Use of left ventricle assist device in a pregnant woman with acute aortic and coronary dissections

Kolesár, Adrián; Sabol, František; Luczy, Ján; Bajmoczi, Milan

doi:10.1510/icvts.2010.238501

Cited by 12 publications

(6 citation statements)

References 5 publications

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“…The literature retrieval yielded 96 reports, comprising 85 case reports and 11 case series or original articles, with 122 patients . Mean patient age (n = 120) was 31.6 ± 4.7 years (range, 19–43 years; median, 31.5 years) on admission.…”

Section: Resultsmentioning

confidence: 99%

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Yuan

2013

Clinical Cardiology

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Aortic dissection (AoD) during pregnancy is a rare but lethal condition and highlights the need for extensive elucidation. The aim of this study is to reveal the risk factors for AoD during pregnancy and to compare the 2 main risk factors, Marfan syndrome and pregnancy itself in the previously healthy woman. The pregnant patients developed AoD at 31.7 ± 7.6 weeks of gestation. It occurred much earlier in the Marfan patients than in the previously healthy women (30.7 ± 8.6 weeks of gestation vs 34.4 ± 4.4 weeks of gestation, P = 0.0263). In the Marfan patients, AoD developed in 3 (3.2%), 15 (15.8%), and 43 (46.3%) patients in the 3 trimesters, respectively, compared with 31 of the previously healthy women, and only in the third trimester. The neonates of the Marfan patients had better Apgar scores at 1 and 5 minutes, lower intubation rates, and fewer stays in the neonatal intensive care unit than those of the previously healthy women. Marfan syndrome and pregnancy itself in the previously healthy woman were the 2 main risk factors responsible for the occurrence of AoD during pregnancy. Marfan patients may develop AoD at an early age and an early stage of pregnancy, probably due to the preexisting weakened aortic wall. Better outcomes for the surviving neonates of Marfan patients compared with neonates of the previously healthy women might be the result of the poor condition of Marfan patients causing a higher death rate for those fetuses.

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Section: Resultsmentioning

confidence: 99%

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Yuan

2013

Clinical Cardiology

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“…In some patients with significant ischemic myocardial dysfunction, successful use of mechanical circulatory support as a bridge to recovery has been reported. 11,12 Location of the intimal tear in the aortic arch or more distally was associated with reduced hospital survival. Lansman and colleagues 13 observed reduced short-and long-term survival in these patients, and found that they tended to be older, less likely to be male or present with aortic regurgitation, and more likely to present with rupture.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for hospital death after surgery for type A aortic dissection

Legras¹,

Bruzzi²,

Nakashima³

et al. 2012

Asian Cardiovasc Thorac Ann

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This study was undertaken to identify perioperative risk factors for hospital death in patients undergoing surgery for acute type A aortic dissection. Between 2000 and 2009, 101 consecutive patients underwent emergency surgery for acute type A aortic dissection. Four patients died before institution of cardiopulmonary bypass or completion of the procedure. In the remaining 97 (68 men; mean age, 63.4±16.7 years), proximal repair was performed using ascending aortic replacement with valve re-suspension in 52 (53.6%) and composite valve graft replacement in 44 (45.4%). Distal repair required hemi- or total arch replacement in 42 (43.3%) patients. Overall hospital mortality reached 25.8% (25/97 patients). Logistic regression analysis revealed that advanced age, location of an intimal tear in the arch or more distally, and preoperative coronary malperfusion were significant independent risk factors for hospital death. No procedure-related variables were significant risk factors. Current hospital mortality in patients undergoing emergency surgery for acute type A aortic dissection remains high, but seems to be mainly determined by preoperative variables. More aggressive proximal or distal repairs were not associated with increased mortality.

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“…Asakura et al report their experience in which 3 out of 9 patients survived using left sided mechanical support following repair of acute type A aortic dissection [1]. Kolesar et al similarly report the use of a left ventricular assist device in a pregnant woman with acute aortic dissection [4]. There is only one report of the successful utilisation of an RVAD in RV failure following an aortic dissection repair.…”

Section: Discussionmentioning

confidence: 99%

Right Ventricular Failure Following Acute Type A Aortic Dissection: An Alternative Strategy

Mashar¹,

Birla²,

Waterworth³

2019

WJCS

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Coronary malperfusion is a complication of aortic dissection, and can lead to ventricular failure. We report 2 cases of right ventricular (RV) failure, following aortic dissection, successfully bridged to recovery using right ventricular assist devices (RVADs). The first was a 54 year-old man, who had difficulty weaning from bypass due to a stunned RV following aortic root replacement. The second was a 34 year-old woman, who after replacement of the ascending aorta, suffered episodes of ventricular fibrillation (VF), and RV failure. Both had an RVAD implanted, allowing eventual recovery. We recommend more widespread use of VADs in such cases.

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Use of left ventricle assist device in a pregnant woman with acute aortic and coronary dissections

Cited by 12 publications

References 5 publications

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Aortic Dissection During Pregnancy: A Difficult Clinical Scenario

Risk factors for hospital death after surgery for type A aortic dissection

Right Ventricular Failure Following Acute Type A Aortic Dissection: An Alternative Strategy

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