Acquired tracheomalacia due to aortic aneurysm managed with veno-pulmonary extracorporeal membrane oxygenation for peri-operative support

Abstract Extracorporeal membrane oxygenation (ECMO) is diverse in its applications. Here we describe a case of tracheomalacia from an thoracic aortic aneurysm causing respiratory failure. Total arch replacement with reverse frozen elephant trunk graft was performed. Perioperative ECMO support was accomplished with veno-pulmonary artery ECMO. This strategy allowed for preoperative oxygenation support, venous drainage during cardiopulmonary bypass, and postoperative support without cannula exchanges. Our patient required ECMO support for 12 days postoperatively. This case illustrates a unique case of acquired tracheomalacia, but also an ECMO cannulation strategy allowing for preoperative oxygenation, seamless transition to cardiopulmonary bypass and postoperative support.