# Use of veno-venous extracorporeal membrane oxygenation for stabilization prior to redo sternotomy for aortic pseudoaneurysm repair

## TL;DR

A 62-year-old man with a life-threatening aortic pseudoaneurysm was stabilized with veno-venous ECMO before undergoing successful surgical repair.

## Contribution

This case highlights the successful use of veno-venous ECMO to stabilize a patient with respiratory distress due to aortic pseudoaneurysm before redo sternotomy.

## Key findings

- Veno-venous ECMO provided respiratory support in a patient with tracheal compression from an aortic pseudoaneurysm.
- The patient underwent successful redo sternotomy and repair of the pseudoaneurysm defect.
- A combination of surgical and respiratory strategies enabled successful treatment of a complex case.

## Abstract

Background: Aortic pseudoaneurysms are particularly dangerous because of the risk of rupture and compression of mediastinal structures, including the trachea, and resultant respiratory distress. If respiratory distress progresses to respiratory failure, extracorporeal membrane oxygenation may be used to provide oxygenation prior to or during pseudoaneurysm repair.

Case presentation: A 62-year-old male with a history of emergent aortic ascending and arch replacement for Stanford Type A dissection 10 months prior presented to his primary care physician with dyspnea. Chest radiography revealed a widened mediastinum, and subsequent computed tomography angiogram revealed a pseudoaneurysm at the distal suture line of the aortic arch replacement. Due to the location of the pseudoaneurysm, the patient’s trachea was compressed, and he was emergently placed on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) following unsuccessful intubation for respiratory distress. Two days later, the patient underwent a redo sternotomy and repair of a 2–3 mm defect in the anterior aspect of the distal suture line of the prior aortic arch replacement. The patient progressed well and was discharged on postoperative day 13.

What we learned: Using a combination of peripheral bypass, hypothermic circulatory arrest, delayed closure, and respiratory support, this case demonstrates how even complex patients can be successfully treated with multiple strategies.