Wang Yong, Piao Hulin, Li Bo, Wang Weitei, Huang Maoxun, Zhu Zhicheng, Li Dan, Wang Tiance, Liu Kexiang
Department of Cardiovascular Surgery, Second Hospital of Jilin University, Jilin University.
Int Heart J. 2019 Jul 27;60(4):845-848. doi: 10.1536/ihj.18-496. Epub 2019 Jul 12.
The aim of this study was to summarize the clinical experience of postoperative extracorporeal membrane oxygenation (ECMO) support in Stanford type A aortic dissection (STAAD) patients.We retrospectively reviewed 246 consecutive acute STAAD patients undergoing operations at our institution from January 2012 to December 2016. Postoperative ECMO was used in 7 patients. There were 5 males and 2 females with a mean age of 43.1 ± 9.3 years. All 7 patients with acute STAAD underwent ascending aorta replacement and total arch repair with a self-designed stent graft (Micropart Corp, Shanghai, China). Concomitant procedures were aortic root replacement in 1 patient and coronary artery bypass grafting (CABG) in 2 patients. All patients received veno-arterial ECMO through the femoral artery and vein. Five patients were extubated before being removed from ECMO. The mean ECMO supporting time was 244.5 ± 57.8 hours. All 7 patients were successfully weaned from ECMO support, and 6 (85.7%) patients survived to discharge. The average hospital time was 26.3 ± 8.8 days. One patient died of cardiac arrest after being weaned from ECMO. Two patients underwent reoperation for bleeding and 1 patient showed transient delirium. The remaining patients all survived during a median follow-up of 19 months.ECMO provides a good temporary cardiopulmonary support in STAAD patients with refractory cardiogenic shock after surgery for aortic dissection. The early use of ECMO and preventing its complications actively can improve the patient survival rate.
本研究的目的是总结体外膜肺氧合（ECMO）支持在斯坦福A型主动脉夹层（STAAD）患者术后的临床经验。我们回顾性分析了2012年1月至2016年12月在我院连续接受手术的246例急性STAAD患者。7例患者术后使用了ECMO。其中男性5例，女性2例，平均年龄43.1±9.3岁。所有7例急性STAAD患者均接受了升主动脉置换和全弓修复，采用自行设计的支架型人工血管（中国上海微创医疗器械（集团）有限公司）。1例患者同时进行了主动脉根部置换，2例患者同时进行了冠状动脉旁路移植术（CABG）。所有患者均通过股动脉和股静脉接受静脉-动脉ECMO。5例患者在撤离ECMO前拔除气管插管。平均ECMO支持时间为244.5±57.8小时。所有7例患者均成功撤离ECMO支持，6例（85.7%）患者存活出院。平均住院时间为26.3±8.8天。1例患者在撤离ECMO后死于心脏骤停。2例患者因出血接受了再次手术，1例患者出现短暂谵妄。其余患者在中位随访19个月期间均存活。ECMO为主动脉夹层手术后出现难治性心源性休克的STAAD患者提供了良好的临时心肺支持。早期使用ECMO并积极预防其并发症可提高患者生存率。
