Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Department of Cardiothoracic Surgery, Henri Mondor University Hospital, AP-HP, Paris-Est University, Créteil, France.
Am J Cardiol. 2020 Jun 15;125(12):1901-1905. doi: 10.1016/j.amjcard.2020.03.012. Epub 2020 Mar 31.
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 VA-ECMO. 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.
体外膜肺氧合（ECMO）在接受急性A型主动脉夹层（TAAD）手术的患者中用于手术后心源性休克（PCS）的静脉动脉（VA）支持存在争议，并且可用的证据仅限于有限的病例系列。我们旨在评估这种抢救治疗在该患者群体中的影响。在 2010 年 1 月至 2018 年 3 月期间，从 PC-ECMO 登记处检索到所有接受 VA-ECMO 治疗 PCS 的 TAAD 患者。比较了医院死亡率和其他次要结局与接受 VA-ECMO 治疗其他心脏病变并接受手术治疗的 PCS 患者。在 PC-ECMO 登记处的 781 名患者中，62 名（7.9%）接受了 TAAD 修复，并因 PCS 需要 VA-ECMO 支持。院内死亡率为 46 例（74.2%），其中 23 例（37.1%）成功撤离 VA-ECMO。TAAD 组和非-TAAD 组在院内死亡率方面无显著差异（74.2%比 63.4%，p=0.089）。然而，TAAD 组的神经系统事件发生率更高（33.9%比 17.6%，p=0.002），但出血/填塞再手术率相似（48.4%比 41.5%，p=0.29），输注≥10 个单位红细胞（77.4%比 69.5%，p=0.19），新发透析（56.7%比 53.1%，p=0.56）和其他次要结局。VA-ECMO 为接受 TAAD 手术后发生 PCS 的患者提供了有效的支持。
