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

Objectives: The study aim was to investigate the outcomes and risk factors for mortality in patients undergoing surgery for acute type A aortic dissection (ATAAD) receiving concomitant veno-arterial extracorporeal membrane oxygenation (ECMO) support.

Methods: Patients from five European centers who underwent surgery for ATAAD and received perioperative veno-arterial ECMO support were included. A multivariable binary logistic regression analysis was performed to identify risk factors for thirty-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 (OR 1.02, 95% 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 thirty-day mortality. For pre-ECMO lactate peak, the area under the curve showed an acceptable value of 0.73 and restricted cubic splines showed significant correlation to survival (p = 0.004) with an increased risk above a lactate level of 85 mg/dL.

Conclusions: Veno-arterial 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 thirty-day mortality.