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.

Cardiac Surgery S Anna Hospital Catanzaro Italy

Cardiothoracic Department University Hospital of Udine Udine Italy

Cardiovascular Surgery University Hospital of Dusseldorf Dusseldorf Germany

Department of Cardiac Surgery Glenfield Hospital University Hospitals of Leicester NHS Trust Leicester United Kingdom

Department of Cardiac Surgery Sahlgrenska University Hospital Gothenburg Sweden

Department of Cardiothoracic Surgery Golden Jubilee National Hospital Glasgow United Kingdom

Department of Cardiothoracic Surgery Henri Mondor University Hospital AP HP Paris Est University Créteil France

Department of Cardiothoracic Surgery Münster University Hospital Münster Germany

Department of Cardiothoracic Surgery University of Lund Lund Sweden

Department of Cardiothoracic Transplantation and Vascular Surgery S Orsola Hospital University of Bologna Bologna Italy

Department of Cardiovascular Surgery Ziekenhuis Oost Limburg Genk Belgium

Department of Molecular Medicine and Surgery Department of Cardiac Surgery Karolinska Institutet Karolinska University Hospital Stockholm Sweden

Department of Thoracic and Cardio Vascular Surgery University Hospital Jean Minjoz Besançon France

Department of Vascular Surgery Nancy University Hospital University of Lorraine Nancy France

Division of Cardiac Surgery Ospedali Riuniti Trieste Italy

Division of Cardiothoracic and Vascular Surgery Pontchaillou University Hospital Rennes France

Division of Cardiothoracic and Vascular Surgery Robert Debré University Hospital Reims France

Hamburg University Heart Center Hamburg Germany

Heart and Lung Center Helsinki University Hospital Helsinki Finland; Research Unit of Surgery Anesthesiology and Critical Care Faculty of Medicine University of Oulu Oulu Finland

Heart and Lung Center Helsinki University Hospital Helsinki Finland; Research Unit of Surgery Anesthesiology and Critical Care Faculty of Medicine University of Oulu Oulu Finland; Heart Center Turku University Hospital and Department of Surgery University of Turku Finland

Institute of Clinical and Experimental Medicine Prague Czech Republic

Prince Sultan Cardiac Center Al Hassa Saudi Arabia

Citace poskytuje Crossref.org

Zobrazit více v PubMed

ClinicalTrials.gov
NCT03508505