Extracorporeal membrane oxygenation for post-aortic surgery: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAN Shujie ¹ , ZHOU Chun ¹ , LIU Gang ¹ , GAO Sizhe ¹ , QI Jiachen ¹ , YU Cuntao ² , CHEN Zujun ³ , JI Bingyang ¹ ,  LOU Song ¹

1. Department of Extracorporeal Circulation, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
2. Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;
3. Department of Surgical ICU, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding author：

LOU Song, Email: lousongfw@163.com

Keywords：

Aortic dissection; extracorporeal membrane oxygenation; aortic surgery

DOI：

10.7507/1007-4848.202209027

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Abstract Full text Figures/Tables Video References Cited by

Objective To describe the outcomes of extracorporeal membrane oxygenation (ECMO) for patients after aortic surgery and to summarize the experience. Methods The clinical data of patients who received ECMO support after aortic surgery in Fuwai Hospital from 2009 to 2020 were retrospectively analyzed. The patients who received an aortic dissection surgery were allocated into a dissection group, and the other patients were allocated into a non-dissection group. The in-hospital and follow-up survival rates were compared between the two groups, and the causes of death were analyzed. Results A total of 22 patients were enrolled, including 17 patients in the dissection group [13 males and 4 females, with a median age of 54 (46, 61) years] and 5 patients in the non-dissection group [3 males and 2 females, with a median age of 51 (41, 65) years]. There was no statistical difference in the age and gender between the two groups (P>0.05). The in-hospital survival rate (11.8% vs. 100.0%, P=0.001) and follow-up survival rate (11.8% vs. 80.0%, P=0.009) of the patients in the dissection group were significantly lower than those in the non-dissection group. The causes of death in the dissection group included massive bleeding and disseminated intravascular coagulation (3 patients), ventricular thrombosis (1 patient), irreversible brain injury (2 patients), visceral malperfusion syndrome (4 patients) and irreversible heart failure (5 patients). Conclusion ECMO after aortic dissection surgery is associated with high mortality, which is related to the pathological features of aortic dissection and severely disrupted coagulation system after the surgery. For these patients, strict indication selection and optimal management strategy are important.

Citation： YAN Shujie, ZHOU Chun, LIU Gang, GAO Sizhe, QI Jiachen, YU Cuntao, CHEN Zujun, JI Bingyang, LOU Song. Extracorporeal membrane oxygenation for post-aortic surgery: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 751-756. doi: 10.7507/1007-4848.202209027 Copy

1.	Lorusso R, Whitman G, Milojevic M, et al. 2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients. J Thorac Cardiovasc Surg, 2021, 161(4): 1287-1331.
2.	Huang D, Xu A, Guan Q, et al. Venoarterial extracorporeal membrane oxygenation with intra-aortic balloon pump for postcardiotomy cardiogenic shock: A systematic review and meta-analysis. Perfusion, 2023, 38(1):142-149.
3.	Lin TW, Tsai MT, Hu YN, et al. Postoperative extracorporeal membrane oxygenation support for acute type A aortic dissection. Ann Thorac Surg, 2017, 104(3): 827-833.
4.	Sultan I, Habertheuer A, Wallen T, et al. The role of extracorporeal membrane oxygenator therapy in the setting of type A aortic dissection. J Card Surg, 2017, 32(12): 822-825.
5.	Mariscalco G, Fiore A, Ragnarsson S, et al. Venoarterial extracorporeal membrane oxygenation after surgical repair of type A aortic dissection. Am J Cardiol, 2020, 125(12): 1901-1905.
6.	Wang Y, Piao H, Li B, et al. Extracorporeal membrane oxygenation in stanford type A aortic dissection. Int Heart J, 2019, 60(4): 845-848.
7.	Fan F, Zhou Q, Pan J, et al. Clinical outcomes of postoperative extracorporeal membrane oxygenation support in Stanford type A aortic dissection. BMC Anesthesiol, 2021, 21(1): 35.
8.	Hou JY, Wang CS, Lai H, et al. Veno-arterial extracorporeal membrane oxygenation for patients undergoing acute type A aortic dissection surgery: A six-year experience. Front Cardiovasc Med, 2021, 8: 652527.
9.	Doguet F, Vierne C, Leguillou V, et al. Place of extracorporeal membrane oxygenation in acute aortic dissection. Interact Cardiovasc Thorac Surg, 2010, 11(5): 708-710.
10.	Bonacchi M, Cabrucci F, Bugetti M, et al. Outcomes' predictors in post-cardiac surgery extracorporeal life support. An observational prospective cohort study. Int J Surg, 2020, 82: 56-63.
11.	Yang B, Norton EL, Rosati CM, et al. Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience. J Thorac Cardiovasc Surg, 2019, 158(3): 675-687.
12.	Renaudier M, de Roux Q, Bougouin W, et al. Acute mesenteric ischaemia in refractory shock on veno-arterial extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care, 2020, 10(1): 62-70.
13.	Anselmi A, Guinet P, Ruggieri VG, et al. Safety of recombinant factor Ⅶa in patients under extracorporeal membrane oxygenation. Eur J Cardiothorac Surg, 2016, 49(1): 78-84.
14.	Mariscalco G, Salsano A, Fiore A, et al. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis. J Thorac Cardiovasc Surg, 2020, 160(5): 1207-1216.
15.	Zhong Z, Jiang C, Yang F, et al. Veno-arterial extracorporeal membrane oxygenation support in patients undergoing aortic surgery. Artif Organs, 2017, 41(12): 1113-1120.

1. Lorusso R, Whitman G, Milojevic M, et al. 2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients. J Thorac Cardiovasc Surg, 2021, 161(4): 1287-1331.
2. Huang D, Xu A, Guan Q, et al. Venoarterial extracorporeal membrane oxygenation with intra-aortic balloon pump for postcardiotomy cardiogenic shock: A systematic review and meta-analysis. Perfusion, 2023, 38(1):142-149.
3. Lin TW, Tsai MT, Hu YN, et al. Postoperative extracorporeal membrane oxygenation support for acute type A aortic dissection. Ann Thorac Surg, 2017, 104(3): 827-833.
4. Sultan I, Habertheuer A, Wallen T, et al. The role of extracorporeal membrane oxygenator therapy in the setting of type A aortic dissection. J Card Surg, 2017, 32(12): 822-825.
5. Mariscalco G, Fiore A, Ragnarsson S, et al. Venoarterial extracorporeal membrane oxygenation after surgical repair of type A aortic dissection. Am J Cardiol, 2020, 125(12): 1901-1905.
6. Wang Y, Piao H, Li B, et al. Extracorporeal membrane oxygenation in stanford type A aortic dissection. Int Heart J, 2019, 60(4): 845-848.
7. Fan F, Zhou Q, Pan J, et al. Clinical outcomes of postoperative extracorporeal membrane oxygenation support in Stanford type A aortic dissection. BMC Anesthesiol, 2021, 21(1): 35.
8. Hou JY, Wang CS, Lai H, et al. Veno-arterial extracorporeal membrane oxygenation for patients undergoing acute type A aortic dissection surgery: A six-year experience. Front Cardiovasc Med, 2021, 8: 652527.
9. Doguet F, Vierne C, Leguillou V, et al. Place of extracorporeal membrane oxygenation in acute aortic dissection. Interact Cardiovasc Thorac Surg, 2010, 11(5): 708-710.
10. Bonacchi M, Cabrucci F, Bugetti M, et al. Outcomes' predictors in post-cardiac surgery extracorporeal life support. An observational prospective cohort study. Int J Surg, 2020, 82: 56-63.
11. Yang B, Norton EL, Rosati CM, et al. Managing patients with acute type A aortic dissection and mesenteric malperfusion syndrome: A 20-year experience. J Thorac Cardiovasc Surg, 2019, 158(3): 675-687.
12. Renaudier M, de Roux Q, Bougouin W, et al. Acute mesenteric ischaemia in refractory shock on veno-arterial extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care, 2020, 10(1): 62-70.
13. Anselmi A, Guinet P, Ruggieri VG, et al. Safety of recombinant factor Ⅶa in patients under extracorporeal membrane oxygenation. Eur J Cardiothorac Surg, 2016, 49(1): 78-84.
14. Mariscalco G, Salsano A, Fiore A, et al. Peripheral versus central extracorporeal membrane oxygenation for postcardiotomy shock: Multicenter registry, systematic review, and meta-analysis. J Thorac Cardiovasc Surg, 2020, 160(5): 1207-1216.
15. Zhong Z, Jiang C, Yang F, et al. Veno-arterial extracorporeal membrane oxygenation support in patients undergoing aortic surgery. Artif Organs, 2017, 41(12): 1113-1120.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Extracorporeal membrane oxygenation for post-aortic surgery: A retrospective study in a single center

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