Veno-arterio-pulmonary-arterial extracorporeal membrane oxygenation in descending aortic surgery
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CASE REPORT
Veno‑arterio‑pulmonary‑arterial extracorporeal membrane oxygenation in descending aortic surgery Tomoyuki Minami1 · Keiji Uchida1 · Shota Yasuda1 · Tomoki Cho1 · Yusuke Matsuki1 · Hiroko Nemoto1 · Yoshiyuki Kobayashi1 · Keiichiro Kasama2 · Daisuke Machida3 · Munetaka Masuda1,3 Received: 30 June 2020 / Accepted: 11 October 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Hypoxia during one-lung ventilation is a significant problem in descending aortic surgery via left thoracotomy. Veno-arteriopulmonary-arterial extracorporeal membrane oxygenation (VAPa-ECMO), which consists of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and an additional arterial branch to perfuse a pulmonary artery (Pa), is useful. Keywords Descending aorta · Aortic operation · Extracorporeal membrane oxygenation · Pulmonary-arterial perfusion
Introduction Descending aortic aneurysm surgery via left thoracotomy is an invasive and high-risk operation and still a challenging operation among cardiovascular surgery. Depending on a location of an aortic aneurysm, a method of extracorporeal circulation changes; for example, partial extracorporeal circulation including cardiopulmonary bypass, left heart bypass, and ultra-low hypothermic circulation arrest [1]. However, in any partial extracorporeal circulation, left thoracotomy and right one-lung ventilation are essential for descending aortic aneurysm surgery. Hypoxia, due to rightside pulmonary hemorrhage, atelectasis, and pneumothorax, can be life-threatening. We experienced a case of hypoxia during descending aortic replacement with partial extracorporeal circulation. Therefore, veno-arterio-pulmonary-arterial extracorporeal membrane oxygenation (VAPa-ECMO) was established by adding a pulmonary-arterial perfusion * Tomoyuki Minami tomo373@yokohama‑cu.ac.jp 1
Cardiovascular Center, Yokohama City University Medical Center, 4‑57 Urafune‑cho, Minami‑ku, Yokohama, Kanagawa 232‑0024, Japan
2
Cardiovascular Surgery, Yokohama Municipal Citizen’s Hospital, 56 Okazawa‑cho, Hodogaya‑ku, Yokohama, Kanagawa 240‑8555, Japan
3
Department of Surgery, Yokohama City University, 3‑9 Fukuura, Kanazawa‑ku, Yokohama, Kanagawa 236‑004, Japan
line to send oxygenated blood for a main pulmonary artery, onto veno-arterial extracorporeal membrane oxygenation (VA-ECMO) using a femoral artery and a femoral vein, and we safely replaced descending aortic aneurysm, withdrew from cardiopulmonary bypass, and performed a hemostatic operation.
Case report A 70-year-old man had undergone an urgent ascending aortic replacement for acute type A aortic dissection 10 years ago. The descending aorta gradually enlarged to 65 mm, and he underwent descending aortic replacement under partial cardiopulmonary bypass. His preoperative respiratory function data were not poor. The lung capacity was 3230 ml and the percent predicted forced expiratory volume in 1 s was 76.4%. He used to smoke, but quit smoking 30 years before surgery. We were not concerned about his respiratory status be
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