Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation.

Data on the frequency of nosocomial infections during extracorporeal membrane oxygenation (ECMO) in adult populations remain scarce. We investigated the risk factors for nosocomial infections in adult patients undergoing venoarterial ECMO (VA-ECMO) support. From January 2011 to December 2015, a total of 259 patients underwent ECMO. Of these, patients aged 17 years or less and patients undergoing ECMO for less than 48 hours were excluded. Of these, 61 patients diagnosed with cardiogenic shock were evaluated. Mean patient age was 60.6 ± 14.3 years and 21 (34.4%) patients were female. The mean preoperative Sequential Organ Failure Assessment (SOFA) score was 8.6 ± 2.2. The mean duration of ECMO support was 6.8 ± 7.4 days. The rates of successful ECMO weaning and survival to discharge were 44.3% and 31.1%, respectively. There were 18 nosocomial infections in 14 (23.0%) patients. These included respiratory tract infections in 9 cases and bloodstream infections in a further 9. In multivariate analysis, independent predictors of infection during ECMO were the preoperative creatinine level (hazard ratio [HR], 2.176; 95% confidence interval [CI], 1.065-4.447; P = 0.033) and the duration of ECMO support (HR, 1.400; 95% CI, 1.081-1.815; P = 0.011). A higher preoperative creatinine level and an extended duration of ECMO support are risk factors for infection. Therefore, to avoid the development of nosocomial infections, strategies to shorten the length of ECMO support should be applied whenever possible.

Transaortic chordae and pannus removal without redo mitral valve replacement in prosthetic mitral valve malfunction.

Both anterior and posterior chordae of the mitral valve are occasionally spared during mitral valve surgery to preserve left ventricular function. In this report, a 43-year-old woman who had undergone mitral valve replacement surgery with anterior and posterior chordal preservation 9 years ago subsequently had mitral valve pannus and anterior chordae covering the prosthetic valve, which led to valve malfunction. Prosthetic mitral valve function was successfully recovered by performing transaortic pannus and chordae removal, avoiding redo mitral valve replacement.

Early and midterm outcomes for tricuspid valve surgery after left-sided valve surgery.

BACKGROUND: The purpose of this study was to compare the early and midterm results of tricuspid valve replacement (TVR) versus tricuspid valve repair (TVr) for late tricuspid regurgitation after left-sided valve surgery. METHODS: Fifty-one consecutive patients who underwent tricuspid valve surgery after left-sided valve surgery between January 1995 and April 2008 were included. Thirty-seven patients underwent TVR, and 14 patients underwent TVr. Tricuspid valve replacement was performed along with concomitant procedures in 27 patients (73.0%). Patients undergoing TVR were more likely to have severe tricuspid regurgitation (64.3% versus 89.2%; p = 0.037), or a previous history of tricuspid regurgitation repair (7.1% versus 51.4%; p = 0.004). RESULTS: There was no hospital death in both TVr and TVR groups. However, in comparison to TVr patients, TVR patients needed a greater amount of hemofiltration (59 +/- 23 versus 80 +/- 36; p = 0.026) and had longer periods of hospital stays (13.5 +/- 4.4 versus 26.9 +/- 25.7 days; p = 0.049). Survival rates at 1, 5, and 10 years were 97%, 93%, and 63% for patients undergoing TVR, and 93%, 93%, and 81% for patients undergoing TVr, respectively. There was no statistical difference in midterm survival rates between the two groups. Cox regression analysis revealed that left ventricular ejection fraction of 0.40 or less (p = 0.034) and age (p = 0.035) were independent predictors of late mortality after TVR or TVr. CONCLUSIONS: Patients undergoing TVR had a more advanced preoperative tricuspid regurgitation grade and significantly prolonged hospital stays. However, there were no statistical differences in early and midterm outcomes between the two groups.

Intraventricular patch repair through an extended aortotomy for repeated left ventricular rupture after mitral valve replacement.

Posterior wall rupture of the left ventricle is a rare but lethal complication after mitral valve replacement. We treated a patient with repeated left ventricular rupture. Initially, type 1 left ventricular rupture was repaired in the intensive care unit, but persistent bleeding occurred after the repair. We treated the bleeding through an extended aortotomy and successfully repaired the repeated type 3 left ventricular rupture with bovine pericardium (Synovis Surgical Innovations Inc, St. Paul, MN).