Mortality rates in patients managed with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for postcardiotomy cardiogenic shock (PCS) were similar for acute type A aortic dissection (TAAD) vs surgeries for other conditions, according to study results published in the American Journal of Cardiology.
With only limited case series supporting the use of VA-ECMO in patients with PCS post-TAAD repair, the approach remains controversial in this setting.
In this international, multicenter, retrospective, observational study (ClinicalTrials.gov Identifier: NCT03508505), the data of 781 adult patients who received VA-ECMO for PCS between January 2010 and March 2018 were examined. Data were retrieved from the Postcardiotomy Veno-arterial Extracorporeal Membrane Oxygenation (PC-ECMO) registry. The study’s primary outcome was in-hospital mortality. Secondary endpoints included reoperation for bleeding/tamponade, death on VA-ECMO and other complications.
In this cohort, 62 patients (7.9%; mean age, 62.9±11.0 years; 27.4% women) underwent TAAD repair, and 719 patients (92.1%; mean age, 63.1±13.1 years; 32.2% women) had other cardiac surgeries. In the TAAD group, 23 patients (37.1%) were weaned off VA-ECMO successfully, and 46 (74.2%) died while in the hospital. The in-hospital mortality rate for the non-TAAD group was 63.4%.
After adjusting for the PC-ECMO score, rates were comparable in patients undergoing VA-ECMO after TAAD vs other surgeries for: in-hospital mortality (74.2% vs 63.4%, respectively; P =.089), repeat surgery for bleeding/tamponade (48.4% vs 41.5%, respectively ; P =.29), red blood cell transfusion of ≥10 units (77.4% vs 69.5%, respectively ; P =.19), renal failure (56.7% vs 53.1%, respectively ; P =.56), and other complications. The rates of neurological events (33.9% vs 17.6%, respectively; P =.002) and death on VA-ECMO (66.1% vs 45.8%, respectively; P =.002) were higher in the TAA vs non-TAAD group.
Study limitations include its observational design, and small sample size.
“[O]ur cohort is currently the largest available series and provides new data on the potential benefits of using VA-ECMO in [patients with] TAAD affected by postoperative PCS,” noted the authors.
Mariscalco G, Fiore A, Ragnarsson S, et al. Venoarterial extracorporeal membrane oxygenation after surgical repair of type A aortic dissection. Am J Cardiol. March 2020. doi:10.1016/j.amjcard.2020.03.012