Venoarterial Extracorporeal Membrane Oxygenation After Surgical Repair of Type A Aortic Dissection

Mariscalco, Giovanni; Fiore, Antonio; Ragnarsson, Sigurður; El-Dean, Zein; Jónsson, Kristján; Dalén, Magnus; Fux, Thomas; Ruggieri, Vito Giovanni; Gatti, Giuseppe; Juvonen, Tatu; Zipfel, S.; Perrotti, Andréa; Bounader, Karl; Settembre, Nicla; Loforte, Antonio; Livi, Ugolino; Pol, Marek; Spadaccio, Cristiano; Pettinari, Matteo; Reichart, Daniel; Alkhamees, Khalid; Welp, Henryk; Maselli, Daniele; Lichtenberg, Artur; Biancari, Fausto

doi:10.1016/j.amjcard.2020.03.012

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…The results showed that the combined use of VA-ECMO and IABP could be a feasible and effective strategy for managing postoperative cardiogenic shock in AAD patients, although the in-hospital mortality rate was high. The high mortality rate observed in our study is consistent with previous reports, indicating that postoperative cardiogenic shock in AAD patients is a severe condition with high mortality [ 2 , 4 , 5 , 7 – 10 ]. However, it is noteworthy that among the six patients who received VA-ECMO plus IABP in the operating room due to difficulty weaning from the CPB, four were successfully weaned from VA-ECMO, and three survived until now with a mean follow-up of 20 months.…”

Section: Discussionsupporting

confidence: 93%

Effectiveness of VA-ECMO plus intra-aortic balloon pump for cardiac shock in patients with type A aortic dissection: a case series

Wu,

Chen,

Wei

et al. 2023

J Cardiothorac Surg

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Limited reports exist on the utilization of venoarterial extracorporeal membrane oxygenation (VA-ECMO) following aortic dissection surgery, possibly due to concerns regarding complications. This case series aimed to evaluate the effectiveness and safety of using VA-ECMO in combination with intra-aortic balloon pump (IABP) for managing postoperative cardiogenic shock in patients with type A aortic dissection (AAD). The study included nine patients with an average age of 57.0 ± 9.5 years. The patients underwent various surgical procedures, including coronary artery bypass grafting (CABG) and aortic root reconstruction. The results showed that the combined use of VA-ECMO and IABP was feasible and effective in managing postoperative cardiogenic shock in AAD patients. However, the in-hospital mortality rate was high, with six out of nine patients succumbing to the condition. Among the patients who received VA-ECMO plus IABP in the operating room, four were successfully weaned from VA-ECMO, and three survived with a mean follow-up of 20 months. The study also highlighted the potential risks of renal complications associated with VA-ECMO and IABP. The findings suggest that the combined therapy of VA-ECMO and IABP may be beneficial for patients who have difficulty weaning from cardiopulmonary bypass (CPB) after AAD surgery.

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Section: Discussionsupporting

confidence: 93%

Effectiveness of VA-ECMO plus intra-aortic balloon pump for cardiac shock in patients with type A aortic dissection: a case series

Wu,

Chen,

Wei

et al. 2023

J Cardiothorac Surg

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“…VA-ECMO can provide temporary mechanical circulatory support and allow time for etiological treatment (6). Previous studies have shown that the in-hospital mortality of patients who receive VA-ECMO assistance after aTAAD surgery is still high (Table 4) (17)(18)(19)(20). Nevertheless, there have been no randomized controlled studies.…”

Section: Discussionmentioning

confidence: 99%

Veno-Arterial Extracorporeal Membrane Oxygenation for Patients Undergoing Acute Type A Aortic Dissection Surgery: A Six-Year Experience

Hou

Wang

Lai

et al. 2021

Front. Cardiovasc. Med.

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Objectives: Acute type A aortic dissection (aTAAD) is usually lethal without emergency surgery. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in patients with cardiogenic shock following cardiac surgery, VA-ECMO support following aTAAD surgery has not been well-described. Based on our 6-year experience, we aimed to retrospectively analyze risk factors, application and timing of VA-ECMO, and outcomes in aTAAD patients.Methods: In this retrospective, single-center study, we enrolled adult patients who underwent aTAAD surgery from January 2014 to December 2019 and were supported with VA-ECMO. Patients were divided into two groups according to whether or not they were successfully weaned from VA-ECMO. Preoperative, intraoperative and postoperative variables were assessed and analyzed. Outcomes of the patients were followed up until discharge.Results: Twenty-seven patients who received aTAAD surgery with VA-ECMO support were included in the study. Nine patients (33.3%) were successfully weaned from VA-ECMO. The median VA-ECMO support time and length of hospital stay in the successfully weaned group were significantly longer than in the group could not be successfully weaned (192 [111–327] vs. 55 [23–95] h, p < 0.01; 29 [18–40] vs. 4 [3–8] days, p < 0.01). Overall in-hospital mortality was 81.5%. The main causes of death were bleeding (37%), neurological complications (15%), and multiple organ dysfunction syndrome (15%). Preoperative levels of creatine kinase-MB (CK-MB) were lower in patients who were successfully weaned from VA-ECMO than in the failed group (14 [6–30] vs. 55 [28–138] U/L, p < 0.01). Postoperative peak levels of CK-MB, cardiac troponin T, lactate dehydrogenase, and lactate were significantly lower in the successful group than in the failed group.Conclusion: Postoperative VA-ECMO support was rarely used in aTAAD patients. Our study showed that VA-ECMO can be considered as a salvage treatment in aTAAD patients, despite the high rate of complications and mortality.

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“…There were 781 patients and 242 variables in the registry from 19 cardiac centers in different European and Arabian countries. The purpose of the registry was to gather data on this mechanical circulatory support treatment from many sites in order to evaluate its efficacy and outcome 1,[9][10][11][12][13][14][15][16][17] . Each participating center collected data and entered them into a Microsoft® Access database.…”

Section: The Pc-ecmo Study Cohortmentioning

confidence: 99%

Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation With and Without Intra-Aortic Balloon Pump

Björnsdóttir

Biancari

Dalén

et al. 2022

Journal of Cardiothoracic and Vascular Anesthesia

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Venoarterial Extracorporeal Membrane Oxygenation After Surgical Repair of Type A Aortic Dissection

Cited by 7 publications

References 15 publications

Effectiveness of VA-ECMO plus intra-aortic balloon pump for cardiac shock in patients with type A aortic dissection: a case series

Effectiveness of VA-ECMO plus intra-aortic balloon pump for cardiac shock in patients with type A aortic dissection: a case series

Veno-Arterial Extracorporeal Membrane Oxygenation for Patients Undergoing Acute Type A Aortic Dissection Surgery: A Six-Year Experience

Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation With and Without Intra-Aortic Balloon Pump

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