Extracorporeal Membrane Oxygenation Following Acute Type A Aortic Dissection Repair: A Systematic Review and Meta-Analysis

Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency. Despite the well-established role of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) after postcardiotomy cardiogenic shock in cardiac surgery patients, its application in the context of ATAAD has been controversial. The goal of this study is to evaluate the role of postcardiotomy ECMO subsequent to ATAAD repair. A meta-analysis of nine retrospective studies approaching this topic was conducted. Finally, a total of 318 patients were analyzed. Despite a successful weaning from ECMO rate of 48.3% (95% confidence interval [CI]: 30.6-66.2), not all of them finally survived, resulting in a higher overall in-hospital mortality of 72.4% (95% CI: 61.9-81.9). Acute kidney injury requiring continuous renal replacement therapy rate was 60.5% (95% CI: 43.9-76.0), neurologic complications rate as a consequence of stroke was 24.4% (95% CI: 13.9-36.3), limb ischemia rate was 7.6% (95% CI: 1.7-16.2) and bleeding requiring reoperation rate was 29.2% (95% CI: 10.3-52.2). We estimated a pooled 6.04 days mean duration on ECMO support (95% CI: 3.88-8.20) and a pooled 24.26 days mean length of stay (95% CI: 18.81-29.71). Concerning medium-term outcomes, a pooled incidence rate of late mortality of 5.8% per 100 person-years (95% CI: 0.8-13.4) was recorded. Despite high mortality and complication rates, postcardiotomy ECMO after ATAAD repair may be reasonable, but it depends on further multicenter research to determine which patients could benefit.