Effects of intra-aortic balloon pump on cerebral blood flow during peripheral venoarterial extracorporeal membrane oxygenation support.

BACKGROUND: The addition of an intra-aortic balloon pump (IABP) during peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) support has been shown to improve coronary bypass graft flows and cardiac function in refractory cardiogenic shock after cardiac surgery. The purpose of this study was to evaluate the impact of additional IABP support on the cerebral blood flow (CBF) in patients with peripheral VA ECMO following cardiac procedures. METHODS: Twelve patients (mean age 60.40±9.80 years) received VA ECMO combined with IABP support for postcardiotomy cardiogenic shock after coronary artery bypass grafting. The mean CBF in the bilateral middle cerebral arteries was measured with and without IABP counterpulsation by transcranial Doppler. The patients provided their control values. The mean CBF data were divided into two groups (pulsatile pressure greater than 10 mmHg, P group; pulsatile pressure less than 10 mmHg, N group) based on whether the patients experienced cardiac stun. The mean cerebral blood flow in VA ECMO (IABP turned off) alone and VA ECMO with IABP support were compared using the paired t test. RESULTS: All of the patients were successfully weaned from VA ECMO, and eight patients survived to discharge. The addition of IABP to VA ECMO did not change the mean CBF (251.47±79.28 ml/min vs. 251.30±79.47 ml/min, P=0.96). The mean CBF was higher in VA ECMO alone than in VA ECMO combined with IABP support in the N group (257.68±97.21 ml/min vs. 239.47±95.60, P=0.00). The addition of IABP to VA ECMO support increased the mean CBF values significantly compared with VA ECMO alone (261.68±82.45 ml/min vs. 244.43±45.85 ml/min, P=0.00) in the P group. CONCLUSION: These results demonstrate that an IABP significantly changes the CBF during peripheral VA ECMO, depending on the antegrade blood flow by spontaneous cardiac function. The addition of an IABP to VA ECMO support decreased the CBF during cardiac stun, and it increased CBF without cardiac stun.

[Analysis of factors related to acute renal failure post deep hypothermia circulatory arrest surgery of type A aorta dissection surgery].

OBJECTIVES: To analyze risk factors associated to acute renal failure (ARF) post deep hypothermia circulatory arrest (DHCA) surgery of type A aorta dissection patients, researching correlations to hospital mortality rate. METHODS: There were 273 samples of type A aorta dissection patients collected between September 2011 and May 2013 , all of which had surgery done under DHCA. Categorize the samples into two groups based on whether postoperative ARF happened: non-ARF group(n = 163) and ARF group(n = 110). Conducted regression analysis correlations between postoperative ARF and mortality and one or more risk factors of gender, age, history of illness, type of aorta dissection, heart functional class, pre- and post-operative serum creatinine (sCr), DHCA time, blood loss and blood transfusion volume, postoperative complications, etc. RESULTS: Among the 110 samples of ARF group (40.3%), 21 (7.7%) conducted continuous renal replacement therapy (CRRT). Among 16 (5.9%) died in hospital, 3 (1.8%) died with functional renal, 13 (11.8%) died with ARF. Single factor analysis: male (χ(2) = 6.075, P = 0.014), preoperative sCr (t = 2.955, P = 0.004), dissection extended to renal artery(χ(2) = 5.103, P = 0.024), cardiopulmonary by-pass (CBP) time (t = 2.435, P = 0.017), DHCA time (t = 2.215, P = 0.031), average lower limb artery blood pressure during CBP (t = -2.832, P = 0.007), during surgery and 24 h postoperative blood loss (t = 2.157, P = 0.034) and blood transfusion (t = 2.426, P = 0.018), postoperative acute respiratory dysfunction (χ(2) = 36.307, P = 0.000), postoperative endotracheal reintubation (χ(2) = 9.167, P = 0.002), postoperative low blood pressure (χ(2) = 10.202, P = 0.001), postoperative temporary neurological deficits (χ(2) = 7.512, P = 0.006), postoperative infection (χ(2) = 11.088, P = 0.001) were the risk factors for ARF. The logistic regression analysis revealed that preoperative sCr (P = 0.023) and acute respiratory dysfunction (P = 0.011) were independent determinants of ARF; preoperative ARF (P = 0.022), CRRT (P = 0.003) and permanent neurological deficits were independent determinants for hospital mortality. CONCLUSIONS: ARF is a common complication of post Type A aorta dissection surgery under DHCA, and is the risk factor of hospital mortality. It is important to enhance peri-operative protection of the renal function.

Extracorporeal membrane oxygenation in curing a young man after modified Fontan operation: A case report.

BACKGROUND: The Fontan operation is the only treatment option to change the anatomy of the heart and help improve patients' hemodynamics. After successful operation, patients typically recover the ability to engage in general physical activity. As a better ventilatory strategy, extracorporeal membrane oxygenation (ECMO) provides gas exchange via an extracorporeal circuit, and is increasingly being used to improve respiratory and circulatory function. After the modified Fontan operation, circulation is different from that of patients who are not subjected to the procedure. This paper describe a successful case using ECMO in curing influenza A infection in a young man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago. The special cardiac structure and circulatory characteristics are explored in this case. CASE SUMMARY: We report a successful case using ECMO in curing influenza A infection in a 23-year-old man, who was diagnosed with Tausing-Bing syndrome and underwent Fontan operation 13 years ago. The man was admitted to the intensive care unit with severe acute respiratory distress syndrome as a result of influenza A infection. He was initially treated by veno-venous (VV) ECMO, which was switched to veno-venous-arterial ECMO (VVA ECMO) 5 d later. As circulation and respiratory function gradually improved, the VVA ECMO equipment was removed on May 1, 2018. The patient was successfully withdrawn from artificial ventilation on May 28, 2018 and then discharged from hospital on May 30, 2018. CONCLUSION: After the modified Fontan operation, circulation is different compared with that of patients who are not subjected to the procedure. There are certainly many differences between them when they receive the treatment of ECMO. Due to the special cardiac structure and circulatory characteristics, an individualized liquid management strategy is necessary and it might be better for them to choose an active circulation support earlier.

[Clinical experience with adults receiving extracorporeal membrane oxygenation for cardiogenic shock and quality of life in survivals].

OBJECTIVE: To review the experience with extracorporeal membrane oxygenation (ECMO) in adult postcardiotomy cardiogenic shock and evaluate quality of life (QOL) in survivals. METHODS: During 4 years 62 of 12, 644 patients (0.49%) undergoing cardiac surgery (valve procedures, n = 39; coronary artery bypass grafting, n = 13; coronary artery bypass grafting plus valve procedures, n = 4; heart transplantation, n = 4, and total aortic arch replacement, n = 2) required temporary postoperative ECMO support. At follow-up (mean 2.3 +/- 1.5 years, 100% complete), 32 were still alive and answered the Short-Form 36 Health Survey QOL questionnaire. RESULTS: Mean duration of ECMO support was 61 +/- 37 hors. Forty patients (64.5%) were successfully weaned from ECMO. Thirty-four patients (54.8%) were discharged from hospital after 44.3 +/- 17.6 days. The in-hospital mortality was 45.2%. The main cause of death was multiple organ failure. The postoperative peak lactate levels >or= 12 mmol/L before ECMO initiation was a risk factor of in-hospital death. Mean QOL scores between the ECMO survivors and other patients after cardiac surgery without ECMO support showed no significant difference, except that the vitality and mental health were significant lower in the ECMO survivors (P < 0.05). Both the ECMO survivors and the patients without ECMO support have significant lower QOL scores (except the vitality and mental health) relative to their respective Chinese population norms (P < 0.05). CONCLUSION: ECMO offers sufficient cardiopulmonary support in adults. Early indication, reduced complication could improve results with increasing experience. However, ECMO survivors had lower physical and mental health that need to be recovered.

[Postoperative acute renal failure in adult patients with cardiac surgery: evaluation of the RIFLE classification].

OBJECTIVE: To evaluate the ability of the RIFLE classification to predict hospital mortality in adult patients who underwent cardiac surgery. METHODS: From October 1st 2006 to December 31st 2006, five hundred and nine adult patients who underwent coronary artery bypass grafting and/or valve operation were enrolled in this study. Renal function was assessed daily according to the RIFLE classification, meanwhile, APACHE II score and SOFA score were also evaluated, as well as the maximum scores were recorded. RESULTS: Mean duration of ventilation support was 18 (14-19) hours, the time of ICU stay was 1.4 +/- 1.0 days, and the time of postoperative hospital stay was 12.0 (10.0-15.0) days. 167 patients (32.8%) incurred postoperative ARF according to the RIFLE classification. The overall mortality was 4.3% (22/502). A significant increase (P < 0.01) was observed for mortality based on RIFLE classification. By applying the area under the receiver operating characteristic curve, the RIFLE classification had more powerful discrimination power [0.933, (95% CI 0.872-0.995), P < 0.001]. CONCLUSIONS: ARF is one of the major complications in postcardiotomy patients. Analytical data suggested the good discriminative power of the RIFLE classification for predicting inpatient mortality of adult postoperative patient with ARF, and the RIFLE classification is simple and practically performed. According to the RIFLE classification, patients with RIFLE class I or class F incur a significantly increased risk of in-hospital mortality compared with those who never develop ARF.

[Extracorporeal membrane oxygenation support in acute cardiorespiratory function failure patients after cardiac surgery].

OBJECTIVE: To investigate the treatment experience of extracorporeal membrane oxygenation (ECMO) support after cardiac surgery. METHODS: Retrospectively analyze the clinical data of 117 postoperative patients supported with ECMO in cardiac intensive care unit from March 2005 to June 2008. There were 32 female and 85 male patients, with a mean age of (48.7 +/- 16.5) years old. The cardiac operations included coronary artery bypass grafting (n = 20), coronary artery bypass grafting and remodeling of left ventricle (n = 9), coronary artery bypass grafting and valvular operation (n = 5), repair of ventricular septal perforation following acute myocardial infarction (n = 2), valvular operation (n = 46), heart transplantation (n = 20), lung heart transplantation and repair of ventricular septal defect (n = 1), correction of congenital heart defects (n = 10), aortic operations (n = 4). Venoarterial bypass was instituted in 115 for hemodynamic failure and venovenous in 2 patient for hypoxemia following cardiac surgery. ECMO was established in 110 patients by cannulation of the right atrium and femoral artery, and 5 of the right atrium and ascending aorta. And 2 case added left atrial drainage to ECMO. Heparin was infused to maintain the whole blood activated coagulation time (ACT) of 160 to 200 s in centrifugal pump (14 cases), and 200 to 250 s in roller pump (3 cases) to avoid thrombotic events. This was administered until decannulation. Intra-aortic balloon pump was used in 15 patients and continuous renal replacement therapy in 29 cases. RESULTS: Mean ECMO duration was 61 h (ranged 3 to 225 h) and the mean duration of ICU stay was 5 d. 87 patients (74.4%) were successfully weaned from ECMO. 69 patients (59.0%) survived to discharge. The most common complications were re-exploration for bleeding (n = 24) and alimentary tract hemorrhage (n = 14), renal failure required renal replacement therapy (n = 29), infection(n = 32), limb ischemia (n = 5), plasma leak of oxygenators (n = 29), hemolysis (n = 7), neurological complication (n = 4). CONCLUSIONS: ECMO is an effective mechanical assistance method for short-term treatment of postoperative cardiorespiratory failure. Indication should be controlled strictly. Earlier institution of ECMO and prevent complication may improve outcome.

[Combined endocardial and epicardial radiofrequency modified Maze procedure in the treatment of atrial fibrillation].

OBJECTIVE: To evaluate the effectiveness of the combined endocardial and epicardial saline-irrigated radiofrequency modified maze procedure for the treatment of atrial fibrillation (AF). METHODS: During a period of 3 years, 295 patients with AF having concomitant cardiac surgery underwent the procedure. Patients underwent either the endocardial and epicardial group (n=185) or the endocardial group (n=110) radiofrequency ablation. There were 124 males, 171 females with a mean age of (52 +/- 11) year old. Mean duration of preoperative AF was 36 +/- 43 months. And about 90.8 percent valve pathology was rheumatic. Valve operation was performed in 289 patients, coronary artery bypass graft surgery in 19 patients and congenital heart disease operation in 6 patients respectively. Follow-up for the whole patients ranged from 3 to 47 months (mean 28 +/- 5 months). RESULTS: Ten patients died postoperatively (3.4%). Four patients died of low cardiac output, five patients died of multisystem and organ failure, one patient died of cerebral hernia. There were 2 patients died of nerves system complication during follow-up. At the end of the procedure 228 patients (77.3%) were sinus rhythm, including 78 patients (70.9%) in endocardial group while 150 patients (81.1%) in endocardial and epicardial group (P<0.05). At late follow-up, 191 of 259 patients (73.7%) were in stable sinus rhythm. Sinus rhythm was present in 64 patients (66.0%) in endocardial group while 127 patients (78.4%) in endocardial and epicardial group (P<0.05). Histopathology of the endocardial group revealed foci coagulative necrosis was limited to the endocardial side. While endocardial and epicardial ablation had full-thickness alteration of atrial tissue besides ill defined borders and inflammatory cell infiltration. CONCLUSIONS: Combined endocardial and epicardial saline-irrigated radiofrequency modified maze procedure was performed safely and efficiently. And it restored sinus rhythm better than endocardial ablation only.

[The application of extracorporeal membrane oxygenation for surgical treatment of coronary artery disease].

OBJECTIVE: To summarize the results and experiences on extracorporeal membrane oxygenation (ECMO) for post-cardiac surgery of coronary artery disease. METHODS: From June 2004 to November 2006, sixteen patients with the mean age of (58 +/- 11) years old undergoing cardiac surgical procedures were placed on ECMO using a heparin-bonded circuit. Fourteen patients were male and two patients were female. Thirteen patients underwent on pump coronary artery bypass surgery (CABG) and three patients underwent off-pump coronary artery bypass grafting. The duration of ECMO support, stay of intensive care unit (ICU stay), complications and turnovers were recorded. RESULTS: The mean duration of ECMO support was 51 hours, and the mean duration of ICU stay was 5 days. Thirteen patients (81.3%) were successfully weaned form ECMO, ten patients (62.5%) were discharged from hospital. The main complications were bleeding, infection, renal failure and ischemia of the lower limbs with the incidence of 18.8%, 37.5%, 25% and 18.8% respectively. CONCLUSION: ECMO is an acceptable technique for shortterm treatment of refractory low cardiac output after cardiac surgery of coronary artery disease.

Outcome of surgical treatment of post-traumatic tricuspid insufficiency.

OBJECTIVE: To investigate the optimal time and procedure of surgical treatment of traumatic tricuspid insufficiency. METHODS: From May 1984 to September 2004, eight patients underwent operation for traumatic tricuspid valve insufficiency. All patients, male, aged from 7 to 67 years median: 38 years, mean: (38.5 +/- 18.1) years. The intervals between trauma and operation ranged from 1 month to 20 years median: 19 months, mean: (52.5 +/- 80.3) months). In seven patients, tricuspid insufficiency was attributed to blunt chest trauma including vehicle accident in three patients and the other patient is a stab wound. Diagnosis was confirmed by echocardiography. Pre-operative cardiac functions in patients were classified as New York Heart Association (NYHA) classes II-IV. During operation, the anterior leaflet of the tricuspid valve was completely or partially flailed as a result of chordal rupture in all patients. Chordal rupture of septal leaflet was found in one patient. Anterior leaflet was perforated in two patients. Septal leaflet was retracted and adherent to ventricular septum in two patients. Valve repair was intended for all patients. Finally, valve repair was performed successfully in 3 patients and tricuspid replacement was performed in 5 patients. RESULTS: No early or late death occurred. With a follow-up through clinical manifestation and echocardiography for 7-129 months median: 39 months, mean: (53.4 +/- 42.8) months, all patients were classified as NYHA class I, without any changes. CONCLUSIONS: The satisfactory treatment of traumatic tricuspid insufficiency can be obtained by surgical treatment. Earlier surgery may increase the feasibility of tricuspid valve repair and prevent the deterioration of right ventricular function.

[Clinical analysis in 34 cases of paravalvular leakage after valve replacement].

OBJECTIVE: To study the treatment of paravalvular leakage (PVL) after cardiac valve replacement retrospectively. METHODS: Between 1993 and 2005, 34 patients with PVL were observed, including aortic PVL in 6 patients and mitral valve PVL in 28 patients. Twenty-five patients with severe anemia and/or heart failure were reoperated, 9 patients without severe clinical symptoms and signs had treated conservatively. Repair of PVL was carried out in 14 patients, and the other 10 patients were performed prosthetic valve replacement. RESULTS: Of 9 patients who had treated conservatively, 1 patients died of septic shock, and 1 patient died of heart failure. During 6 - 72 months follow-up, of the seven survivals, 2 patients died of heart failure. And the other 5 patients were in NYHA class II. Echocardiography demonstrated no obvious enlargement of the PVL and diameter of the heart. Among the 25 patients who were reoperated, the overall operative mortality was 12% (3 patients). Twenty-one survivals were in NYHA class II during the follow-up of 4 - 132 months. While a mitral valve PVL and a aortic valve PVL were diagnosed among them after the reoperation 4 years and 6 months respectively. CONCLUSIONS: Patients with PVL and no severe symptoms can be treated conservatively and followed up. A more aggressive surgical treatment is recommended for patients with PVL and severe anemia and/or heart failure.

Extracorporeal Membrane Oxygenation as a Bridge for Heart Failure and Cardiogenic Shock.

Heart failure (HF) can be defined as cardiac structural or functional abnormality leading to a series of symptoms due to deficiency of oxygen delivery. In the clinical practice, acute heart failure (AHF) is usually performed as cardiogenic shock (CS), pulmonary edema, and single or double ventricle congestive heart failure. CS refers to depressed or insufficient cardiac output (CO) attributable to myocardial infarction, fulminant myocarditis, acute circulatory failure attributable to intractable arrhythmias or the exacerbation of chronic heart failure, postcardiotomy low CO syndrome, and so forth. Epidemiological studies have shown that CS has higher in-hospital mortality in patients with AHF. Besides, we call the induced, sustained circulatory failure even after administration of high doses of inotropes and vasopressors refractory cardiogenic shock. In handling these cases, mechanical circulatory support devices are usually needed. In this review, we discuss the current application status and clinical points in utilizing extracorporeal membrane oxygenation (ECMO).

[Effect of surgical treatment of tricuspid regurgitation late after valve replacement of left heart].

OBJECTIVE: To investigate the appropriate methodology and outcome of surgical treatment of tricuspid regurgitation late after valve replacement of left heart. METHODS: Eighteen patients with tricuspid insufficiency, with the diagnosis conformed by echocardiogram and in New York Heart Association (NYHA) class III to IV, were treated surgically 3 to 14 years after left heart valve replacement, including 13 mitral valve replacements and 5 double valve replacements, from January 1995 to May 2004. DeVega was used in 5 patients. The ages at the time of tricuspid surgery ranged from 35 to 65 years (median 50 years). The patients were followed up for 36.7 months (12-114 months). RESULTS: There was no death from hemorrhage because of re-open. Tricuspid repair was performed in 8 patients, tricuspid replacement was done in 10 patients, 5 bioprostheses and 5 mechanical valves were implanted. The hospital mortality was 16.7%. Among the survivors, the three-year survival rate was 78.8%. Twelve patients showed improvement of symptoms, while there was no improvement in 3 patients who needed medical therapy. CONCLUSION: The pathophysiology of tricuspid regurgitation is associated with delayed left heart operation, implement of tricuspid repair in the first operation or progressive right ventricular failure. The surgical intervention should be earlier before the onset of severe right ventricular failure Tricuspid valve repair is the procedure of choice, while tricuspid valve replacement is also acceptable.

[Surgical treatment of the aortic root aneurysm related to Marfan syndrome].

OBJECTIVE: To review the experience of surgical treatment of aortic root aneurysm of Marfan syndrome. METHODS: We The clinical data of 84 Marfan syndrome patients, 61 males and 23 females, aged 35 +/- 12 (5 - 62), 41 cases presenting with aortic dissection (Debakey type I in 32 cases and type II in 9), 52 cases with moderate to severe aortic regurgitation, and 9 cases with moderate to severe mitral regurgitation, 43 cases with cardiac function of class I - II, 30 with class III and 11 with class IV according the New York Heart Association (NYHA) standard, who underwent surgical treatment for aortic root aneurysm with a mean diameter of 68 mm +/- 14 mm, were analyzed. Bentall procedure was performed in 68 cases, Wheat procedure in 6, Cabrol procedure in 5, and aortic valve replacement and aortoplasty in 5. Concomitant procedures included mitral value replacement and mitral valvuoplasty in 3 cases respectively. Urgent surgery was conducted in 28 cases, and elective operation in 56 cases. RESULTS: There were 3 in-hospital deaths (3.57%). 76 cases were followed up for a mean duration of 55 +/- 31 months. Three patients underwent reoperation. The cardiac function returned to class I - II except for 2 cases that remained at the class III. CONCLUSION: Bentall procedure should be the first choice of the surgery for aortic root aneurysm of Marfan syndrome with a low mortality and a good late outcome.

[Surgical management for Stanford A aortic dissection].

OBJECTIVE: To summarize the surgical experience for Stanford A aortic dissection. METHODS: Sixty-eight patients with Stanford A aortic dissection underwent surgery from March 1998 to October 2004, acute aortic dissection in 45 cases, chronic aortic dissection in 23 cases. The operation were performed by using moderate hypothermic cardiopulmonary bypass in 53 cases, deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) in 11 cases; DHCA with antegrade selective cerebral perfusion (SCP) in 4 cases. Surgical procedures included ascending aortic grafting in 7 cases, ascending and hemiarch grafting in 6, ascending and total arch grafting in 3, ascending and total arch grafting with Frozen elephant trunk procedure in 4. Concomitant procedures included Bentall procedure in 34 cases, Wheat procedure in 12 cases, aortic valvuloplasty in 2 cases, mitral valvuloplasty in 1 cases. Urgent surgery was in 39 cases (emergency surgery in 19). RESULTS: Operative mortality was 7% (urgent surgery mortality was 8%, elective surgery mortality was 7%). Fifty-eight cases were followed up for (37 +/- 22) months. Actuarial survival of 58 cases at 1, 3 and 5 years was 100%, 95% and 86% respectively. CONCLUSION: The choice of surgical procedures depend on the location of intimal tear for Stanford A aortic dissection. Proper surgical indication, technique and brain protections are the key factors of Stanford A aortic dissection surgery.

The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: A retrospective observational study.

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is used to support postcardiotomy cardiogenic shock patients. Elevated serum lactate levels might reflect hypoxia in the tissues, which is associated with mortality in critically ill patients. This study examined the association between the early dynamic behavior of lactate and mortality after ECMO support. METHODS: We included 123 adult patients who had undergone cardiac surgery and received venous-arterial ECMO implantation to treat refractory postcardiotomy cardiogenic shock. The dynamic behaviors of lactate within 6 hours and 12 hours after the beginning of the ECMO support were incorporated into 2 regression models. RESULTS: A total of 56% of the patients were successfully weaned from ECMO support. The in-hospital mortality was 65.9% overall. Univariate and multivariate analyses indicated that age (odds ratio [OR]: 1.1 in the 6-hour model; 1.1 in the 12-hour model), gender (female; OR: 5.6 in the 6-hour model; 7.7 in the 12-hour model), mean lactate concentration (OR: 1.1 in the 6-hour model; 1.2 in the 12-hour model) and lactate clearance (OR: 0.5 in the 6-hour model; 0.1 in the 12-hour model) were reliable predictors (P < .05) of in-hospital mortality. The mean lactate concentration (C statistic: 0.71) and lactate clearance (C statistic: 0.72) 12 hours after the initiation of ECMO support provided better prognostic guidance. The mean lactate concentration (OR: 1.2) and lactate clearance (OR: 0.3) were able to predict successful weaning from ECMO in the 12-hour model only. CONCLUSIONS: In addition to age and gender (female), early lactate behaviors, particularly lactate clearance, after ECMO support are highly associated with in-hospital mortality in postcardiotomy patients. Additionally, early lactate behavior is also predictive of successful weaning from ECMO.

Outcome of veno-arterial extracorporeal membrane oxygenation for patients undergoing valvular surgery.

BACKGROUND: We evaluated retrospectively the early and midterm results of using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support in patients undergoing valvular surgery. METHODS: A total of 87 patients undergoing valvular surgery received VA-ECMO due to refractory postcardiotomy cardiogenic shock (PCS), who were eligible for inclusion were enrolled in this study. Preoperative, perioperative, and postoperative variables were assessed and analyzed for possible associations with mortality in hospital and after discharge. RESULTS: The mean age, additive EuroSCORE, and left ventricular ejection fraction (LVEF) for all patients was 65 ± 7 years, 6.1 ± 1.9 points, and 46% ± 12%, respectively. The mean duration of VA-ECMO support was 61 ± 37 hours. Intra-aortic balloon pumps (IABP) were implanted in 47.1% of patients. Weaning from VA-ECMO was successful in 59% of patients, and 49% were discharged. Multivariate analysis revealed that being >65 years old (odds ratio [OR], 2.75), receiving postoperative renal replacement treatment (OR, 2.47), having a peak lactate level ≥ 12 mmol L(-1) (OR, 2.18), and receiving VA-ECMO for >60 hours (OR, 3.2) were independent predictors of in-hospital mortality. IABP support (OR, 0.46) was protective. In addition, persistent heart failure with an LVEF <40% was an independent predictor of mortality after discharge. CONCLUSIONS: VA-ECMO is an acceptable technique for the treatment of PCS in patients undergoing valvular surgery, who would otherwise die. It is justified by the good long-term outcomes of hospital survivors, but the use of VA-ECMO must be decided on an individual risk profile basis because of high morbidity and mortality rates.

Pulmonary oligemia maneuver can alleviate pulmonary artery injury during pulmonary thromboendarterectomy procedure.

BACKGROUND: Pulmonary thromboendarterectomy (PTE) has evolved as a treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to characterize if pulmonary oligemia maneuver (POM) can alleviate pulmonary artery injury during PTE procedure. METHODS: A total of 112 cases of CTEPH admitted to Beijing Anzhen Hospital from March 2002 to August 2011 received PTE procedure. They were retrospectively classified as non-POM group (group A, n = 55) or POM group (group B, n = 57). Members from group B received POM during rewarming period, whereas members from group A did not. RESULTS: There were three (5.45%) early deaths in group A, no death in group B (0) (Fisher's exact test, P = 0.118). Six patients in group A needed extracorporeal membrane oxygenation (ECMO) as life support after the PTE procedure, no patients in group B needed ECMO (Fisher's exact test, P = 0.013). The patients in group B had a shorter intubation and ICU stay, lower mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR), higher partial pressure of oxygen in artery (PaO2) and arterial oxygen saturation (SaO2) and less medical expenditure than patients in group A. With a mean follow-up time of (58.3 ± 30.6) months, two patients in group A and one patient in group B died. The difference of the actuarial survival after the procedure between the two groups did not reach statistical significance. Three months post the PTE procedure, the difference of residual occluded pulmonary segment between the two groups did not reach statistical significance (P = 0.393). CONCLUSION: POM can alleviate pulmonary artery injury, shorten ICU stay and intubation time, and lower down the rate of ECMO after PTE procedure.

A successful team treatment for left main shock syndrome.

Acute myocardial infarction complicated by cardiogenic shock and left main coronary artery disease is called left main shock syndrome. It is reported that the morbility and mortality of the syndrome is approximately 0.46% and 55%-80%, respectively. However, the best treatment strategy in these cases is unknown. In this article, we present a patient with LMSS who successively underwent emergency percutaneous coronary intervention and coronary artery bypass grafting with hemodynamic support within 5 days. The patient is now on his three month uneventful out-patient follow-up.

Femoral artery cannulation in Stanford type A aortic dissection operations.

The aim of this study was to evaluate femoral artery cannulation in Stanford type A aortic dissection operations. Between March 1994 and December 2001, 88 patients with Stanford type A aortic dissection underwent surgery with cardiopulmonary bypass and perfusion through the femoral artery; 31 of them had deep-hypothermic circulatory arrest. False lumen perfusion was detected in 8 patients (9.1%). There were 4 (4.5%) cerebral events: 2 patients had diffuse cerebral injury, with one death; and 2 patients had hemiplegia, with one death. Six patients (8.0%) had delayed incision healing, with local infection in one. There was no lower extremity ischemia associated with femoral artery cannulation. It was concluded that retrograde perfusion through the femoral artery was effective for repair of aortic dissection, with a low risk of those cerebral events associated with a high mortality rate.