A Case of Acute Aortic Dissection with Severe Aortic Regurgitation Successfully Treated by Postoperative Extracorporeal Membrane Oxygenation

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  • 急性A 型大動脈解離術後，人工心肺離脱不能症例に対してVeno-Arterial Extracorporeal Membrane Oxygenation を使用し救命した1 例

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We report here a case of acute aortic dissection (Stanford Type A) with severe aortic regurgitation (AR) successfully treated by postoperative ECMO (extracorporeal membrane oxygenation). The patient was a 52-year-old man who was transferred to our hospital after complaining of chest-back pain. An emergent operation was performed after diagnosis of a type A acute aortic dissection with severe AR. We performed ascending aortic replacement under hypothermia arrest and retrograde cerebral perfusion. ECMO became necessary, because of postoperative acute respiratory failure. We used axillary artery cannulation with a graft anastomosis for inflow perfusion in ECMO because of central support with antegrade flow and excellent upper body oxygenation. During ECMO, anticoagulation with nafamostat mesilate was used to control bleeding complications. Postoperative bleeding decreased gradually and the patient was successfully weaned from ECMO 65 hours after the operation with no neurological complications. The recovery was uneventful, and at discharge the patient was able to walk out of the hospital without assistance. In this case, V-A ECMO with axillary arterial perfusion was performed successfully after acute aortic dissection, with no cerebral complications. Moreover, we reported that nafamostat mesilate was effective in preventing bleeding during ECMO.

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