A salvaged case of severe pulmonary edema related to type A acute aortic dissection requiring preoperative ECMO

Abstract

Preoperative utilization of ECMO in type A aortic dissection (TAAD) patient is a rare situation with limited reports. A 51-year-old man presenting with acute aortic insufficiency and coronary malperfusion induced by TAAD was referred to our hospital for surgical repair. After arrival at the Emergency Department, oxygenation of the patient was deteriorated due to ongoing severe bilateral pulmonary edema related to aortic insufficiency and left coronary artery (LCA) obstruction. Following the introduction of preoperatively veno-arterial ECMO support as a “bridge to surgery,” emergent ascending aortic repair was carried out. Closure of the false lumen was performed with BioGlue® (Cryolife, Kennesaw, GA, USA). Gluing of the left coronary sinus was carefully accomplished under the insertion of catheter into the LCA. Adequate aortic valve coaptation was confirmed by water test after closure of the false lumen. Construction of the proximal and distal aortic stump was simply done with our Hydrofit®-gluing (Terumo Corporation, Tokyo, Japan) felt strip method to minimize the bleeding. Evaluation by TEE before CPB weaning revealed disappearance of valve insufficiency. Postoperative course of the patient was uneventful. We successfully salvaged the severe pulmonary edema patients related to TAAD required preoperative ECMO support.