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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Article info
Publication history
Published online: March 31, 2020
Footnotes
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
Trial Registration: Clinicaltrials.gov - NCT03508505
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