Intra-aortic balloon pump can be used after acute type A aortic dissection repair

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Acute type A aortic dissection is a life-threatening condition requiring surgical repair.
• Intraoperative circulatory support, including extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump (IABP), may be necessary for complex cases.
• Evaluating the safety and efficacy of these support methods is crucial for improving patient outcomes.

Purpose of the Study:

• To assess the safety and feasibility of intraoperative ECMO and IABP use during acute type A aortic dissection repair.
• To determine the impact of these circulatory support strategies on in-hospital mortality and complications.

Main Methods:

• Retrospective review of 690 patients undergoing acute type A aortic dissection repair between December 1999 and December 2020.
• Identification of 31 patients who received intraoperative ECMO or IABP support to facilitate weaning from cardiopulmonary bypass.
• Analysis of patient demographics, preoperative conditions, operative details, and in-hospital outcomes.

Main Results:

• Of 31 patients receiving support, 11 had ECMO and 20 had IABP. The median age was 65 years, with 45% females.
• Pre-existing conditions included coronary malperfusion (42%), visceral malperfusion (23%), acute coronary syndrome (13%), and need for cardiopulmonary resuscitation (26%).
• Overall in-hospital mortality was 67%. ECMO group had 91% mortality, while the IABP group had 55% mortality. No IABP-specific aortic complications were observed.

Conclusions:

• Intraoperative ECMO support in acute type A aortic dissection is associated with discouragingly high mortality rates.
• IABP may have a beneficial role in selected patients following acute type A aortic dissection repair, aiding recovery from cardiogenic shock.
• Further investigation into patient selection and optimal use of IABP is warranted.