Anesthetic management of extracorporeal membrane oxygenation-supported aortic bypass surgery for atypical coarctation with severe left ventricular dysfunction: A case report

TL;DR

This case report describes the anesthetic management of a rare aortic condition in a patient with severe heart dysfunction, using ECMO during surgery.

Contribution

The paper presents a novel anesthetic strategy for aortic bypass surgery in a patient with atypical coarctation and severe cardiac dysfunction, emphasizing ECMO readiness.

Findings

ECMO was successfully used to manage circulatory collapse during anesthesia induction.

Preoperative planning with ECMO standby was crucial for safe surgical outcomes.

Postoperative cardiac function improved following successful surgery.

Abstract

Atypical aortic coarctation is an exceedingly rare condition, and there are very few reported cases of anesthetic management for bypass surgery in patients with severe impaired cardiac function. We present the anesthetic management of a 68-year-old woman with atypical aortic coarctation due to Takayasu arteritis and severely impaired cardiac function, who underwent ascending-to-abdominal aorta bypass surgery under extracorporeal membrane oxygenation (ECMO).

The patient's severe cardiac dysfunction was due to sustained afterload from the coarctation, leading to recurrent episodes of heart failure. Surgical intervention was deemed necessary, and a decision was made to perform a bypass operation. The patient experienced a transient state of shock following induction of anesthesia, but subsequent perioperative care was safely managed with the implementation of ECMO. For bypass surgery performed on patients with severe cardiac dysfunction due to atypical coarctation of the aorta, it is crucial to prepare for potential circulatory collapse during anesthesia induction and the surgical procedure. This preparation includes meticulous planning of the anesthesia induction method and ensuring that ECMO can be established promptly if needed.

•Anesthetic strategy for aortic bypass in a patient with severe cardiac dysfunction.•Preoperative ECMO standby for potential circulatory collapse.•Anesthesia-induced tachycardia and hemodynamic instability.•Successful surgery under ECMO, improving postoperative cardiac function.

Anesthetic strategy for aortic bypass in a patient with severe cardiac dysfunction.

Preoperative ECMO standby for potential circulatory collapse.

Anesthesia-induced tachycardia and hemodynamic instability.

Successful surgery under ECMO, improving postoperative cardiac function.

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