Severe Bronchospasm During Aortic Surgery for Type A Aortic Dissection

Severe bronchospasm during cardiopulmonary bypass is an unusual but potentially fatal event. No literature previously has reported such an event observed during surgery for type A aortic dissection. Herein, we report on a case of severe bronchospasm following cardiopulmonary bypass, during aortic surgery for type A aortic dissection. Bronchospasm did not respond to any conventional therapy, necessitating extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation thus serves as an alternative and effective therapy for refractory bronchospasm.

Download Full-text

Stanford Type A Aortic Dissection caused by veno-arterial extracorporeal membrane oxygenation

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.04.046 ◽

2021 ◽

Author(s):

Makoto Aoki ◽

Satomi Senoo ◽

Takaaki Mori ◽

Takuya Fukada ◽

Yoshiaki Kawai ◽

...

Keyword(s):

Aortic Dissection ◽

Extracorporeal Membrane Oxygenation ◽

Type A ◽

Type A Aortic Dissection ◽

Membrane Oxygenation

Download Full-text

Veno-Arterial Extracorporeal Membrane Oxygenation for Patients Undergoing Acute Type A Aortic Dissection Surgery: A Six-Year Experience

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.652527 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jun-yi Hou ◽

Chun-sheng Wang ◽

Hao Lai ◽

Yong-xin Sun ◽

Xin Li ◽

...

Keyword(s):

Aortic Dissection ◽

Extracorporeal Membrane Oxygenation ◽

Troponin T ◽

Type A ◽

Ecmo Support ◽

Acute Type ◽

Type A Aortic Dissection ◽

Membrane Oxygenation ◽

Creatine Kinase Mb ◽

Va Ecmo

Objectives: Acute type A aortic dissection (aTAAD) is usually lethal without emergency surgery. Although veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is widely used in patients with cardiogenic shock following cardiac surgery, VA-ECMO support following aTAAD surgery has not been well-described. Based on our 6-year experience, we aimed to retrospectively analyze risk factors, application and timing of VA-ECMO, and outcomes in aTAAD patients.Methods: In this retrospective, single-center study, we enrolled adult patients who underwent aTAAD surgery from January 2014 to December 2019 and were supported with VA-ECMO. Patients were divided into two groups according to whether or not they were successfully weaned from VA-ECMO. Preoperative, intraoperative and postoperative variables were assessed and analyzed. Outcomes of the patients were followed up until discharge.Results: Twenty-seven patients who received aTAAD surgery with VA-ECMO support were included in the study. Nine patients (33.3%) were successfully weaned from VA-ECMO. The median VA-ECMO support time and length of hospital stay in the successfully weaned group were significantly longer than in the group could not be successfully weaned (192 [111–327] vs. 55 [23–95] h, p < 0.01; 29 [18–40] vs. 4 [3–8] days, p < 0.01). Overall in-hospital mortality was 81.5%. The main causes of death were bleeding (37%), neurological complications (15%), and multiple organ dysfunction syndrome (15%). Preoperative levels of creatine kinase-MB (CK-MB) were lower in patients who were successfully weaned from VA-ECMO than in the failed group (14 [6–30] vs. 55 [28–138] U/L, p < 0.01). Postoperative peak levels of CK-MB, cardiac troponin T, lactate dehydrogenase, and lactate were significantly lower in the successful group than in the failed group.Conclusion: Postoperative VA-ECMO support was rarely used in aTAAD patients. Our study showed that VA-ECMO can be considered as a salvage treatment in aTAAD patients, despite the high rate of complications and mortality.

Download Full-text

Venoarterial Extracorporeal Membrane Oxygenation After Surgical Repair of Type A Aortic Dissection

The American Journal of Cardiology ◽

10.1016/j.amjcard.2020.03.012 ◽

2020 ◽

Vol 125 (12) ◽

pp. 1901-1905

Author(s):

Giovanni Mariscalco ◽

Antonio Fiore ◽

Sigurdur Ragnarsson ◽

Zein El-Dean ◽

Kristján Jónsson ◽

...

Keyword(s):

Aortic Dissection ◽

Extracorporeal Membrane Oxygenation ◽

Surgical Repair ◽

Type A ◽

Type A Aortic Dissection ◽

Membrane Oxygenation ◽

Venoarterial Extracorporeal Membrane Oxygenation

Download Full-text

Clinical outcomes of postoperative extracorporeal membrane oxygenation support in Stanford type a aortic dissection

BMC Anesthesiology ◽

10.1186/s12871-021-01252-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fudong Fan ◽

Qing Zhou ◽

Jun Pan ◽

Hailong Cao ◽

Kai Li ◽

...

Keyword(s):

Aortic Dissection ◽

Extracorporeal Membrane Oxygenation ◽

Clinical Outcomes ◽

Type A ◽

Ecmo Support ◽

Type A Aortic Dissection ◽

Membrane Oxygenation ◽

Va Ecmo ◽

Support Time

Abstract Background Extracorporeal membrane oxygenation (ECMO) support may be considered to reduce mortality but survival and clinical outcomes are uncertain after Stanford type A Aortic dissection (TAAD). We analyzed the data of TAAD patients with postoperative ECMO support in our institution to investigate clinical outcomes. Methods In this retrospective cohort study, all clinical data of TAAD patients with postoperative ECMO support from January 2013 to October 2019 in our institution were harvested. Cases with redo or incomplete records were excluded. Results 22 cases were enrolled, 18 male and 4 female. The mean age was52.85±10.91 years. 20 patients underwent VA-ECMO treatment and 2 patients received VV-ECMO support. The support time was92.54±78.71 hours. 9 patients were successfully weaned from ECMO. 30-day in-hospital survival rate was 27.27 % (6/22). The follow-up duration is from 5 to 74 months. The median follow-up time is 35 months. Only four patients were still alive at the end of the follow-up period. Conclusions The mortality of TAAD patients with postoperativesevere circulatory and respiratory dysfunctions is high. ECMO would be considered as a valuable contribution to save lives. But more experience needs to be accumulated to improve clinical outcome.

Download Full-text