Bilateral Coronary Malperfusion due to Type A Acute Aortic Dissection Treated with Veno-Arterial Extracorporeal Membrane Oxygenation/Impella5.5 After Intraoperative Reversal of Apixaban-Mediated Anticoagulation by Andexanet Alfa

Abstract

Patients with acute type A aortic dissection complicated by bilateral coronary malperfusion have a poor prognosis. Mechanical heart-assist devices are often used in the management of post-cardiotomy cardiogenic shock. However, the anticoagulation therapy regimen and device insertion site selection pose challenges and are subject to ongoing debate. No current research addresses anticoagulation management in patients requiring heart-assist devices following aortic arch replacement. Furthermore, the preoperative use of direct oral anticoagulants and intraoperative reversal complicates management. We herein report a case of type A acute aortic dissection with bilateral coronary malperfusion treated with veno-arterial extracorporeal membrane oxygenation/Impella5.5 after intraoperative reversal of apixaban-mediated anticoagulation using andexanet alfa.