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Case Report: Surgery combined with extracorporeal membraneoxygenation for acute type A aortic dissection complicated

Jianming Xia1, Yan Qiu1, Shuo Chang2

  • 1Department of Cardiovascular Surgery, Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences/Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, China.

Frontiers in Cardiovascular Medicine
|February 17, 2025
PubMed

Insights

Acute myocardial infarction (AMI) complicates acute type A aortic dissection (ATAAD), increasing mortality. A one-stage surgical repair strategy, supported by extracorporeal membrane oxygenation (ECMO), offers a life-saving approach for these critical patients.

Area of Science:

  • Cardiovascular Surgery
  • Cardiology
  • Thoracic Surgery

Background:

  • Acute myocardial infarction (AMI) is a severe complication of acute type A aortic dissection (ATAAD), significantly increasing mortality.
  • Optimal simultaneous treatment strategies for ATAAD with AMI remain controversial and challenging for cardiovascular surgeons.

Observation:

  • Three patients presenting with chest pain were diagnosed with ATAAD and AMI.
  • Electrocardiogram showed ST-segment depression, and elevated myocardial enzyme levels confirmed AMI.
  • Emergency physicians and cardiovascular surgeons collaborated for a planned emergency surgery.

Findings:

  • A one-stage surgical approach combining coronary revascularization and central aortic repair was successfully performed.
  • Extracorporeal membrane oxygenation (ECMO) was used as a bridge, supporting hemodynamics until stabilization.
  • All three patients recovered well and were discharged, demonstrating an excellent prognosis.

Implications:

  • One-stage surgery for ATAAD with right ventricular AMI, supported by ECMO, can be a life-saving treatment.
  • This combined surgical strategy offers a viable and effective option for improving outcomes in complex cardiovascular emergencies.
Abstract

Keywords:
acute myocardial infarction (AMI)acute type A aortic dissection (ATAAD)extracorporeal membrane oxygenation (ECMO)malperfusion syndromeone-stage surgery

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