Left Atrial Veno-Arterial Extracorporeal Membrane Oxygenation Case Series: A Single-Center Experience.

INTRODUCTION: We aimed to review the characteristics and outcomes of left atrial veno-arterial extra corporeal membrane oxygenation (LAVA ECMO) at our institution over a 4-y period from 2017 to 2020. METHODS: Among 227 adult patients who received VA ECMO support from January 2017 to December 2020, we reviewed 33 of these who underwent transseptal cannulation and were converted to LAVA ECMO. The timing of transseptal cannulation, either at initiation of VA ECMO (n = 25) or with a later transseptal cannulation to treat complications of left ventricular (LV) distention while on VA ECMO (n = 8), was reviewed. The clinical characteristics, indications, echocardiography data, and outcomes were assessed. RESULTS: Duration of LAVA ECMO support ranged from 1 to 13 d, with a median of 5 d. Successful weaning from the LAVA ECMO circuit was achieved for 15 patients (45%). The in-hospital mortality rate was 66%. There were 11 patients (33%) who survived to be discharged from the hospital. CONCLUSIONS: LV distention is a known complication of VA ECMO and impedes the recovery of the heart. LAVA ECMO provides a novel approach to treating LV distention. Additionally, our review shows that this modality may be used as a bridge to durable mechanical circulatory support, cardiac transplantation, or recovery.

Thoracoplasty: Still relevant to current practice.

BACKGROUND: Management of residual pleural space remains a challenge in the practice of thoracic surgery. Options include thoracotomy with muscle flap/wound vac, Eloesser procedure, or thoracoplasty. We examine current practice and short-term outcomes of thoracoplasty in the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP). METHODS: A retrospective review of thoracoplasty procedures (by CPT® code 32900, 32905, or 32906) in the ACS NSQIP database from the years 2012 to 2017 was performed. The ACS NSQIP prospectively collects perioperative and rigorous 30-day outcome data for patients undergoing major thoracic surgical nationally. RESULTS: The dataset contained 131 thoracoplasties in patients with an average age of 48 years (SD 19), average BMI of 26 kg/m2 (SD 5), 48% female, and 21% of minority race. Forty percent of patients were ASA class III and 10% class IV-V. Five percent of the patients had muscle flap in addition to thoracoplasty. Median operative duration was 101 min (interquartile range 61-167) and 8% of patients required blood transfusion. The average length of hospital stay was 6 days (SD 9), and 93% of patients were discharged home. There was one death, and 23% experienced other major morbidity. Thirty-day readmission occurred in 8% of patients and 6% returned to the operating room within 30 days. Four percent of patients experienced respiratory failure, 4% sepsis, and 5% developed pneumonia. CONCLUSIONS: Short-term outcomes of current thoracoplasty demonstrate low mortality and morbidity. Thoracoplasty should remain in our armamentarium for managing residual pleural space.