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

We analyzed our data to evaluate the safety and feasibility of intraoperative extracorporeal membrane oxygenation and intra-aortic balloon pump use in acute type A aortic dissection repair.

Between December 1999-December 2020, we identified patients who received intraoperative extracorporeal membrane oxygenation and/or intra-aortic balloon pump support to wean off cardiopulmonary bypass were retrospectively reviewed.

A total of 690 patients who underwent acute type A dissection repair. In all, 31 patients received intraoperative circulatory support (11 extracorporeal membrane oxygenation, 20 intra-aortic balloon pump) to wean off cardiopulmonary bypass. In all, 14 patients (45%) were female and the median age was 65 years (interquartile range 51-73). Prior to the acute type A dissection repair, 13 (42%) had coronary malperfusion, 7 (23%) had visceral malperfusion, 4 (13%) presented with acute coronary syndrome, and 8 (26%) received cardiopulmonary resuscitation. The median clamp time was 108 min (interquartile range 89-157) and circulatory arrest time was 25 min (interquartile range 19-31). Concomitant procedures included 11 coronary artery bypass grafting (35%), 4 root replacements (13%) and 1 total arch replacement (3%). Overall, in-hospital mortality was 67%: 10 of 11 (91%) patients with extracorporeal membrane oxygenation and 11 of 19 patients (55%) with intra-aortic balloon pump expired. There were no intra-aortic balloon pump-specific aortic complications (i.e. aortic rupture, extension of dissection).

Outcomes after extracorporeal membrane oxygenation support in acute type A dissection were discouraging. There may be a role for intra-aortic balloon pump following acute type A dissection repair to allow patients to recover from cardiogenic shock in the selected patients.