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

Mariscalco, Giovanni ; Fiore, Antonio ; Ragnarsson, Sigurdur LU ; El-Dean, Zein ; Jónsson, Kristján ; Dalén, Magnus ; Fux, Thomas ; Ruggieri, Vito G. ; Gatti, Giuseppe and Juvonen, Tatu , et al. (2020) In American Journal of Cardiology 125(12). p.1901-1905
Abstract

Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support for postcardiotomy cardiogenic shock (PCS) in patients undergoing surgery for acute type A aortic dissection (TAAD) is controversial and the available evidence is confined to limited case series. We aimed to evaluate the impact of this salvage therapy in this patient population. Between January 2010 and March 2018, all TAAD patients receiving VA-ECMO for PCS were retrieved from the PC-ECMO registry. Hospital mortality and other secondary outcomes were compared with PCS patients undergoing surgery for other cardiac pathologies and treated with VA-ECMO. Among the 781 patients in the PC-ECMO registry, 62 (7.9%) underwent TAAD repair and required VA-ECMO support for PCS.... (More)

Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support for postcardiotomy cardiogenic shock (PCS) in patients undergoing surgery for acute type A aortic dissection (TAAD) is controversial and the available evidence is confined to limited case series. We aimed to evaluate the impact of this salvage therapy in this patient population. Between January 2010 and March 2018, all TAAD patients receiving VA-ECMO for PCS were retrieved from the PC-ECMO registry. Hospital mortality and other secondary outcomes were compared with PCS patients undergoing surgery for other cardiac pathologies and treated with VA-ECMO. Among the 781 patients in the PC-ECMO registry, 62 (7.9%) underwent TAAD repair and required VA-ECMO support for PCS. In-hospital mortality accounted for 46 (74.2%) patients, while 23 (37.1%) were successfully weaned from VA-ECMO. No significant differences were observed between the TAAD and non-TAAD cohorts with reference to in-hospital mortality (74.2% vs 63.4%, p = 0.089). However, patients in the TAAD group had a higher rate of neurological events (33.9% vs 17.6%, p = 0.002), but similar rates of reoperation for bleeding/tamponade (48.4% vs 41.5%, p = 0.29), transfusion of ≥10 red blood cell units (77.4% vs 69.5%, p = 0.19), new-onset dialysis (56.7% vs 53.1%, p = 0.56), and other secondary outcomes. VA-ECMO provides a valid support for patients affected by PCS after surgery for TAAD.

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organization
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type
Contribution to journal
publication status
published
subject
in
American Journal of Cardiology
volume
125
issue
12
pages
5 pages
publisher
Excerpta Medica
external identifiers
  • scopus:85083339015
  • pmid:32305219
ISSN
0002-9149
DOI
10.1016/j.amjcard.2020.03.012
language
English
LU publication?
yes
id
8dc39bf2-adaa-40db-a1a7-6b7c4aec3da2
date added to LUP
2020-05-11 16:05:52
date last changed
2024-06-13 16:40:49
@article{8dc39bf2-adaa-40db-a1a7-6b7c4aec3da2,
  abstract     = {{<p>Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) support for postcardiotomy cardiogenic shock (PCS) in patients undergoing surgery for acute type A aortic dissection (TAAD) is controversial and the available evidence is confined to limited case series. We aimed to evaluate the impact of this salvage therapy in this patient population. Between January 2010 and March 2018, all TAAD patients receiving VA-ECMO for PCS were retrieved from the PC-ECMO registry. Hospital mortality and other secondary outcomes were compared with PCS patients undergoing surgery for other cardiac pathologies and treated with VA-ECMO. Among the 781 patients in the PC-ECMO registry, 62 (7.9%) underwent TAAD repair and required VA-ECMO support for PCS. In-hospital mortality accounted for 46 (74.2%) patients, while 23 (37.1%) were successfully weaned from VA-ECMO. No significant differences were observed between the TAAD and non-TAAD cohorts with reference to in-hospital mortality (74.2% vs 63.4%, p = 0.089). However, patients in the TAAD group had a higher rate of neurological events (33.9% vs 17.6%, p = 0.002), but similar rates of reoperation for bleeding/tamponade (48.4% vs 41.5%, p = 0.29), transfusion of ≥10 red blood cell units (77.4% vs 69.5%, p = 0.19), new-onset dialysis (56.7% vs 53.1%, p = 0.56), and other secondary outcomes. VA-ECMO provides a valid support for patients affected by PCS after surgery for TAAD.</p>}},
  author       = {{Mariscalco, Giovanni and Fiore, Antonio and Ragnarsson, Sigurdur and El-Dean, Zein and Jónsson, Kristján and Dalén, Magnus and Fux, Thomas and Ruggieri, Vito G. and Gatti, Giuseppe and Juvonen, Tatu and Zipfel, Svante and Dell'Aquila, Angelo M. and Perrotti, Andrea and Bounader, Karl and Settembre, Nicla and Loforte, Antonio and Livi, Ugolino and Pol, Marek and Spadaccio, Cristiano and Pettinari, Matteo and Reichart, Daniel and Alkhamees, Khalid and Welp, Henryk and Maselli, Daniele and Lichtenberg, Artur and Biancari, Fausto}},
  issn         = {{0002-9149}},
  language     = {{eng}},
  month        = {{06}},
  number       = {{12}},
  pages        = {{1901--1905}},
  publisher    = {{Excerpta Medica}},
  series       = {{American Journal of Cardiology}},
  title        = {{Venoarterial Extracorporeal Membrane Oxygenation After Surgical Repair of Type A Aortic Dissection}},
  url          = {{http://dx.doi.org/10.1016/j.amjcard.2020.03.012}},
  doi          = {{10.1016/j.amjcard.2020.03.012}},
  volume       = {{125}},
  year         = {{2020}},
}