The Annals of thoracic surgery
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Differential hypoxia exists in peripheral venoarterial (VA) extracorporeal membrane oxygenation (ECMO) patients with compromised lungs, causing hypoxic damage to heart or brain. We proposed an Avalon Elite (Maquet, Rastatt, Germany) double lumen cannula-based hybrid ECMO to add a venovenous (VV) blood flow into the pulmonary circulation onto the existing VA ECMO circuit to increase oxygen saturation in the left ventricle and ascending aorta, mitigating heart/brain hypoxia. ⋯ The Avalon Elite double-lumen cannula-based hybrid ECMO circuit is a simple circuit that provides efficient performance and flexible VA/VV blood distribution. In this hybrid ECMO circuit, incremental VV blood flow (10% to 50%) progressively increased left ventricular blood oxygen level, ensuring adequate heart and brain oxygen supply.
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In addition to severe hypoxia and hypercapnia, acute respiratory distress syndrome (ARDS) can present with substantial hemodynamic compromise, requiring inotropic or vasopressor support or both. Either venovenous (VV) or venoarterial (VA) extracorporeal membrane oxygenation (ECMO) can be offered in this situation. However, a contemporary comparison of these two cannulation strategies has yet to be well described. ⋯ In this review of ARDS patients requiring pre-ECMO hemodynamic support, VV ECMO was not associated with worse survival or complication rates compared with VA ECMO. These data suggest that, in appropriately selected patients, it may be reasonable to initially institute VV ECMO support, reserving VA ECMO for conversion for refractory hypotension.
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Long segment tracheobronchial stenosis is a rare congenital anomaly that can also occur in combination with abnormal bronchial arborization. Long segment tracheal reconstruction in the setting of a supernumerary bridging bronchus has been reported; however, these repairs can be particularly complex. We present our experience using the bridging bronchus to augment long segment tracheal stenosis with a side-to-side tracheobronchoplasty. ⋯ Side-to-side tracheal reconstruction is feasible in severe cases of long segment tracheal stenosis with a right upper lobe bronchus and a bridging bronchus. This technique can be successfully applied in high-risk patients and in the neonatal period and can provide excellent midterm results.
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Selecting the ventricular access site on the basis of mitral valve anatomy improves the outcomes for a subgroup of patients undergoing the transapical echocardiographically guided NeoChord (NeoChord, Inc, St. Louis Park, MN) repair procedure to correct mitral regurgitation and who have a leaflet-to-annulus index lower than the recommended efficacy threshold of 1.25.
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Multicenter Study
Long-Term Risk of Ischemic Stroke After the Cox-Maze III Procedure for Atrial Fibrillation.
The long-term risk of stroke after surgical treatment of atrial fibrillation is not well known. We performed an observational cohort study with long follow-up after the "cut-and-sew" Cox-maze III procedure (CM-III), including left atrial appendage excision. The aim was to analyze the incidence of stroke/transient ischemic attack (TIA) and the association to preoperative CHA2DS2-VASc (age in years, sex, congestive heart failure history, hypertension history, stroke/TIA, thromboembolism history, vascular disease history, diabetes mellitus) score. ⋯ This multicenter study showed a low incidence of perioperative and long-term postoperative ischemic stroke/TIA after CM-III. Although general risk of ischemic stroke/TIA was reduced, patients with CHA2DS2-VASc score 2 or greater had a higher risk compared with score 0 or 1. Complete left atrial appendage excision may be an important reason for the low ischemic stroke rate.