Sultan Ibrahim, Habertheuer Andreas, Wallen Tyler, Siki Mary, Szeto Wilson, Bavaria Joseph E, Williams Matthew, Vallabhajosyula Prashanth
Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
J Card Surg. 2017 Dec;32(12):822-825. doi: 10.1111/jocs.13245. Epub 2017 Dec 7.
Patients presenting with type A aortic dissection (TAAD) present with a wide clinical spectrum ranging from hemodynamic stability to multiorgan malperfusion with cardiovascular collapse. Extracorporeal membrane oxygenator (ECMO) therapy is increasingly being utilized as salvage therapy in patients with acute cardiopulmonary failure and for post-cardiotomy shock. We sought to determine the utility of ECMO implementation post-TAAD repair.
The Pennsylvania Health Care Cost Containment Council (PHC4) database, maintained by an independently functioning state agency, was retrospectively reviewed from 2004 to 2014. Patients with a primary diagnosis of aortic dissection requiring ECMO support during the same hospital visit were included in the analysis.
Thirty-nine patients were identified with diagnosis/procedure codes for TAAD repair and ECMO, of which four patients did not undergo TAAD repair. Of the remaining 35, 31 patients underwent open repair, and four patients underwent TEVAR. ECMO was instituted on the same day of TAAD surgery in 27 (69.2%) patients, and on post-operative day >1 in eight (20.5%) patients. Overall mortality in patients who were on ECMO the same day was 88.9% and 87.5% when it was done after the first post-operative day. All four patients with TAAD who underwent ECMO only died. Median time from ECMO implantation to death was 1.0 day.
Requirement for ECMO support in acute aortic dissection is associated with extremely high mortality irrespective of when the intervention is performed.
A型主动脉夹层（TAAD）患者临床表现范围广泛，从血流动力学稳定到多器官灌注不良伴心血管衰竭。体外膜肺氧合（ECMO）治疗越来越多地被用作急性心肺衰竭患者和心脏手术后休克患者的挽救治疗。我们试图确定TAAD修复术后实施ECMO的效用。
对由一个独立运作的州机构维护的宾夕法尼亚医疗保健成本控制委员会（PHC4）数据库进行回顾性分析，时间跨度为2004年至2014年。分析纳入在同一次住院期间初次诊断为主动脉夹层且需要ECMO支持的患者。
确定了39例有TAAD修复和ECMO诊断/手术编码的患者，其中4例未接受TAAD修复。在其余35例中，31例接受了开放修复，4例接受了腔内修复术（TEVAR）。27例（69.2%）患者在TAAD手术当天开始使用ECMO，8例（20.5%）患者在术后第1天之后开始使用。在手术当天使用ECMO的患者总体死亡率为88.9%，术后第1天之后使用的患者总体死亡率为87.5%。仅接受ECMO治疗的4例TAAD患者均死亡。从植入ECMO到死亡的中位时间为1.0天。
急性主动脉夹层患者对ECMO支持的需求与极高的死亡率相关，无论何时进行干预。
