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Place of extracorporeal membrane oxygenation in acute aortic dissection
Fabien Doguet1, Caroline Vierne, Vincent Leguillou
1Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, 1 rue de Germont, 76000 Rouen, France. fabien.doguet@chu-rouen.fr
Insights
Coronary artery dissection (CAD) is a rare complication of type A aortic dissection (AD). This report details the first successful use of extracorporeal membranous oxygenation for AD with CAD and major arrhythmias.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Diseases
Background:
- Coronary artery dissection (CAD) is a serious complication of type A aortic dissection (AD).
- Treatment typically involves surgical repair and bypass grafting.
- No reported cases exist of AD with CAD and major arrhythmias requiring assisted circulation.
Observation:
- A patient with type A aortic dissection and coronary artery dissection presented with major arrhythmias.
- Cardiotomy was performed during surgical repair.
- Extracorporeal membranous oxygenation (ECMO) was implemented for circulatory support.
Findings:
- The patient survived the complex procedure.
- Successful management of both AD, CAD, and associated arrhythmias was achieved.
- This case demonstrates the feasibility of ECMO in critical AD with CAD scenarios.
Implications:
- This case highlights a novel approach to managing life-threatening AD with CAD and arrhythmias.
- Assisted circulation with ECMO may be a viable option in select, high-risk patients.
- Further research is warranted to explore ECMO's role in complex aortic dissection cases.
Abstract:
Coronary artery dissection (CAD) is a rare but serious complication of type A aortic dissection (AD) which may be discovered preoperatively in the presence of clinical or ECG signs of ischemia, or intraoperatively after dissection of the coronary ostium. Treatment of CAD consists of surgical repair with glue and, if necessary, coronary artery bypass graft. No case of AD with CAD complicated by major arrhythmias treated by assisted circulation has been reported in the literature. We report the first case of AD with implementation of extracorporeal membranous oxygenation following cardiotomy with a favorable outcome.
