.8%) 26 (8.1%) 51 (5.5%) 0.125 Right Ventricular Failure 106 (21.2%) 95 (33.5%) 167 (18.1%) <0.001 Acute Kidney Injury 272 (54.5%) 225 (70.8%) 483 (52.4%) <0.001 Pneumonia 109 (21.8%) 93 (32.7%) 187 (20.3%) <0.001 Septic Shock 86 (17.2%) 50 (17.7%) 153 (16.6%) 0.901 Distributive Shock Syndrome 49 (9.8%) 24 (8.5%) 99 (10.7%) 0.536 Acute Respiratory Distress Syndrome 19 (3.8%) 28 (8.7%) 41 (4.4%) 0.003 Multi-Organ Failure 198 (39.5%) 131 (33.9%) 311 (31.6%) 0.010 Embolism 27 (5.4%) 37 (13.0%) 41 (4.4%) <0.001 Main Cause Of Death Multiorgan Failure 108 (35.2%) 79 (37.3%) 211 (37.8%) 0.433 Sepsis 21 (6.8%) 18 (8.5%) 43 (7.7%) Persistent Heart Failure 124 (40.4%) 77 (36.3%) 197 (35.3%) Vasoplegia 7 (2.3%) 2 (0.9%) 11 (2.0%) Bleeding 21 (6.8%) 7 (3.3%) 32 (5.7%) Neurological Injury 12 (3.9%) 14 (6.6%) 28 (5.0%) Bowel Ischemia 7 (2.3%) 2 (0.9%) 11 (2.0%) Other 7 (2.3%) 13 (6.1%) 25 (4.5%) Data are reported as n (% as valid percentage excluding missing values) or median (interquartile range); *Data on Leg Ischemia are reported only for Femoral Cannulated patients. NA, Not Available Table 5 – Neurological Monitoring Data. Monitoring Tool Missing Data Aorta (n=503) Subclavian/Axillary Artery (n=397) Femoral Artery (n=997) P-value Near InfraRed Spectroscopy 491 (25.9%) 94 (20.5%) 8 (4.3%) 178 (23.4%) <0.001 TransCranial Doppler 490 (25.8%) 2 (0.4%) 0 (0.0%) 3 (0.4%) 0.673 ElectroEncephalogram 490 (25.8%) 12 (2.6%) 0 (0.0%) 38 (5.0%) 0.002 Brain Computed Tomography 423 (22.3%) 57 (12.3%) 51 (21.5%) 155 (20.0%) <0.001 Brain Biomarkers 491 (25.9%) 30 (6.6%) 3 (1.6%) 64 (8.4%) 0.004 Data are reported as n (% as valid percentage excluding missing values). Table 6 – The Association between Cannulation and Composite Endpoint of Neurological Outcomes by Mixed-Logistic Regression Analyses. (N= 1560). Reference Group for Cannulation: Femoral Artery. Aorta (n=503) Subclavian/Axillary Artery (n=397) OR (95% CI) P-value OR (95% CI) P-value Model 1. Crude model with variable “Arterial cannulation site” 1.33 (0.97-2.18) 0.079 1.50 (1.05-2.15) 0.027 Model 2. Model 1 + Peripheral artery disease 1.32 (0.96-1.83) 0.088 1.49 (1.04-2.14) 0.029 Model 3. Model 2 + Stroke 1.33 (0.96-1.84) 0.083 1.49 (1.04-2.13) 0.030 Model 4. Model 3 + interaction stroke*Peripheral artery disease 1.33 (0.96-1.84) 0.084 1.50 (1.04-2.14) 0.028 Model 5. Model 3 +hypertension, dialysis, diabetes, preoperative cardiac arrest 1.34 (0.96-1.87) 0.082 1.45 (1.00-2.11) 0.049 Model 6. Model 5 + Coronary artery bypass graft, aortic surgery, cardiopulmonary bypass time 1.38 (0.97-1.96) 0.070 1.48 (1.00-2.17) 0.050 Model 7. Model 6 + Implant timing, Cardiac arrest as indication for ECLS 1.46 (1.02-2.10) 0.039 1.57 (1.06-2.34) 0.026 Data are odds ratios (OR) with 95% confidence intervals (95% CI) for aortic or subclavian/axillary cannulation compared to femoral cannulation (as reference). A higher OR indicates an increased composite end-point of major neurological complications compared to femoral cannulation. CI, Confidence Interval. ECLS, Extracorporeal Life Support. Supplementary Figure 1 Supplementary Figure 1 is not available with this version Additional Declarations Competing interest reported. DW: consultant/proctor for Abbott; scientific advisor for Xenios. RL: consultant for Medtronic, Getinge and LivaNova; Advisory Board Member of Eurosets (honoraria paid as research funding). KR: received honoraria from Baxter and Fresenius Ltd for educational lectures. Supplementary Files SupplementaryFiguresLegendandAbbreviations.docx SUPPLEMENTARYFIGURE2BarplotcompositeneurobycannulationgroupedbarsSens20100.1.jpeg SUPPLEMENTARYFIGURE3BarplotsurvivalbycannulationgoupedSENS20100.1.jpeg SUPPLEMENTARYFIGURE4SensitivitysurvivalbysexKM10yrs201020200.2.jpeg SUPPLEMENTARYFIGURE5BarplotcompositeneurobycannulationgroupedbarsSensCAplus0.1.jpeg SUPPLEMENTARYFIGURE6BarplotsurvivalbycannulationgoupedSENSCA0.1.jpeg SUPPLEMENTARYFIGURE7OverallsurvivalbycannulationKM10yrssensCA.jpeg VisualAbstract.png finalPELSNEUROAppendixCRITICALCARE1.3SM.docx Cite Share Download PDF Status: Published Journal Publication published 07 Aug, 2024 Read the published version in Critical Care → Version 1 posted Editorial decision: Revision requested 03 Jul, 2024 Reviews received at journal 28 Jun, 2024 Reviews received at journal 28 Jun, 2024 Reviews received at journal 25 Jun, 2024 Reviews received at journal 24 Jun, 2024 Reviewers agreed at journal 19 Jun, 2024 Reviewers agreed at journal 18 Jun, 2024 Reviewers agreed at journal 15 Jun, 2024 Reviewers agreed at journal 13 Jun, 2024 Reviewers invited by journal 13 Jun, 2024 Editor assigned by journal 10 Jun, 2024 Submission checks completed at journal 10 Jun, 2024 First submitted to journal 05 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Monasterio\"","correspondingAuthor":false,"prefix":"","firstName":"Giacomo","middleName":"","lastName":"Bianchi","suffix":""},{"id":318859782,"identity":"892ce58c-441f-4460-a934-6c66e94035d7","order_by":33,"name":"Matteo Pettinari","email":"","orcid":"","institution":"Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg","correspondingAuthor":false,"prefix":"","firstName":"Matteo","middleName":"","lastName":"Pettinari","suffix":""},{"id":318859783,"identity":"a30ec21a-cf1c-4f12-9c3d-57ae775de8b5","order_by":34,"name":"Alessandro Barbone","email":"","orcid":"","institution":"Cardiac Surgery Unit, IRCCS Humanitas Research Hospital","correspondingAuthor":false,"prefix":"","firstName":"Alessandro","middleName":"","lastName":"Barbone","suffix":""},{"id":318859784,"identity":"d1d93057-f2d6-42c9-9aad-b2a3d9b462d9","order_by":35,"name":"José P. Garcia","email":"","orcid":"","institution":"IU Health Advanced Heart \u0026 Lung Care, Indiana University Methodist Hospital","correspondingAuthor":false,"prefix":"","firstName":"José","middleName":"P.","lastName":"Garcia","suffix":""},{"id":318859785,"identity":"467df785-d939-4972-aba9-3ec75b635357","order_by":36,"name":"Kiran Shekar","email":"","orcid":"","institution":"Adult Intensive Care Services, The Prince Charles Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kiran","middleName":"","lastName":"Shekar","suffix":""},{"id":318859786,"identity":"cf3bf3fe-9948-4b94-8025-337e5817d42a","order_by":37,"name":"Glenn J.R. Whitman","email":"","orcid":"","institution":"Cardiac Intensive Care Unit, Johns Hopkins Hospital","correspondingAuthor":false,"prefix":"","firstName":"Glenn","middleName":"J.R.","lastName":"Wh","suffix":"J.R."},{"id":318859787,"identity":"b2070137-d7d1-4548-865b-78c34cd47d05","order_by":38,"name":"Roberto Lorusso","email":"","orcid":"","institution":"Cardio-Thoracic Surgery Department, and Cardiovascular Research Institute Maastricht","correspondingAuthor":false,"prefix":"","firstName":"Roberto","middleName":"","lastName":"Lorusso","suffix":""}],"badges":[],"createdAt":"2024-06-05 16:47:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4535505/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4535505/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13054-024-05047-2","type":"published","date":"2024-08-07T15:57:19+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":59516134,"identity":"cfb23d62-e45e-4425-b221-6ceca171d76d","added_by":"auto","created_at":"2024-07-02 17:35:43","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":729309,"visible":true,"origin":"","legend":"\u003cp\u003eComposite Neurologic End-point including stroke, cerebral hemorrhage and brain edema.\u003c/p\u003e","description":"","filename":"FIGURE1Barplotcompositeneurobycannulationgroupedbars0.1.png","url":"https://assets-eu.researchsquare.com/files/rs-4535505/v1/d2ad43dd1efd6b73ab3a2e6f.png"},{"id":59514636,"identity":"5a4de801-69ff-44ce-b7e5-063e86f360af","added_by":"auto","created_at":"2024-07-02 17:27:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":788729,"visible":true,"origin":"","legend":"\u003cp\u003eOverall In-hospital Mortality. ECLS= Extracorporeal Life Support.\u003c/p\u003e","description":"","filename":"FIGURE2Barplotsurvivalbycannulationgouped0.1.png","url":"https://assets-eu.researchsquare.com/files/rs-4535505/v1/08646ef5cd5c28186a519a87.png"},{"id":59514637,"identity":"e99de8c9-85b7-4a33-af27-f7430d604a07","added_by":"auto","created_at":"2024-07-02 17:27:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1619457,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan–Meier Plot of Survival in Subclavian Artery Vs Femoral Artery Vs Aorta Cannulation\u003c/p\u003e","description":"","filename":"FIGURE3OverallsurvivalbycannulationKM10yrs0.2.png","url":"https://assets-eu.researchsquare.com/files/rs-4535505/v1/5436e9cb638e0d4b2f052541.png"},{"id":62298300,"identity":"5b3487d8-2133-43b0-be9e-80a49ea5ee4d","added_by":"auto","created_at":"2024-08-12 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17:27:43","extension":"png","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":1589564,"visible":true,"origin":"","legend":"","description":"","filename":"VisualAbstract.png","url":"https://assets-eu.researchsquare.com/files/rs-4535505/v1/784f284a3633ea1390d7a60e.png"},{"id":59514646,"identity":"6da4220e-6977-49f0-a3f0-9816cb352e7e","added_by":"auto","created_at":"2024-07-02 17:27:43","extension":"docx","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":1407871,"visible":true,"origin":"","legend":"","description":"","filename":"finalPELSNEUROAppendixCRITICALCARE1.3SM.docx","url":"https://assets-eu.researchsquare.com/files/rs-4535505/v1/7c9f33dd9445342dd394db06.docx"}],"financialInterests":"Competing interest reported. DW: consultant/proctor for Abbott; scientific advisor for Xenios. RL: consultant for Medtronic, Getinge and LivaNova; Advisory Board Member of Eurosets (honoraria paid as research funding). KR: received honoraria from Baxter and Fresenius Ltd for educational lectures.","formattedTitle":"Neurologic Complications in Patients Receiving Aortic vs Subclavian vs Femoral Arterial Cannulation for Post-cardiotomy Extracorporeal Life Support: Results of the PELS Observational Multicenter Study","fulltext":[{"header":"Background","content":"\u003cp\u003eExtracorporeal life support (ECLS) represents a strategy of temporary mechanical circulatory support for refractory post-cardiotomy (PC) cardiogenic shock(1, 2). ECLS has gained an important role in perioperative care, especially in patients with high-risk profiles undergoing complex cardiac surgical procedures(3). Nonetheless, morbidity and mortality in such patients are consistently high, with minimal evidence available on long-term and functional outcomes(3, 4). Particularly, data regarding patients\u0026rsquo; neurological outcomes and association with different cannulation approaches in PC-ECLS are lacking and urgently needed to understand the pathophysiology of these complications, monitor and prevent them(5-7). Since cerebral perfusion patterns during ECLS may be different depending on the arterial cannulation site (antegrade vs. retrograde flow in ascending or descending aorta), as well as baseline vascular condition, the choice of the return site could potentially lead to a different likelihood of neurologic complications, although evidence on this topic is scarce(8). Moreover, little evidence addressing the relationship between the return cannulation site and neurologic injury exists to inform our cannulation strategy in PC-ECLS patients.\u003c/p\u003e\n\u003cp\u003eIn this study, we hypothesize that different ECLS cannulation strategies are associated with different rates of major neurological outcomes including stroke, cerebral bleeding and brain edema. We aim to compare patients\u0026apos; neurologic outcomes in three commonly used ECLS arterial cannulation sites: aortic [A] vs subclavian/axillary [SA] vs femoral [F] artery.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe multicenter, retrospective observational Post-cardiotomy Extracorporeal Life Support (PELS) study enrolled consecutive patients supported with ECLS in the post-operative phase (ClinicalTrials.gov: NCT03857217) in 34 centers from 16 countries. Adults (\u0026ge;18 years old) were included if they underwent veno-arterial (V-A) ECLS implantation during or after cardiac surgery between January 2000 and December 2020. For the present analysis, we compared three cannulation strategies analyzing preoperative, intra-operative and post-operatory characteristics, neurologic complications and in-hospital mortality (Supplementary Table 1 and 2). Exclusion criteria were veno-venous configuration, mixed cannulations, pulmonary artery cannulation, and cannulation sites unknown (Supplementary\u0026nbsp;Figure 1).\u003c/p\u003e\n\u003cp\u003eThe current study was conducted in accordance with the Declaration of Helsinki. Institutional Review Board (IRB) approval was acquired in all centers based on the IRB-approval of the coordinating center (METC-2018-0788). The need for informed consent was waived due to the observational character of the study, the emergency of the performed procedure, and the de-identification of shared data. Study was performed following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement (Appendix)(9).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Data Collection and Outcomes\u003c/p\u003e\n\u003cp\u003eData were collected centrally according to data-sharing agreements between participating centers\u0026nbsp;(3). Demographics, pre-operative clinical, procedural characteristics, ECLS details, in-hospital morbidity and mortality, and post-discharge survival were included in a dedicated form (data.castoredc.com). Follow-up data were collected through the review of the most recent medical records or contact with patients at discretion of the treating center. The primary outcome was a composite end-point of major neurologic complications (ischemic stroke, cerebral hemorrhage, brain edema). Secondary outcomes included seizures and vasospasm, all-cause in-hospital mortality, neurologic complication as cause of in-hospital mortality and mortality at follow-up after hospital discharge.\u003c/p\u003e\n\u003cp\u003eStatistical Analysis\u003c/p\u003e\n\u003cp\u003eThe full cohort was categorized into three study groups based on arterial cannulation site (ascending aorta, subclavian/axillary artery, femoral artery). Missing data analysis (Supplementary Table 2) was conducted with the mice: Multivariate Imputation by Chained Equations R package(10). Missing data patterns were investigated and were identified as missing completely at random (MCAR). Descriptive statistics were conducted on available data only and no imputations were performed for this purpose. Normality was tested for continuous variables. Continuous variables were reported as median and interquartile range (IQR) and analyzed with Mann Whitney U-test. Chi-square Test and Fisher\u0026rsquo;s Exact Test were used to compare group differences for categorical variables expressed as count (percentage). In case of significant differences between groups, post-hoc comparisons were performed and adjusted by the Bonferroni correction for multiple tests (Supplementary Table 3). A p-value \u0026lt;0.05 was considered statistically significant. Survival was investigated with the Kaplan-Meier method and comparisons were performed with Log-rank test. Based on the possible variations in ECLS management over the study period and the confounding factors represented by cardiac arrest, previous stroke, previous transient ischemic attack, peripheral artery disease (PAD), two sensitivity analysis were performed after exclusion of patients who received post-cardiotomy ECLS before 2010 (2010-2020 cohort) and those with the abovementioned conditions. To estimate the associations between type of cannulation (reference group: femoral cannulation) and composite end-point of major neurological complications, we conducted a mixed-effects multivariable logistic regression, using the lme4: Linear Mixed-Effects Models using \u0026apos;Eigen\u0026apos; and S4 R package (11). The random effect was used to account for dependency of observations due to clustering in centers and in years. We first estimated a crude model, which was subsequently adjusted for sets of variables deemed potential confounders for the association with the outcome: Model 1, crude model with variable \u0026ldquo;Arterial cannulation site\u0026rdquo;; Model 2, arterial cannulation site, peripheral artery disease; Model 3, arterial cannulation site, peripheral artery disease (PAD), stroke; Model 4, arterial cannulation site, peripheral artery disease, stroke, interaction stroke*PAD; Model 5, arterial cannulation site, peripheral artery disease, stroke, hypertension, dialysis, diabetes, preoperative cardiac arrest; Model 6, arterial cannulation site, peripheral artery disease, stroke, hypertension, dialysis, diabetes, preoperative cardiac arrest, coronary artery bypass graft (CABG), aortic surgery, cardiopulmonary bypass (CPB) time; Model 7, arterial cannulation site, peripheral artery disease, stroke, hypertension, dialysis, diabetes, preoperative cardiac arrest, CABG, aortic surgery, CPB time, implant timing, cardiac arrest as indication for ECLS. Data were merged and analyzed using SPSS 26.0 (IBM, New York, USA), and R 4.4.0 (R Foundation for Statistical Computing, Vienna, Austria).\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBaseline, Surgical, and ECLS Characteristics\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOverall, 1897 PC-ECLS patients were included in the current study: 503 patients (26.5%) underwent aortic, 397 (20.9%) subclavian/axillary and 997 (52.6%) femoral cannulation (Table 1). Each center enrolled a minimum of 1 and a maximum of 458 patients, with a median value of 24 patients per center. A history of hypertension (aortic: n=335, 66.6%; subclavian/axillary: n=298, 75.1%; femoral: n=590, 63.1%; p\u0026lt;0.001), smoking (aortic: n=116, 24.0%; subclavian/axillary: n=115, 29.0%; femoral: n=228, 22.9%; p=0.013), diabetes (aortic: n=144, 28.6%; subclavian/axillary: n=129, 32.5%; femoral: n=237, 23.8%; p=0.002), previous stroke (aortic: n=47, 9.3%; subclavian/axillary: n=62, 15.6%; femoral: n=145, 14.5%; p=0.007; Table 1 and Supplementary Table 3), previous myocardial infarction (aortic: n=146, 29.0%; subclavian/axillary: n=129, 32.5%; femoral: n=237, 23.8%; p=0.002), and dialysis (aortic: n=41, 8.5%; subclavian/axillary: n=44, 12.1%; femoral: n=76, 7.7%; p=0.041) was more frequent in the subclavian/axillary cannulation group. Peripheral artery disease was less frequent in femoral cannulation (n=99, 9.9%), compared to aortic (n=96, 19.1%) and subclavian/axillary cannulation (n=86, 21.7%; p\u0026lt;0.001; Table 1 and Supplementary Table 3). A higher rate of pre-operative cardiac arrest was observed in subclavian/axillary cannulation (aortic: n=50, 10.1%; subclavian/axillary: n=49, 12.7%; femoral: n=72, 7.3%; p=0.005). Emergency surgery occurred less frequently before femoral cannulation (aortic: n=162, 32.2%; subclavian/axillary: n=122, 32.5%; femoral: n=208, 20.9%; p\u0026lt;0.001) and CABG was more frequent in subclavian/axillary and aortic than femoral cannulation (aortic: n=238, 47.3%; subclavian/axillary: n=202, 50.9%; femoral: n=399, 40.0%; p\u0026lt;0.001, Table 2). Cardiopulmonary bypass (CPB) time was longer in aortic (215 min [IQR 143-294 min]) and subclavian/axillary (218 min [IQR 161-307 min]) groups, compared to femoral cannulation (192 min [IQR 129-272 min], p\u0026lt;0.001, Table 2 and Supplementary Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMost common indication for ECLS was failure to wean from cardiopulmonary bypass which was more common in the subclavian/axillary group compared to others (aortic: n=204, 40.9%; subclavian/axillary: n=195, 52.0%; femoral: n=347, 35.0%). Other common indications were represented by cardiogenic shock (aortic: n=127, 25.5%; subclavian/axillary: n=71, 18.9%; femoral: n=281, 28.4%), and right ventricular failure (aortic: n=58, 11.6%; subclavian/axillary: n=41, 10.9%; femoral: n=114, 11.5%, Table 3). Active left ventricular unloading strategies were applied in 205 patients (49.6%) in aortic, 43 patients (15.0%) in subclavian/axillary and 237 patients (27.4%) in femoral cannulation (p\u0026lt;0.001). Patients were supported on ECLS for a median of 120 hours (IQR, 56\u0026ndash;206 hours) in aortic, 116 hours (IQR, 69\u0026ndash;182 hours) in subclavian/axillary and 116 hours (IQR, 52\u0026ndash;192 hours) in femoral group (p=0.557). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNeurological Outcomes and Associated Variables\u003c/p\u003e\n\u003cp\u003eThe composite end-point of major neurological complications was differently distributed between subclavian/axillary (n=78, 19.6%), aortic (n=79, 15.8%) and femoral cannulation (n=118, 11.9%, p\u0026lt;0.001) with subclavian/axillary cannulation showing a higher rate of events compared to femoral cannulation (p=0.001;\u0026nbsp;Figure 1). Cerebral hemorrhage (aortic: n=16, 3.2%; subclavian/axillary: n=22, 5.9%; femoral: n=21, 2.3%, p=0.004) and stroke (aortic: n=59, 11.8%; subclavian/axillary: n=63, 15.9%; femoral: n=80, 8.1%, p\u0026lt;0.001) were more frequent in patients cannulated with subclavian/axillary approach. Seizures were more common in subclavian/axillary (n=13, 3.4%) compared to aortic (n=9, 1.8%) and femoral cannulation (n=12, 1.3%, p=0.036). No difference between groups was observed in cerebral hemorrhage severity (p=0.051) and stroke severity (p=0.197,\u0026nbsp;Table 4). Neuro-monitoring was used very infrequently regardless of the monitoring system considered (Table 5). In a mixed-effects crude logistic regression model with random effects for centers and years, subclavian/axillary cannulation was associated with higher risk of neurological complications (OR 1.50 [95%CI 1.05-2.15], p=0.027), also after adjustment for\u0026nbsp;peripheral artery disease, stroke, hypertension, dialysis, diabetes, preoperative cardiac arrest, CABG, aortic surgery, CPB time, implant timing, cardiac arrest as indication for ECLS (OR 1.57 [95%CI 1.06-2.34], p=0.026;\u0026nbsp;Table 6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSecondary Outcomes\u003c/p\u003e\n\u003cp\u003eIntensive care unit stay was longer in subclavian/axillary (16 days [IQR 8-33 days]) than aortic (12 days [IQR 5-25 days]) or femoral cannulation (13 days [IQR 6-24 days], p\u0026lt;0.001,\u0026nbsp;Table 4),\u0026nbsp;with a higher in-hospital mortality in the aortic group (aortic: n=344, 68.4%; subclavian/axillary : n=223, 56.2%; femoral: n=587, 58.9%; p\u0026lt;0.001,\u0026nbsp;Figure 2 and Supplementary Table 3), also confirmed by Kaplan-Meier curves (Figure 3). More patients deceased during ECLS support in the aortic cannulation group (n=217, 43.8%) compared to subclavian/axillary (n=103, 29.9%) and femoral groups (n=360, 36.3%, p\u0026lt;0.001\u0026nbsp;Supplementary Table 3). No differences were found in main causes of in-hospital death between groups (p=0.433). Median Follow-up time was 11 days for in-hospital deaths (IQR: 4-22) \u0026nbsp;and 885 days for hospital survivors (IQR: 91-1916).\u003c/p\u003e\n\u003cp\u003eSensitivity Analysis\u003c/p\u003e\n\u003cp\u003eIn the sensitivity analysis excluding patients supported before 2010 (Supplementary Tables 4-7), we confirmed the same distribution of the primary outcomes observed in the main analysis, particularly with more frequent composite end-point of neurological complications in subclavian/axillary patients (aortic: n=57, 14.4%; subclavian/axillary: n=68, 19.3%; femoral: n=99, 12.5%; p=0.011). In-hospital mortality was higher after aortic cannulation (aortic: n=274, 69.0%; subclavian/axillary: n=195, 55.2%; femoral: n=477, 59.4%; p\u0026lt;0.001,\u0026nbsp;Supplementary Figure 2-3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the sensitivity analysis excluding patients\u0026nbsp;who suffered previous stroke, previous transient ischemic attack, peripheral vessel disease or with\u0026nbsp;cardiac arrest during hospital stay (Supplementary Tables 8-11), the composite neurological end-point occurred more frequently in the subclavian/axillary group (aortic: n=48, 15.6%; subclavian/axillary: n=38, 18.0%; femoral: n=62, 9.2%; p=0.001;\u0026nbsp;Supplementary Figure 5). In-hospital mortality remained higher in the aortic cannulation group (aortic: n=215, 69.8%; subclavian/axillary: n=103, 48.8%; femoral: n=370, 56.3%; p\u0026lt;0.001;\u0026nbsp;Supplementary Figure 6-7).\u0026nbsp;\u003c/p\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated neurological complications in one of the largest cohorts of PC-ECLS patients. The study has four main findings. First, femoral cannulation remains the most used cannulation approach (53%), while subclavian/axillary cannulation (21%) and aortic cannulation (26%) are less used. Second, we found that patients with subclavian/axillary cannulation had worse baseline vascular conditions as shown by higher prevalence of previous stroke,\u0026nbsp;previous myocardial infarction, dialysis, preoperative cardiac arrest and peripheral artery disease.\u0026nbsp;Third, we showed that the composite outcome of neurological complications occurred in almost 20% of patients cannulated with subclavian/axillary, compared to 12-16% of patients cannulated with femoral and aortic approach. Finally, we found higher in-hospital mortality in the aortic group, despite the lower incidence of neurological complications, confirmed by two sensitivity analyses after exclusion of patients supported before 2010 and those with cardiac arrest, stroke, previous transient ischemic attack, peripheral vessel disease.\u003c/p\u003e\n\u003cp\u003eOverall neurological complications occur in almost 20% of veno-arterial ECLS patients as reported by literature(12). However, it is still difficult to identify which patient might develop such a complication, its predicted severity, or whether a specific ECLS setting may be related to more neurological events. Moreover, effective strategies to prevent such complications or monitor their early onset, are urgently needed to improve PC-ECLS outcomes. Literature supports the hypothesis that cerebral perfusion during ECLS might be influenced by the arterial cannulation site, but whether this could influence neurologic complications is still unknown(13, 14). Arterial cannulation approach may significantly vary, as demonstrated by this analysis of the PELS population, with femoral cannulation used in 52.6% of patients, subclavian/axillary cannulation in 20.9% and aortic cannulation used in 26.5% of patients. Femoral cannulation remains the preferred cannulation strategy in PC-ECLS(15), but its superiority in terms of fewer brain embolization events compared to the central aortic one is still debated, as mechanisms underlying the potential beneficial effects of peripheral cannulation have to be confirmed\u0026nbsp;(16-19).\u003c/p\u003e\n\u003cp\u003eThe first step to understanding the association of neurological outcomes and cannulation strategy implies an analysis of patients\u0026rsquo; characteristics to identify specific risk profiles for adverse events or best candidates for each cannulation strategy. This study showed that patients who were cannulated with subclavian/axillary approach were characterized by a worse vascular status compared to others. Moreover, a significant amount of them received emergency surgery and experienced cardiogenic shock or cardiac arrest before the operation. This observation suggests that the subclavian/axillary cannulation is preferred in case of worse patient\u0026rsquo;s vascular status, possibly because the subclavian/axillary artery is more often free from atheromatic disease compared to femoral vessels or ascending aorta(20, 21). Surprisingly, subclavian/axillary cannulation was not predominantly used in aortic surgery, even though the subclavian/axillary artery is often cannulated to initiate CPB during this type of operation(20). Aortic surgery is usually associated with higher neurological risks due to the possible disease involvement of neck vessels or the need for a circulatory arrest(16, 22), but interaction between disease extension and ECLS cannulation approach needs further investigations.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInterestingly, CPB time was slightly longer in patients cannulated with subclavian/axillary and aortic approach compared to femoral approach. This could be explained by the higher surgical complexity that characterize the subclavian/axillary group, whose patients underwent two or more procedures in 28% of cases compared to the 16-18% of other groups. A longer CPB time might influence cerebral circulation and neurological outcomes. However, the interaction between CPB time and flow, intra-operative CPB cannulation and ECLS cannulation sites, hemodynamic parameters, and patient\u0026rsquo;s vascular status is still under-investigated and requires the development of dedicated studies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eObservations from this study demonstrated that the composite neurological end-point including stroke, brain hemorrhage and brain oedema occurs more frequently in subclavian/axillary cannulation, with 6% of patients suffering cerebral hemorrhage and 16% of patients suffering ischemic stroke in the subclavian/axillary group. Also, clinical seizures were more common in subclavian/axillary patients. Although tracing the pathophysiological mechanism of these events was beyond the scope of this observational study, we can hypothesize an additive effect of baseline cerebral and vascular comorbidities, an intra-operative alteration of the cerebral blood flow, the lack of pulsatility due to ECLS and the flow pattern determined by the arterial cannulation site.\u0026nbsp;Moreover, an autoregulatory dysfunction may contribute to\u0026nbsp;neurological dysfunction, but how it interacts with ECLS and cannula flow is still unknown(13, 14, 23, 24)\u0026nbsp;and\u0026nbsp;mechanisms of\u0026nbsp;cerebral autoregulation in the specific setting of non-pulsatile blood flow and after different cannulation strategies are still an active research area(8, 19, 21).\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo further investigate all these aspects and allow for an early detection of neurological complications, dedicated neurological monitoring strategies during ECLS are advised even if no specific guidelines still exist. PELS study demonstrated that neurologic monitoring (such as near-infrared spectroscopy, transcranial doppler, electroencephalogram and brain computed tomography) is still not routinely used. However, literature suggests that standardized neuromonitoring, when implemented, significantly improves the detection(25, 26)\u0026nbsp;of acute brain injuries in ECLS patients; particularly lack of blood flow monitoring may be associated with increased stroke incidence\u0026nbsp;(27-29).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral studies report in-hospital mortality of patients undergoing PC V-A ECLS around 60% with different variations, depending on weight of surgery, patient\u0026rsquo;s age and center\u0026rsquo;s expertise(3, 21, 27, 29-32). The current study showed a higher in-hospital mortality after aortic cannulation, but no differences in the distribution of neurological cause of death between groups. This finding opens the discussion on the fate of ECLS patients with neurological damage. Previous\u0026nbsp;studies showed that patients on V-A ECLS support experiencing neurological complications had an increased in-hospital mortality, by a factor of 2-3(13, 33-35). Moreover, severe neurological damage could be a reason to withdraw the support. However, neurological complications remain limited in the ECLS population, and they seem not to be the main driver of mortality(33). Therefore, these complications, especially the \u0026quot;minor\u0026quot; ones, should not push toward support withdrawal. As clinical experience accumulates and ECLS becomes more widely used, focused research on neurological monitoring and management of neurological complications are imperative to improve early and long-term outcomes. Particularly, it is warranted to evaluate if improving neurological monitoring, neurological targeted therapy, prognostication, and follow-up, may mitigate incidence and severity of neurological complications in all patients, and especially in those with bad vascular status and/or subclavian cannulation. Since we included patients from different centers and countries, our results may be applicable to a large variety of patients treated with PC-ECLS.\u003c/p\u003e\n\u003cp\u003eStrengths and Limitations\u003c/p\u003e\n\u003cp\u003ePELS is observational by nature, so causal inference is not possible, and it was not designed to specifically investigate neurological outcomes with dedicated diagnostic tools(12, 16, 35). Details about CPB cannulation strategies during the index operation or timing (on ECLS, before or after ECLS) of neurological complications were not available, preventing any deeper causal investigation. Moreover, specific data on ECLS selection criteria, protocols, weaning strategies, cannulation technique (surgical vs percutaneous) are not captured by the database and could therefore not be included in this study, as well as intraoperative and postoperative hemodynamic parameters, anesthesia management protocols, reasons for withdrawal of ECLS support, post-discharge quality of life, functional status, and follow-up specific data. As previously mentioned, patients with compromised vascular status more frequently received subclavian/axillary. Therefore, we cannot rule out the effects of confounding by severity and indication. Since the observational nature of PELS study, we also cannot infer on relations between other complications (acute kidney injury, pneumonia, acute respiratory distress syndrome, embolism, and arrhythmia, etc.) more common after subclavian/axillary, and neurological complications(3). Furthermore, we had no access to long-term functional status of these patients, therefore additional studies are warranted in this respect. Finally, we encountered some missing data, especially regarding severity of stroke or cerebral hemorrhage and vasospasm (Supplementary Table 2).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this cohort of the PELS Study, subclavian/axillary cannulation was used in patients with compromised vascular status and it was associated with higher rates of major neurologic complications and seizure, especially compared to femoral cannulation. In-hospital mortality was higher after aortic cannulation, despite no significant differences in incidence of neurological cause of death in these patients. These results focus attention on the application of preventive strategies in patients with impaired vascular status and/or subclavian/axillary cannulation, encouraging dedicated prospective trials. Eventually, this study suggests the need for an adequate neurologic monitoring of patients undergoing PC-ECLS, especially in subclavian/axillary cannulated patients.\u003c/p\u003e\n"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.169059011164276%\" valign=\"top\"\u003e\n \u003cp\u003eCABG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"77.83094098883572%\" valign=\"top\"\u003e\n \u003cp\u003eCoronary artery bypass surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.169059011164276%\" valign=\"top\"\u003e\n \u003cp\u003eCPB\u003c/p\u003e\n \u003cp\u003eECLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"77.83094098883572%\" valign=\"top\"\u003e\n \u003cp\u003eCardiopulmonary bypass\u003c/p\u003e\n \u003cp\u003eExtracorporeal Life Support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.169059011164276%\" valign=\"top\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"77.83094098883572%\" valign=\"top\"\u003e\n \u003cp\u003eInterquartile range\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.169059011164276%\" valign=\"top\"\u003e\n \u003cp\u003eIRB\u003c/p\u003e\n \u003cp\u003eNYHA\u003c/p\u003e\n \u003cp\u003ePAD\u003c/p\u003e\n \u003cp\u003ePELS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"77.83094098883572%\" valign=\"top\"\u003e\n \u003cp\u003eInstitutional Review Board\u003c/p\u003e\n \u003cp\u003eNew York Heart Association\u003c/p\u003e\n \u003cp\u003ePeripheral Artery Disease\u003c/p\u003e\n \u003cp\u003ePost-Cardiotomy Extracorporeal Life Support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.169059011164276%\" valign=\"top\"\u003e\n \u003cp\u003ePC\u003c/p\u003e\n \u003cp\u003eV-A\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"77.83094098883572%\" valign=\"top\"\u003e\n \u003cp\u003ePost-Cardiotomy\u003c/p\u003e\n \u003cp\u003eVeno-Arterial\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInstitutional Review Board (IRB) approval was required for all centers, based on the IRB-approval of the coordinating center (MUMC+, number: METC-2018-0788, date: December 19th, 2018). The study was registered at ClinicalTrials.gov (trial registration ID: NCT03857217). Need for informed consent was waived based on the retrospective nature of the study, the emergency of the performed procedure, and the pseudonymization of shared data. The current study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDW: consultant/proctor for Abbott; scientific advisor for Xenios. RL: consultant for Medtronic, Getinge and LivaNova; Advisory Board Member of Eurosets (honoraria paid as research funding). KR: received honoraria from Baxter and Fresenius Ltd for educational lectures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo financial support for this study was provided\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGC, AS, SM, RL conceived and designed the study. GC and SM conceived and performed the analysis. GC, AS, SM, RL drafted the manuscript. All authors interpreted the results, critically edited the manuscript, approved the final work, and agreed to be accountable for the accuracy and integrity of the work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLorusso R, Shekar K, MacLaren G, Schmidt M, Pellegrino V, Meyns B, et al. 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Characterization of Cerebral Hemodynamics with TCD in Patients Undergoing VA-ECMO and VV-ECMO: a Prospective Observational Study. Neurocrit Care. 2023;38(2):407-13.\u003c/li\u003e\n\u003cli\u003evon Elm E, Altman DG, Egger M, Pocock SJ, G\u0026oslash;tzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495-9.\u003c/li\u003e\n\u003cli\u003evan Buuren S, Groothuis-Oudshoorn K. mice: Multivariate Imputation by Chained Equations in R. Journal of Statistical Software. 2011;45(3):1\u0026ndash;67.\u003c/li\u003e\n\u003cli\u003eBates D, M\u0026auml;chler M, Bolker B, Walker S. Fitting Linear Mixed-Effects Models Using lme4. Journal of Statistical Software. 2015;67(1):1 - 48.\u003c/li\u003e\n\u003cli\u003eShoskes A, Migdady I, Rice C, Hassett C, Deshpande A, Price C, et al. Brain Injury Is More Common in Venoarterial Extracorporeal Membrane Oxygenation Than Venovenous Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis. Crit Care Med. 2020;48(12):1799-808.\u003c/li\u003e\n\u003cli\u003eMateen FJ, Muralidharan R, Shinohara RT, Parisi JE, Schears GJ, Wijdicks EF. Neurological injury in adults treated with extracorporeal membrane oxygenation. Arch Neurol. 2011;68(12):1543-9.\u003c/li\u003e\n\u003cli\u003eKazmi SO, Sivakumar S, Karakitsos D, Alharthy A, Lazaridis C. Cerebral Pathophysiology in Extracorporeal Membrane Oxygenation: Pitfalls in Daily Clinical Management. Crit Care Res Pract. 2018;2018:3237810.\u003c/li\u003e\n\u003cli\u003eRadakovic D, Hamouda K, Penov K, Bening C, Sayed S, Gietzen C, et al. Central Versus Peripheral Arterial Cannulation for Veno-Arterial Extracorporeal Membrane Oxygenation in Post-Cardiotomy Patients. Asaio j. 2021;67(1):67-73.\u003c/li\u003e\n\u003cli\u003ePuthettu M, Vandenberghe S, Demertzis S. Effect of cannulation site on emboli travel during cardiac surgery. J Cardiothorac Surg. 2021;16(1):181.\u003c/li\u003e\n\u003cli\u003eRaffa GM, Kowalewski M, Brodie D, Ogino M, Whitman G, Meani P, et al. Meta-Analysis of Peripheral or Central Extracorporeal Membrane Oxygenation in Postcardiotomy and Non-Postcardiotomy Shock. Ann Thorac Surg. 2019;107(1):311-21.\u003c/li\u003e\n\u003cli\u003eMariscalco G, Salsano A, Fiore A, Dal\u0026eacute;n M, Ruggieri VG, Saeed D, et al. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis. J Thorac Cardiovasc Surg. 2020;160(5):1207-16.e44.\u003c/li\u003e\n\u003cli\u003eLee SI, Lim YS, Park CH, Choi WS, Choi CH. Importance of pulse pressure after extracorporeal cardiopulmonary resuscitation. J Card Surg. 2021;36(8):2743-50.\u003c/li\u003e\n\u003cli\u003ePapadopoulos N, Ahmad Ael S, Marinos S, Moritz A, Zierer A. Simple and controlled method to avoid hyperperfusion of the right arm following axillary artery cannulation for extracorporeal membrane oxygenator support. Thorac Cardiovasc Surg. 2013;61(7):581-3.\u003c/li\u003e\n\u003cli\u003eKowalewski M, Zieliński K, Brodie D, MacLaren G, Whitman G, Raffa GM, et al. Venoarterial Extracorporeal Membrane Oxygenation for Postcardiotomy Shock-Analysis of the Extracorporeal Life Support Organization Registry. Crit Care Med. 2021;49(7):1107-17.\u003c/li\u003e\n\u003cli\u003eSchaefer AK, Distelmaier K, Riebandt J, Goliasch G, Bernardi MH, Zimpfer D, et al. Access site complications of postcardiotomy extracorporeal life support. J Thorac Cardiovasc Surg. 2022;164(5):1546-58.e8.\u003c/li\u003e\n\u003cli\u003eZhang LQ, Chang H, Kalra A, Humayun M, Rosenblatt KR, Shah VA, et al. Continuous Monitoring of Cerebral Autoregulation in Adults Supported by Extracorporeal Membrane Oxygenation. Neurocrit Care. 2024.\u003c/li\u003e\n\u003cli\u003eKhanduja S, Kim J, Kang JK, Feng CY, Vogelsong MA, Geocadin RG, et al. Hypoxic-Ischemic Brain Injury in ECMO: Pathophysiology, Neuromonitoring, and Therapeutic Opportunities. Cells. 2023;12(11).\u003c/li\u003e\n\u003cli\u003eLorusso R, Raffa GM, Kowalewski M, Alenizy K, Sluijpers N, Makhoul M, et al. Structured review of post-cardiotomy extracorporeal membrane oxygenation: Part 2-pediatric patients. J Heart Lung Transplant. 2019;38(11):1144-61.\u003c/li\u003e\n\u003cli\u003eKowalewski M, Raffa G, Zielinski K, Meani P, Alanazi M, Gilbers M, et al. Baseline surgical status and short-term mortality after extracorporeal membrane oxygenation for post-cardiotomy shock: a meta-analysis. Perfusion. 2020;35(3):246-54.\u003c/li\u003e\n\u003cli\u003eWang L, Yang F, Wang X, Xie H, Fan E, Ogino M, et al. Predicting mortality in patients undergoing VA-ECMO after coronary artery bypass grafting: the REMEMBER score. Crit Care. 2019;23(1):11.\u003c/li\u003e\n\u003cli\u003eOng CS, Etchill E, Dong J, Shou BL, Shelley L, Giuliano K, et al. Neuromonitoring detects brain injury in patients receiving extracorporeal membrane oxygenation support. J Thorac Cardiovasc Surg. 2023;165(6):2104-10.e1.\u003c/li\u003e\n\u003cli\u003eHu RTC, Broad JD, Osawa EA, Ancona P, Iguchi Y, Miles LF, Bellomo R. 30-Day Outcomes Post Veno-Arterial Extra Corporeal Membrane Oxygenation (VA-ECMO) After Cardiac Surgery and Predictors of Survival. Heart Lung Circ. 2020;29(8):1217-25.\u003c/li\u003e\n\u003cli\u003eBrewer JM, Tran A, Yu J, Ali MI, Poulos CM, Gates J, et al. ECMO after cardiac surgery: a single center study on survival and optimizing outcomes. J Cardiothorac Surg. 2021;16(1):264.\u003c/li\u003e\n\u003cli\u003eChen F, Wang L, Shao J, Wang H, Hou X, Jia M. Survival following venoarterial extracorporeal membrane oxygenation in postcardiotomy cardiogenic shock adults. Perfusion. 2020;35(8):747-55.\u003c/li\u003e\n\u003cli\u003eBiancari F, Dal\u0026eacute;n M, Fiore A, Dell\u0026apos;Aquila AM, J\u0026oacute;nsson K, Ragnarsson S, et al. Gender and the Outcome of Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation. J Cardiothorac Vasc Anesth. 2022;36(6):1678-85.\u003c/li\u003e\n\u003cli\u003eCho SM, Farrokh S, Whitman G, Bleck TP, Geocadin RG. Neurocritical Care for Extracorporeal Membrane Oxygenation Patients. Crit Care Med. 2019;47(12):1773-81.\u003c/li\u003e\n\u003cli\u003eLorusso R, Gelsomino S, Parise O, Di Mauro M, Barili F, Geskes G, et al. Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: Findings From the Extracorporeal Life Support Organization Database. Crit Care Med. 2017;45(8):1389-97.\u003c/li\u003e\n\u003cli\u003eRisnes I, Wagner K, Nome T, Sundet K, Jensen J, Hyn\u0026aring;s IA, et al. Cerebral outcome in adult patients treated with extracorporeal membrane oxygenation. Ann Thorac Surg. 2006;81(4):1401-6.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003e\u0026ndash; Pre-operative Characteristics of the Overall Population.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"765\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.973821989528794%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"20.54973821989529%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAorta\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=503)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.455497382198953%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclavian/Axillary Artery\u003cbr\u003e\u0026nbsp;(n=397)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.895287958115183%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemoral Artery\u003cbr\u003e\u0026nbsp;(n=997)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.12565445026178%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(55-72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(57-74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(55-71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"70.06535947712419%\" colspan=\"7\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(39.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(47.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(39.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.6764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e(60.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.676470588235293%\" valign=\"top\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.205882352941176%\" valign=\"top\"\u003e\n \u003cp\u003e(52.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.647058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e605\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.705882352941176%\" valign=\"top\"\u003e\n \u003cp\u003e(60.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003eBody Surface Area (m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e1.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(1.73-2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e1.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(1.79-2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(1.73-2.023)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"70.06535947712419%\" colspan=\"7\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(66.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(75.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(63.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Dialysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Previous Myocardial Infarction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(29.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(23.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Previous Endocarditis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(36.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(25.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Previous Stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(9.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(14.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Atrial Fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(25.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(25.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Previous Pulmonary Embolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Diabetes Mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(29.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(22.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Previous Transient Ischemic Attack\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.718\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Chronic Obstructive Pulmonary Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(10.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Peripheral Artery Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003eLeft Ventricular Ejection Fraction (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e47.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(30-55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(25-60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e48.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(30-60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003eEuroscore II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(3.2-18.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e14.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(6.4-29.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e5.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(2.4-16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003ePreoperative Conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;NYHA Class\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"70.06535947712419%\" colspan=\"7\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Class I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(7.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.6764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Class II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e(20.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.676470588235293%\" valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.205882352941176%\" valign=\"top\"\u003e\n \u003cp\u003e(16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.647058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.705882352941176%\" valign=\"top\"\u003e\n \u003cp\u003e(23.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.6764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Class III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e(39.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.676470588235293%\" valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.205882352941176%\" valign=\"top\"\u003e\n \u003cp\u003e(32.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.647058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.705882352941176%\" valign=\"top\"\u003e\n \u003cp\u003e(41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.6764705882353%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Class IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.147058823529411%\" valign=\"top\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.941176470588236%\" valign=\"top\"\u003e\n \u003cp\u003e(32.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.676470588235293%\" valign=\"top\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.205882352941176%\" valign=\"top\"\u003e\n \u003cp\u003e(43.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.647058823529412%\" valign=\"top\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.705882352941176%\" valign=\"top\"\u003e\n \u003cp\u003e(27.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Preoperative Cardiogenic Shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(25.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Preoperative Cardiac Arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Preoperative Right Ventricular Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(10.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(13.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Preoperative Biventricular Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.934640522875817%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Emergency Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.50326797385621%\" valign=\"top\"\u003e\n \u003cp\u003e(32.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.712418300653595%\" valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.84967320261438%\" valign=\"top\"\u003e\n \u003cp\u003e(32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.7973856209150325%\" valign=\"top\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.071895424836601%\" valign=\"top\"\u003e\n \u003cp\u003e(20.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.11111111111111%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eData are reported as n (% as valid percentage excluding missing values) or median (interquartile range). NYHA, New York Heart Association.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e - Procedural Characteristics\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"735\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.64625850340136%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"17.82312925170068%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAorta\u0026nbsp;\u003cbr\u003e\u0026nbsp;(N=503)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.095238095238095%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclavian/Axillary Artery\u003cbr\u003e\u0026nbsp;(n=397)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.27891156462585%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemoral Artery\u003cbr\u003e\u0026nbsp;(N=997)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.884353741496598%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.272108843537415%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.64625850340136%\" valign=\"top\"\u003e\n \u003cp\u003eWeight Of Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.21768707482993%\" colspan=\"8\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"0.1360544217687075%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Isolated Coronary Artery Bypass Graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Isolated Non Coronary Artery Bypass Graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(60.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(40.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(60.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 2 Procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 3 Or More Procedures\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(28.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eCoronary Artery Bypass Graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(47.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(50.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eAortic Valve Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(34.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(39.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.64625850340136%\" valign=\"top\"\u003e\n \u003cp\u003eAortic Valve Surgery Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.08163265306122%\" colspan=\"7\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"0.272108843537415%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Aortic Valve Repair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(20.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Biological Prosthesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(59.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(47.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mechanical Prosthesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(16.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eMitral Valve Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(31.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(36.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(30.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.64625850340136%\" valign=\"top\"\u003e\n \u003cp\u003eMitral Valve Surgery Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.08163265306122%\" colspan=\"7\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"0.272108843537415%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mitral Valve Repair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(38.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(46.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(41.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Biological Prosthesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(36.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Mechanical Prosthesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(24.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(20.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(13.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eTricuspid Valve Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eAortic Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(19.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(18.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.64625850340136%\" valign=\"top\"\u003e\n \u003cp\u003eAortic Surgery Type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"64.08163265306122%\" colspan=\"7\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"0.272108843537415%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Aortic Root\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(13.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e0.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Ascending Aorta And Root\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Ascending Aorta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(32.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(22.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Ascending Aorta And Arch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(19.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"39.9390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; Aortic Arch And Descending Aorta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.317073170731708%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.652439024390244%\" valign=\"top\"\u003e\n \u003cp\u003e(1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.335365853658536%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.091463414634147%\" valign=\"top\"\u003e\n \u003cp\u003e(3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.99390243902439%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.365853658536585%\" valign=\"top\"\u003e\n \u003cp\u003e(8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.3048780487804878%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eLeft Ventricular Assist Device\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(1.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.967\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eRight Ventricular Assist Device\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eHeart Transplantation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(10.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eOff-Pump Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Conversion To Cardiopulmonary Bypass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eCardiopulmonary Bypass Time (Min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e215\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(143-294)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(161-307)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(129-272)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eCrossclamp Time (Min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(65-152)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(68-154)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(62-146)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.59782608695652%\" valign=\"top\"\u003e\n \u003cp\u003eIntraoperative Transfusions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.521739130434782%\" valign=\"top\"\u003e\n \u003cp\u003e209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.277173913043478%\" valign=\"top\"\u003e\n \u003cp\u003e(90.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.755434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.451086956521738%\" valign=\"top\"\u003e\n \u003cp\u003e(100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.016304347826088%\" valign=\"top\"\u003e\n \u003cp\u003e437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.23913043478261%\" valign=\"top\"\u003e\n \u003cp\u003e(91.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.869565217391305%\" valign=\"top\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"0.2717391304347826%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"10\" valign=\"top\"\u003e\n \u003cp\u003eData are reported as n (% as valid percentage excluding missing values) or median (interquartile range).\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e - Details on Extracorporeal Life Support.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"735\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.170068027210885%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"24.35374149659864%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAorta\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=503)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.08843537414966%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclavian/Axillary Artery\u003cbr\u003e\u0026nbsp;(n=397)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.632653061224488%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemoral Artery\u003cbr\u003e\u0026nbsp;(N=997)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.755102040816326%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.204359673024523%\" valign=\"top\"\u003e\n \u003cp\u003eECLS Indication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"74.79564032697547%\" colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.238744884038198%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Failure To Wean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.960436562073669%\" valign=\"top\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.459754433833561%\" valign=\"top\"\u003e\n \u003cp\u003e(40.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.867667121418826%\" valign=\"top\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.141882673942701%\" valign=\"top\"\u003e\n \u003cp\u003e(52.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.867667121418826%\" valign=\"top\"\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.687585266030014%\" valign=\"top\"\u003e\n \u003cp\u003e(35.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.776261937244202%\" rowspan=\"10\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Acute Pulmonary Embolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Arrhythmia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cardiac Arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(9.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cardiogenic Shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(18.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e281\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(28.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Pulmonary Hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(0.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Right Ventricular Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(11.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Respiratory Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(6.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(2.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Biventricular Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(8.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.238744884038198%\" valign=\"top\"\u003e\n \u003cp\u003eLeft Ventricular Unloading\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.960436562073669%\" valign=\"top\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.459754433833561%\" valign=\"top\"\u003e\n \u003cp\u003e(49.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.867667121418826%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.141882673942701%\" valign=\"top\"\u003e\n \u003cp\u003e(15.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.867667121418826%\" valign=\"top\"\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.687585266030014%\" valign=\"top\"\u003e\n \u003cp\u003e(27.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.776261937244202%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.238744884038198%\" valign=\"top\"\u003e\n \u003cp\u003eECLS Duration (Hours)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.960436562073669%\" valign=\"top\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.459754433833561%\" valign=\"top\"\u003e\n \u003cp\u003e(56-206)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.867667121418826%\" valign=\"top\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.141882673942701%\" valign=\"top\"\u003e\n \u003cp\u003e(69-182)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.867667121418826%\" valign=\"top\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.687585266030014%\" valign=\"top\"\u003e\n \u003cp\u003e(52-192)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.776261937244202%\" valign=\"top\"\u003e\n \u003cp\u003e0.557\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.204359673024523%\" valign=\"top\"\u003e\n \u003cp\u003eAnticoagulation Regimen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"74.79564032697547%\" colspan=\"7\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.238744884038198%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;None\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.960436562073669%\" valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.459754433833561%\" valign=\"top\"\u003e\n \u003cp\u003e(11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.867667121418826%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.141882673942701%\" valign=\"top\"\u003e\n \u003cp\u003e(5.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.867667121418826%\" valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.687585266030014%\" valign=\"top\"\u003e\n \u003cp\u003e(8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.776261937244202%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Heparin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e429\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(87.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(94.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(91.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Bivalirudin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"27.366863905325445%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Argatroban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.053254437869823%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.42603550295858%\" valign=\"top\"\u003e\n \u003cp\u003e(0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.165680473372781%\" valign=\"top\"\u003e\n \u003cp\u003e(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.615384615384615%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.757396449704142%\" valign=\"top\"\u003e\n \u003cp\u003e(0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eData are reported as n (% as valid percentage excluding missing values) or median (interquartile range). ECLS, Extracorporeal Life Support.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4\u003c/strong\u003e \u0026ndash; Post-operative Outcomes.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"697\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"22.381635581061694%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAorta\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=503)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.086083213773314%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclavian/Axillary Artery\u003cbr\u003e\u0026nbsp;(n=397)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.068866571018653%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemoral Artery\u003cbr\u003e\u0026nbsp;(n=997)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eIntensive Care Unit Stay (Days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(5-25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(8-33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(6-24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eHospital Stay (Days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(6-35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(10-46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(8-39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003ePostoperative Bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e339\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(68.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e217\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(54.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e526\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(53.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Requiring Rethoracotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Cannulation Site Bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(11.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.400\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Diffuse No-Surgical Related Bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(33.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(28.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eComposite Endpoint Of Neurological Outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(15.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(11.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eBrain Edema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.098\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eCerebral Hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Severity:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.71879483500717%\" colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Minor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(43.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Disabling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Fatal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(30.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eSeizure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(1.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eStroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(15.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; Severity:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.71879483500717%\" colspan=\"7\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Minor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(45.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(58.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(38.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Disabling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(29.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(32.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Fatal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(28.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eVasospasm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eLeg Ischemia*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e4.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e3.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e13.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eDistal Femoral Perfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(NA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(NA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e653\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e74.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eArrhythmia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(32.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(45.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e289\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eCardiac Arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(15.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.540\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eBowel Ischemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eRight Ventricular Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(33.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eAcute Kidney Injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(70.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(52.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(21.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(32.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(20.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eSeptic Shock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(16.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.901\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eDistributive Shock Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(10.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eAcute Respiratory Distress Syndrome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eMulti-Organ Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(39.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(31.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eEmbolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(13.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003eMain Cause Of Death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"67.71879483500717%\" colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"32.281205164992826%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Multiorgan Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.043041606886657%\" valign=\"top\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.338593974175035%\" valign=\"top\"\u003e\n \u003cp\u003e(35.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.895265423242467%\" valign=\"top\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.190817790530847%\" valign=\"top\"\u003e\n \u003cp\u003e(37.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.0215208034433285%\" valign=\"top\"\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.047345767575322%\" valign=\"top\"\u003e\n \u003cp\u003e(37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.182209469153515%\" rowspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Sepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Persistent Heart Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(40.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(36.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Vasoplegia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Neurological Injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; Bowel Ischemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(2.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"35.54502369668246%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;Other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.058451816745656%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.58609794628752%\" valign=\"top\"\u003e\n \u003cp\u003e(2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.794628751974724%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.322274881516588%\" valign=\"top\"\u003e\n \u003cp\u003e(6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"5.529225908372828%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.164296998420221%\" valign=\"top\"\u003e\n \u003cp\u003e(4.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"8\" valign=\"top\"\u003e\n \u003cp\u003eData are reported as n (% as valid percentage excluding missing values) or median (interquartile range); *Data on Leg Ischemia are reported \u0026nbsp;only for Femoral Cannulated patients. NA, Not Available\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e \u0026ndash;\u0026nbsp;Neurological Monitoring Data.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"699\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.608011444921317%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMonitoring Tool\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.59656652360515%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMissing Data\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.447782546494993%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAorta\u0026nbsp;\u003cbr\u003e\u0026nbsp;(n=503)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.88412017167382%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclavian/Axillary Artery\u003cbr\u003e\u0026nbsp;(n=397)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemoral Artery\u003cbr\u003e\u0026nbsp;(n=997)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.872675250357654%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.608011444921317%\" valign=\"top\"\u003e\n \u003cp\u003eNear InfraRed Spectroscopy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.59656652360515%\" valign=\"top\"\u003e\n \u003cp\u003e491 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.447782546494993%\" valign=\"top\"\u003e\n \u003cp\u003e94 (20.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.88412017167382%\" valign=\"top\"\u003e\n \u003cp\u003e8 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e178 (23.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.872675250357654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.608011444921317%\" valign=\"top\"\u003e\n \u003cp\u003eTransCranial Doppler\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.59656652360515%\" valign=\"top\"\u003e\n \u003cp\u003e490 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.447782546494993%\" valign=\"top\"\u003e\n \u003cp\u003e2 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.88412017167382%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e3 (0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.872675250357654%\" valign=\"top\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.608011444921317%\" valign=\"top\"\u003e\n \u003cp\u003eElectroEncephalogram\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.59656652360515%\" valign=\"top\"\u003e\n \u003cp\u003e490 (25.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.447782546494993%\" valign=\"top\"\u003e\n \u003cp\u003e12 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.88412017167382%\" valign=\"top\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e38 (5.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.872675250357654%\" valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.608011444921317%\" valign=\"top\"\u003e\n \u003cp\u003eBrain Computed Tomography\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.59656652360515%\" valign=\"top\"\u003e\n \u003cp\u003e423 (22.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.447782546494993%\" valign=\"top\"\u003e\n \u003cp\u003e57 (12.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.88412017167382%\" valign=\"top\"\u003e\n \u003cp\u003e51 (21.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e155 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.872675250357654%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.608011444921317%\" valign=\"top\"\u003e\n \u003cp\u003eBrain Biomarkers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.59656652360515%\" valign=\"top\"\u003e\n \u003cp\u003e491 (25.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.447782546494993%\" valign=\"top\"\u003e\n \u003cp\u003e30 (6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.88412017167382%\" valign=\"top\"\u003e\n \u003cp\u003e3 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.590844062947067%\" valign=\"top\"\u003e\n \u003cp\u003e64 (8.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.872675250357654%\" valign=\"top\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eData are reported as n (% as valid percentage excluding missing values).\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u003c/strong\u003e \u0026ndash;\u0026nbsp;The Association between Cannulation and Composite Endpoint of Neurological Outcomes by Mixed-Logistic Regression Analyses. (N= 1560). Reference Group for Cannulation: Femoral Artery.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.229329173166924%\" rowspan=\"2\" valign=\"top\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"35.257410296411855%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAorta (n=503)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.513260530421217%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubclavian/Axillary Artery (n=397)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"28.6046511627907%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.186046511627907%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.441860465116278%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.767441860465116%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.12597200622084%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1.\u0026nbsp;\u003c/strong\u003eCrude model with variable \u0026ldquo;Arterial cannulation site\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.12908242612753%\" valign=\"top\"\u003e\n \u003cp\u003e1.33 (0.97-2.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.174183514774494%\" valign=\"top\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.351477449455675%\" valign=\"top\"\u003e\n \u003cp\u003e1.50 (1.05-2.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.219284603421462%\" valign=\"top\"\u003e\n \u003cp\u003e0.027\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.12597200622084%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2.\u0026nbsp;\u003c/strong\u003eModel 1 + Peripheral artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.12908242612753%\" valign=\"top\"\u003e\n \u003cp\u003e1.32 (0.96-1.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.174183514774494%\" valign=\"top\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.351477449455675%\" valign=\"top\"\u003e\n \u003cp\u003e1.49 (1.04-2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.219284603421462%\" valign=\"top\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.12597200622084%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 3.\u0026nbsp;\u003c/strong\u003eModel 2 + Stroke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.12908242612753%\" valign=\"top\"\u003e\n \u003cp\u003e1.33 (0.96-1.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.174183514774494%\" valign=\"top\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.351477449455675%\" valign=\"top\"\u003e\n \u003cp\u003e1.49 (1.04-2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.219284603421462%\" valign=\"top\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.12597200622084%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 4.\u0026nbsp;\u003c/strong\u003eModel 3 + interaction stroke*Peripheral artery disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.12908242612753%\" valign=\"top\"\u003e\n \u003cp\u003e1.33 (0.96-1.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.174183514774494%\" valign=\"top\"\u003e\n \u003cp\u003e0.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.351477449455675%\" valign=\"top\"\u003e\n \u003cp\u003e1.50 (1.04-2.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.219284603421462%\" valign=\"top\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.12597200622084%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 5.\u0026nbsp;\u003c/strong\u003eModel 3 +hypertension, dialysis, diabetes, preoperative cardiac arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.12908242612753%\" valign=\"top\"\u003e\n \u003cp\u003e1.34 (0.96-1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.174183514774494%\" valign=\"top\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.351477449455675%\" valign=\"top\"\u003e\n \u003cp\u003e1.45 (1.00-2.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.219284603421462%\" valign=\"top\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.12597200622084%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 6.\u0026nbsp;\u003c/strong\u003eModel 5 + Coronary artery bypass graft, aortic surgery, cardiopulmonary bypass time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.12908242612753%\" valign=\"top\"\u003e\n \u003cp\u003e1.38 (0.97-1.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.174183514774494%\" valign=\"top\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.351477449455675%\" valign=\"top\"\u003e\n \u003cp\u003e1.48 (1.00-2.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.219284603421462%\" valign=\"top\"\u003e\n \u003cp\u003e0.050\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.12597200622084%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 7.\u0026nbsp;\u003c/strong\u003eModel 6 + Implant timing, Cardiac arrest as indication for ECLS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.12908242612753%\" valign=\"top\"\u003e\n \u003cp\u003e1.46 (1.02-2.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.174183514774494%\" valign=\"top\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.351477449455675%\" valign=\"top\"\u003e\n \u003cp\u003e1.57 (1.06-2.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.219284603421462%\" valign=\"top\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are odds ratios (OR) with 95% confidence intervals (95% CI) for aortic or subclavian/axillary cannulation compared to femoral cannulation (as reference). A higher OR indicates an increased composite end-point of major neurological complications compared to femoral cannulation. CI, Confidence Interval. ECLS, Extracorporeal Life Support.\u003cem\u003e\u003c/em\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Supplementary Figure 1","content":"\u003cp\u003eSupplementary Figure 1 is not available with this version\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"critical-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cric","sideBox":"Learn more about [Critical Care](http://ccforum.biomedcentral.com/)","snPcode":"13054","submissionUrl":"https://submission.nature.com/new-submission/13054/3","title":"Critical Care","twitterHandle":"@Crit_Care","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Extracorporeal Membrane Oxygenation, Cardiac Surgery, Neurologic Complications, Cardiac arrest, stroke, ICH","lastPublishedDoi":"10.21203/rs.3.rs-4535505/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4535505/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Cerebral perfusion may change depending on arterial cannulation site and may affect the incidence of neurologic adverse events in post-cardiotomy extracorporeal life support (ECLS). The current study compares patients' neurologic outcomes with three commonly used arterial cannulation strategies (aortic [A] vs. subclavian/axillary [SA] vs. femoral [F] artery) to evaluate if each ECLS configuration is associated with different rates of neurologic complications. Methods: This retrospective, multicenter (34 centers), observational study included adults requiring post-cardiotomy ECLS between January 2000 and December 2020 present in the Post-Cardiotomy Extracorporeal Life Support (PELS) Study database. Patients with Aortic, Subclavian/Axillary and Femoral cannulation were compared on the incidence of a composite neurological end-point (ischemic stroke, cerebral hemorrhage, brain edema). Secondary outcomes were overall in-hospital mortality, neurologic complications as cause of in-hospital death, and post-operative minor neurologic complications (seizures and vasospasm). Association between cannulation and neurological outcomes were investigated through mixed-Cox proportional hazards models.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: This study included 1897 patients comprising 26.5% A (n=503), 20.9% SA (n=397) and 52.6% F (n=997) cannulations. The SA group featured a more frequent history of hypertension, smoking, diabetes, previous myocardial infarction, dialysis, peripheral artery disease and previous stroke. Neuro-monitoring was used infrequently in all groups. Major neurologic complications were more frequent in SA (A: n=79, 15.8%; SA: n=78, 19.6%,; F: n=118, 11.9%; p\u0026lt;0.001). Seizures were more common in SA (n=13, 3.4%) than A ( n=9, 1.8%) and F cannulation (n=12, 1.3%, p=0.036). In-hospital mortality was higher after A cannulation (A: n=344, 68.4%, SA: n=223, 56.2%, F: n=587, 58.9%, p\u0026lt;0.001), as shown by Kaplan-Meier curves, with more patients deceased during ECLS support. Anyhow, neurologic cause of death (A: n=12, 3.9%, SA: n=14, 6.6%, F: n=28, 5.0%, p=0.433) was similar.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: In this analysis of the PELS Study, SA was associated with higher rates of major neurologic complications and seizures. In-hospital mortality was higher after A cannulation, despite no significant differences in incidence of neurological cause of death in these patients. These results encourage vigilance for neurologic complications and neuromonitoring use in patients on ECLS, especially with SA cannulation.\u003c/p\u003e","manuscriptTitle":"Neurologic Complications in Patients Receiving Aortic vs Subclavian vs Femoral Arterial Cannulation for Post-cardiotomy Extracorporeal Life Support: Results of the PELS Observational Multicenter Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-02 17:27:38","doi":"10.21203/rs.3.rs-4535505/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-03T11:35:03+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-28T14:55:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-28T14:45:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-25T13:21:02+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-24T19:24:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96207626634716192624269849473570165375","date":"2024-06-19T07:00:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"71965232109502754105910465402677260553","date":"2024-06-18T20:17:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335135900392896986453225244248492995354","date":"2024-06-15T16:45:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225705185996286480536670324736343381218","date":"2024-06-13T22:12:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-13T16:18:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-10T13:52:18+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-10T13:51:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"Critical Care","date":"2024-06-05T16:46:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"critical-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cric","sideBox":"Learn more about [Critical Care](http://ccforum.biomedcentral.com/)","snPcode":"13054","submissionUrl":"https://submission.nature.com/new-submission/13054/3","title":"Critical Care","twitterHandle":"@Crit_Care","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f0f9909c-af80-4225-8fe5-b827cc315779","owner":[],"postedDate":"July 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-12T16:01:11+00:00","versionOfRecord":{"articleIdentity":"rs-4535505","link":"https://doi.org/10.1186/s13054-024-05047-2","journal":{"identity":"critical-care","isVorOnly":false,"title":"Critical Care"},"publishedOn":"2024-08-07 15:57:19","publishedOnDateReadable":"August 7th, 2024"},"versionCreatedAt":"2024-07-02 17:27:38","video":"","vorDoi":"10.1186/s13054-024-05047-2","vorDoiUrl":"https://doi.org/10.1186/s13054-024-05047-2","workflowStages":[]},"version":"v1","identity":"rs-4535505","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4535505","identity":"rs-4535505","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}