Venoarterial Extracorporeal Membrane Oxygenation After Surgical Repair of Type A Aortic Dissection - 27/05/20

Doi : 10.1016/j.amjcard.2020.03.012

Giovanni Mariscalco, MD, PhD ^a,^⁎ , Antonio Fiore, MD ^b, Sigurdur Ragnarsson, MD, PhD ^c, Zein El-Dean, MRCS, LLM ^a, Kristján Jónsson, MD, PhD ^d, Magnus Dalén, MD, PhD ^e, Thomas Fux, MD ^e, Vito G. Ruggieri, MD, PhD ^f, Giuseppe Gatti, MD ^g, Tatu Juvonen, MD, PhD ^h,ⁱ, Svante Zipfel, MD ^j, Angelo M. Dell'Aquila, MD ^k, Andrea Perrotti, MD, PhD ^l, Karl Bounader, MD ^m, Nicla Settembre, MD, PhD ⁿ, Antonio Loforte, MD, PhD ^o, Ugolino Livi, MD ^p, Marek Pol, MD ^q, Cristiano Spadaccio, MD ^r, Matteo Pettinari, MD ^s, Daniel Reichart, MD ^j, Khalid Alkhamees, MD ^t, Henryk Welp, MD ^j, Daniele Maselli, MD ^u, Artur Lichtenberg, MD ^v, Fausto Biancari, MD, PhD ^h,^i,^z
the PC-ECMO group^⁎
Collaborators are listed in the supplemental material.
^a Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
^b Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France
^c Department of Cardiothoracic Surgery, University of Lund, Lund, Sweden
^d Department of Cardiac Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
^e Department of Molecular Medicine and Surgery, Department of Cardiac Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
^f Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
^g Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
^h Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
ⁱ Research Unit of Surgery, Anesthesiology and Critical Care, Faculty of Medicine, University of Oulu, Oulu, Finland
^j Hamburg University Heart Center, Hamburg, Germany
^k Department of Cardiothoracic Surgery, Münster University Hospital, Münster, Germany
^l Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
^m Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
ⁿ Department of Vascular Surgery, Nancy University Hospital, University of Lorraine, Nancy, France
^o Department of Cardiothoracic, Transplantation and Vascular Surgery, S. Orsola Hospital, University of Bologna, Bologna, Italy
^p Cardiothoracic Department, University Hospital of Udine, Udine, Italy
^q Institute of Clinical and Experimental Medicine, Prague, Czech Republic
^r Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
^s Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
^t Prince Sultan Cardiac Center, Al Hassa, Saudi Arabia
^u Cardiac Surgery, S. Anna Hospital, Catanzaro, Italy
^v Cardiovascular Surgery, University Hospital of Dusseldorf, Dusseldorf, Germany
^z Heart Center, Turku University Hospital and Department of Surgery, University of Turku, Finland

^⁎⁎Corresponding author: Tel: +44.01162583099.

Résumé

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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	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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Vol 125 - N° 12

P. 1901-1905 - juin 2020 Retour au numéro

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Venoarterial Extracorporeal Membrane Oxygenation After Surgical Repair of Type A Aortic Dissection - 27/05/20

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