Use of venoarterial (VA) extracorporeal membrane oxygenation (ECMO) in the setting of type A aortic dissection (TAAD) has been described in the literature as salvage therapy, with morbid results. The use of venovenous (VV) ECMO in TAAD patients is not reported. We sought to characterize the outcomes of this population of patients.

Patients undergoing surgical repair of TAAD at our institution from 2015 to 2022 were retrospectively reviewed, and patients who underwent support with VV ECMO perioperatively were identified. Patient characteristics, indications for cannulation, timing, duration, and outcomes were assessed in comparison to patients with no mechanical circulatory support.

Of 550 patients who underwent repair of TAAD from 2015 to 2022 at our institution, 35 (6.4%) required any mechanical support; of those, 8 (1.5%) required VV ECMO. VV ECMO requirement was associated with increased rates of severe aortic insufficiency and malperfusion as well as with prolonged bypass and cross-clamp times, postoperative dialysis, and prolonged intubation. Five patients (67.5%) survived to ECMO decannulation with an average duration of 7.2 ± 5.0 days; 4 patients survived to discharge. VV ECMO patients had significantly worse 3-year survival than patients not requiring ECMO support (P = .001); however, in comparison to patients requiring prolonged intubation (>7 days), no difference in 3-year survival was observed (P = .190).

VV ECMO after TAAD is selectively used as a last resort for respiratory support and thus is associated with high mortality. However, noting the poor outcomes of patients with severe respiratory compromise after TAAD repair, there may exist additional patients in this cohort who could benefit from VV ECMO support.