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

Autor: Angelo M. Dell’Aquila, Daniele Maselli, Fausto Biancari, Ugolino Livi, Antonio Loforte, Matteo Pettinari, Tatu Juvonen, Artur Lichtenberg, Cristiano Spadaccio, Giovanni Mariscalco, Daniel Reichart, Vito G. Ruggieri, Karl Bounader, Andrea Perrotti, Nicla Settembre, Sigurdur Ragnarsson, Giuseppe Gatti, Magnus Dalén, Thomas Fux, Antonio Fiore, Kristján Jónsson, Henryk Welp, Zein El-Dean, S. Zipfel, Marek Pol, Khalid Alkhamees
Přispěvatelé: HUS Heart and Lung Center, III kirurgian klinikka, Clinicum, Department of Surgery, HUS Abdominal Center
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
SURGERY
medicine.medical_treatment
Operative Time
Salvage therapy
Heart failure
Hospital mortality
030204 cardiovascular system & hematology
ECMO
ECLS
Postcardiotomy
03 medical and health sciences
0302 clinical medicine
Extracorporeal Membrane Oxygenation
Postoperative Complications
Internal medicine
SUPPORT
Extracorporeal membrane oxygenation
Medicine
Humans
Hospital Mortality
Registries
Dialysis
Aged
RISK
Surgical repair
Aortic dissection
Salvage Therapy
STATEMENT
business.industry
Cardiogenic shock
Cardiac surgery
Middle Aged
3126 Surgery
anesthesiology
intensive care
radiology
medicine.disease
3. Good health
Surgery
Aortic Dissection
surgical procedures
operative
030228 respiratory system
Cardiology
Female
Tamponade
Cardiology and Cardiovascular Medicine
business
Zdroj: The American journal of cardiology. 125(12)
ISSN: 1879-1913
Popis: 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 VAECMO. 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. (C) 2020 Elsevier Inc. All rights reserved.
Databáze: OpenAIRE
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