Use of Extracorporeal Membrane Oxygenation Support in Adult Aortic Surgery

Purpose Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used for post-cardiotomy shock (PCS). Its application to post-aortic surgical patients is challenging. We report our experience of VA-ECMO support for PCS following aortic surgery. Methods A total of 126 adult patients required VA-ECMO for PCS from Jan 2007 to Feb 2017. Of this group, 27 patients underwent aortic surgery (Group AO). Outcomes were examined, as well as risk factors for mortality, and this group was compared to those requiring ECMO for PCS following coronary artery bypass graft (CABG) and/or valve procedures (Group CV, n=65). Results Fifteen patients had acute type A aortic dissection and 6 had ascending and/or root aneurysm. Root replacement was performed in 13 patients, ascending in 11, and arch replacement 2, with concomitant procedures in 17 patients. Mean cardiopulmonary bypass time was 280±125 minutes and mean aortic cross-clamp time was 153±79 minutes. In-hospital mortality was 51.8%. Significant bleeding, new hemodialysis requirement, and neurological complications occurred in 59%, 37%, and 11% of patients, respectively. Risk factors for in-hospital mortality in logistic regression analysis included coronary artery disease (OR 7.3, 95% CI 1.3-60.3, p=0.034), aortic cross-clamp time >150 minutes (OR 6.0, 95% CI 1.2-41.1, p=0.048), lactate > 6 mg/dL at 24 hours post-ECMO initiation (OR 12.0, 95% CI 1.6-255.6, p=0.037) and bleeding complication (OR 5.9, 95% CI 1.2-37, p=0.041). Compared to Group CV, Group AO had significantly longer bypass and cross-clamp times, and a greater proportion of patients underwent ECMO cannulation via the axillary artery. In-hospital mortality was not significantly different (51.8% vs. 63.1%, p=0.356). Conclusion ECMO support for aortic surgical patients provides survival comparable to that for CABG and/or valve patients. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used for post-cardiotomy shock (PCS). Its application to post-aortic surgical patients is challenging. We report our experience of VA-ECMO support for PCS following aortic surgery. A total of 126 adult patients required VA-ECMO for PCS from Jan 2007 to Feb 2017. Of this group, 27 patients underwent aortic surgery (Group AO). Outcomes were examined, as well as risk factors for mortality, and this group was compared to those requiring ECMO for PCS following coronary artery bypass graft (CABG) and/or valve procedures (Group CV, n=65). Fifteen patients had acute type A aortic dissection and 6 had ascending and/or root aneurysm. Root replacement was performed in 13 patients, ascending in 11, and arch replacement 2, with concomitant procedures in 17 patients. Mean cardiopulmonary bypass time was 280±125 minutes and mean aortic cross-clamp time was 153±79 minutes. In-hospital mortality was 51.8%. Significant bleeding, new hemodialysis requirement, and neurological complications occurred in 59%, 37%, and 11% of patients, respectively. Risk factors for in-hospital mortality in logistic regression analysis included coronary artery disease (OR 7.3, 95% CI 1.3-60.3, p=0.034), aortic cross-clamp time >150 minutes (OR 6.0, 95% CI 1.2-41.1, p=0.048), lactate > 6 mg/dL at 24 hours post-ECMO initiation (OR 12.0, 95% CI 1.6-255.6, p=0.037) and bleeding complication (OR 5.9, 95% CI 1.2-37, p=0.041). Compared to Group CV, Group AO had significantly longer bypass and cross-clamp times, and a greater proportion of patients underwent ECMO cannulation via the axillary artery. In-hospital mortality was not significantly different (51.8% vs. 63.1%, p=0.356). ECMO support for aortic surgical patients provides survival comparable to that for CABG and/or valve patients.