Predictors and outcomes in patients undergoing surgery for acute type A aortic dissection requiring concomitant venoarterial extracorporeal membrane oxygenation support - a retrospective multicentre cohort study

Abstract

OBJECTIVES: The study's aim was to investigate the outcomes and risk factors for mortality in patients undergoing surgery for acute type A aortic dissection receiving concomitant venoarterial extracorporeal membrane oxygenation (ECMO) support. METHODS: Patients from 5 European centre who underwent surgery for acute type A aortic dissection and received perioperative venoarterial ECMO support were included. A multivariable binary logistic regression analysis was performed to identify risk factors for 30-day mortality. A receiver operating characteristic curve and restricted cubic splines were designed to investigate the association between pre-ECMO lactate peak and survival. RESULTS: The final cohort comprised 117 patients. Mean time on ECMO support was 3 days (interquartile range 1-7). In 36 patients (31%), successful ECMO weaning was achieved. Thirty-day mortality was 72%, leading cause for early mortality was multiorgan failure (39%). In total, 20% of patients were discharged from hospital. Pre-ECMO lactate peak [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.005-1.032], presence of preoperative shock (OR 9.47, 95% CI 1.749-98.257) and need for total arch replacement (OR 6.628, 95% CI 1.492-33.373) were identified as associates for 30-day mortality. For pre-ECMO lactate peak, the area under the curve showed an acceptable value of 0.73 and restricted cubic splines showed a significant correlation to survival (P = 0.004) with an increased risk above a lactate level of 85 mg/dl. CONCLUSIONS: Venoarterial ECMO support may not be futile but should be well balanced against the high-risk profile in this patient cohort. The pre-ECMO lactate peak is an independent risk factor and a valid predictor of 30-day mortality.