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Abstract: Severe adult respiratory distress syndrome (ARDS) is associated with failure to maintain adequate gas exchange. There is increasing success using extracorporeal membrane oxygenation (ECMO) for respiratory failure; the longest reported surviving patient has been supported by ECMO for 57 days. At best about 50% wean from ECMO and should weaning fail their course is fatal. ECMO is generally considered to be a contraindication for successful lung transplantation. This report describes a patient maintained on ECMO for 107 days who underwent bilateral lung transplantation and weaned from organ-perfusion support. He survived for 351 days post-transplantation and died from Pseudomonas aeruginosa pneumonia. ECMO can be used for prolonged intervals to support patients with severe ARDS without complications that preclude lung transplantation. As ECMO use becomes more frequent, it becomes critical to determine criteria that would optimise patient selection for transplantation from ECMO. [Copyright &y& Elsevier]

Abstract: Extra-corporeal membrane oxygenation (ECMO) is accepted as a salvage therapy to treat life-threatening complications following lung transplantation such as primary graft dysfunction, acute rejection or airway dehiscence. Levitronix Centrimag® (Levitronix LLC, Waltham, MA) is a centrifugal pump that consists of a magnetically levitated bearing-less rotor designed to reduce blood friction. ECMO using the Levitronix Centrimag® pump may be an ideal medium-term support for lung transplant recipients suffering these serious complications. We describe our early experience of using ECMO with Levitronix Centrimag® device and the Hilite hollow fibre membrane oxygenator (Medos Hilite® LT, Medos Medizintechnik AG) in three cases following lung transplantation. The device is technically easy to implant and manage with a low complication rate on minimal anticoagulation. [Copyright &y& Elsevier]

Fulminant myocarditis, Extracorporeal membrane oxygenation, Aortopulmonary collateral arteries. [Extracted from the article]

Tracheobronchial rupture by a double-lumen endobronchial tube is a rare but life-threatening complication. We report a case of bronchial rupture during contralateral bilobectomy. Venovenous extracorporeal membrane oxygenation support was instituted via the right femoral vein and the internal jugular vein with the patient in the left lateral decubitus position. Sleeve resection of the ruptured bronchus was performed. The patient was successfully discharged home. Rapid institution of venovenous extracorporeal membrane oxygenation is helpful to manage this intraoperative complication. [ABSTRACT FROM AUTHOR]

Anastomotic leak after oesophagectomy is associated with poor outcomes. We report the successful utilization of venovenous extracorporeal membrane oxygenation in conjunction with tracheal stent to treat and heal multiple tracheal–neo-oesophageal fistulae following oesophagectomy. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement has emerged as an alternative to surgical aortic valve replacement for high-risk and inoperable patients. Although transcatheter aortic valve replacement avoids the use of extracorporeal circulation and sternotomy, it is nonetheless associated with inherent complications. We aim to present an embolized valve-in-valve complex in the ascending aorta, which required emergency surgery with deep hypothermic circulatory arrest and proximal aortic cannulation. [ABSTRACT FROM AUTHOR]

Extracorporeal cardiopulmonary resuscitation can be used as a rescue strategy in cases of prolonged cardiac arrest caused by massive pulmonary embolism. We present a case of a male patient who was in prolonged cardiac arrest following massive pulmonary embolism. Veno-arterial extracorporeal membrane oxygenation was initiated approximately 93 min after prolonged cardiopulmonary resuscitation. After resuscitation, bedside echocardiography and a chest computed tomography angiogram revealed a massive pulmonary embolism during extracorporeal membrane oxygenation support. The patient received transcatheter mechanical thrombectomy without haemodynamic instability in extracorporeal membrane oxygenation support. He was also treated with therapeutic hypothermia to improve neurological outcome. Renal replacement therapy for acute kidney injury was continued for 36 days. The patient was discharged at 60 days after admission with no serious complications. This case demonstrates that veno-arterial extracorporeal membrane oxygenation and therapeutic hypothermia are an effective treatment strategy for prolonged cardiac arrest caused by massive pulmonary embolism. [ABSTRACT FROM AUTHOR]

We report a case of acute tamponade of the left paracorporeal pump house in a patient supported by a Berlin Heart EXCOR biventricular assist device (BiVAD) caused by mechanical defect in the membrane of the arterial chamber. A 36-year old male was admitted for composite graft surgery due to a large aortic regurgitation and consecutive heart failure, decompensated postoperatively and was rescued by with an extracorporeal membrane oxygenation (ECMO) device. He was accepted for heart transplantation, and a BiVAD (Berlin Heart EXCOR) was implanted as bridge-to-transplantation. Two months after discharge, he experienced dyspnoea and received error signals from his BiVAD. Relatives released him from his BiVAD companion driver, connected him to the hand pump and transported him to our institution. On arrival, he was in cardiogenic shock and was stabilized by ECMO. Inspection of the arterial chamber revealed a wear hole and delamination of the diaphragm, which had led to a tamponade by air insufflation into the three-layer membrane. New BiVAD paracorporeal pumps were connected, and the patient was subsequently successfully transplanted. The case depicts the difficulty of diagnosis in this specific patient setting. Despite transparent design of the BiVAD chambers, the development of a chamber tamponade remained undetected until explantation of the system. [ABSTRACT FROM AUTHOR]

The author discusses the challenges in providing mechanical circulatory support to children with congenital heart disease in. The author cites the success of a team from Newcastle, England with bridge to heart transplantation with extracorporeal membrane oxygenator (ECMO). The author believes that using VAD as a rescue strategy is link with high mortality but mechanical support can successfully bridge congenital heart disease to transplantation.

The author discusses aspects of lung transplantation which has evolved as an alternative intervention and solution to donor organ shortage for children and young adult recipients. She explains that lobar lung transplantation allows the use of large organ donors and utilization of lungs with a localized single lobe pathology. The author reveals that the bronchial anastomosis in lobar transplantation is more difficult to suture and can result to varied complications.

We present the case of a 41-year old patient suffering from end-stage pulmonary hypertension secondary to veno-occlusive disease who underwent implantation of a veno-arterial extracorporeal membrane oxygenator as a bridge to lung transplantation (LTx) due to significant deterioration of myocardial pump and liver function. After 33 days on support, lungs with extended donor criteria were offered. Owing to the deteriorating clinical condition of the patient, the lungs were assessed using our ex vivo lung perfusion system. After reconditioning of the graft, a bilateral LTx was performed. [ABSTRACT FROM PUBLISHER]

The author discusses the study by the Mount Sinai Medical Center Group regarding an immediate primary implantation of a ventricular assist device (VAD) in patients with acute myocardial infarction (AMI). He says that the device should deliver a pump output and achieve full left ventricular decompression to meet the needs of the patient. He adds that the advantage of using extracorporeal membrane oxygenation (ECMO) is without any surgical intervention.

A letter to the editor is presented in response to the article "Bilateral lobar lung transplantation and size mismatch by pTLC-ratio," by Eberlein M., Bolukbas S., and Reed R. M. in the 2013 issue.

In this article, the author discusses the transplant heart failures. The authors states several reasons for graft failure including long ischaemic times, inadequate myocardial preservation and poor adaptation of the graft to the recipients' haemodynamic environment. The author informs that the measure that aims at reducing the transplant failure includes the use of inhaled nitric oxide and introduction of mechanical circulatory support (MCS).

Abstract: We herein describe a simple and safe technique to avoid compartment syndrome/arm ischemia during direct right axillary artery cannulation, especially in patients who require long-term extracorporeal membrane oxygenation support. [Copyright &y& Elsevier]

Abstract: Idiopathic pulmonary artery hypertension (IPAH) is a progressive disease with a dismal prognosis and lung transplantation is often the only option for patients, who do not respond to pharmacological therapy. We report the use of an extracorporeal membrane oxygenation (ECMO) system in a 49-year-old woman with primary pulmonary hypertension, previously liver transplanted. The patient, listed for lung transplantation, developed respiratory and circulatory failure despite maximal pharmacological therapy and was successfully bridged to emergent bilateral lung transplantation with veno-arterial ECMO. Emergent veno-arterial ECMO was able to rescue the patient and bridge her to bilateral lung transplantation and should therefore be an option for patients with PAH and circulatory collapse. [Copyright &y& Elsevier]

Abstract: Continuous renal replacement therapy is particularly suited in the setting of acute renal failure, occurring after cardiac surgery, in patients requiring extracorporeal life support (ECLS) or membrane oxygenation. In such patients, temporary catheters are not necessary since the circuit of haemodialysis or haemofiltration may be connected on the ECLS cannulae. We report how to modify a classical ECLS circuit to connect directly the haemodialysis (Prismaflex device, Gambro-Hospal, Lyon, France) to the ECLS. We also detail parameters used to initiate the haemodialysis. Actually, we modify all our ECLS circuits as described here, at implantation time, allowing rapid haemodialysis initiations. Since 2004, 21 patients have been treated, as described here, without supplemental mortality or related complication. [Copyright &y& Elsevier]

Abstract: Diffuse coronary vasospasm is an unpredictable and serious complication following coronary artery bypass surgery. The treatment of this emergency is dependent on patient suitability for angiography and direct injection of vasodilators into the affected vessels. In patients unable to proceed to angiography the diagnosis can only be suspected but treatment is nevertheless still towards reinstitution of coronary blood flow. We present one such case in which re-grafting and extracorporeal membranous oxygenation proved successful in restoring cardiac function in a patient with diffuse coronary artery spasm. [Copyright &y& Elsevier]

Abstract: Bleeding remains a potential complication for patients requiring extracorporeal life support systems. Recombinant activated factor VII (rFVIIa) is one of the drugs used in controlling bleeding. Its use is generally found to be safe. We report a paediatric patient who developed fatal thrombosis with the use of rFVIIa whilst on extracorporeal membrane oxygenation and discuss the possible factors that lead to fatal thrombosis. [Copyright &y& Elsevier]

OBJECTIVES Lung transplantation (LTx) is a life-saving therapy for patients with end-stage lung disease. However, there remains a significant postoperative complication rate and mortality in this extreme patient group. The aim of the present study was to identify donor, recipient and perioperative risk factors for one-year mortality after LTx. METHODS A total of 252 LTxs were performed in our institution between 2007 and 2013. Donor and recipient demographics and clinical characteristics of 1-year survivors and non-survivors were collected and compared retrospectively. Multivariate logistic regression analysis was performed on univariate predictors for 1-year mortality with an entry criterion of P < 0.05. RESULTS Multivariate analysis revealed female-to-male transplantation (95% CI: 0.088–0.767; P = 0.015), lower pO2/FiO2-ratio at 72 h postoperatively (95% CI: 0.988–0.999; P = 0.024), need for postoperative extracorporeal membrane oxygenation (ECMO) support (95% CI: 0.035–0.658; P = 0.012) and on-pump technique (95% CI: 0.007–0.944; P = 0.045) as the only independent predictors for 1-year mortality. Mainly unplanned intraoperative conversion to cardiopulmonary bypass contributed to poorer survival in patients who underwent LTx using cardiopulmonary bypass (P < 0.001). CONCLUSIONS Our results show that the unplanned use of CPB (conversion from off- to on-pump) might adversely affect outcome after LTx. Also, the negative impact of female-to-male transplantation should not be underestimated during recipient selection. Furthermore, poor early postoperative oxygenation, particularly with the need for extracorporeal oxygenation, might be a very strong negative prognostic factor after LTx. [ABSTRACT FROM AUTHOR]

OBJECTIVES Left ventricular assist devices (LVADs) are a routine treatment for patients with advanced heart failure as a bridge to transplantation. The aim of this study was to present our institutional experience and mid-term outcomes after implantation of 139 continuous-flow (cf) LVADs as a bridge to transplantation. METHODS One hundred and thirty-nine consecutive LVAD implantations were performed in our institution between July 2007 and August 2013. The mean age of the population was 44.0 ± 13.7 years and 24 (17%) of the patients were female. A substantial number of the patients were on preoperative mechanical support: 35 (25%) with an intra-aortic balloon pump, 9 (6.5%) with an extracorporeal membrane oxygenator and 25 (18%) with previous LVAD, for LVAD exchange. RESULTS The mean support duration was 514 ± 481 days, whereas the longest support duration was 2493 days (>6 years). The overall cumulative survival rate following cfLVAD implantation was 89% at 30 days, 76% at 1 year and 66% at 2 years (Fig. 1). There was a statistically significant difference in survival in favour of first LVAD implantation compared with VAD exchange: 91 vs 80% at 30 days, 79 vs 57% at 1 year and 70 vs 43% at 2 years (log-rank P = 0.010). Postoperatively, patients had a significant improvement in end-organ function 1 month after LVAD implantation. In addition, comparison of two different devices [HeartMate II (HM II) and HeartWare] using propensity score matching showed no significant differences in survival and most postoperative adverse events. However, patients supported with HM II required significantly more units of fresh frozen plasma (P = 0.020) with a trend towards a higher use of red blood cells (P = 0.094), and were also more likely to develop percutaneous site infections (P = 0.022). CONCLUSIONS HM II and HeartWare cfLVADs have excellent early postoperative outcomes and good mid-term survival, despite a considerable number of patients needing VAD exchange. [ABSTRACT FROM AUTHOR]

OBJECTIVES The high mortality rate observed on the regular waiting list (RWL) before lung transplantation (LTx) prompted the French organ transplantation authorities to set up in 2007 a dedicated graft allocation strategy, the so-called ‘high-emergency waiting list’ (HEWL), for patients with an abrupt worsening of their respiratory function. This study reports on the early results of this new allocation system. METHODS Among 11 active French LTx programmes, 7 were able to provide full outcome data by 31 December 2011. The medical records of 101 patients who were listed on the HEWL from July 2007 to December 2011 were reviewed for an intention-to-treat analysis. RESULTS Ninety-five patients received LTx within a median waiting time on the HEWL of 4 days (range 1–26), and 6 died before transplantation. Conditions were cystic fibrosis (65.2%), pulmonary fibrosis (24.8%), emphysema (5%) and miscellaneous (5%). The median age of the recipient was 30 years (range 16–66). Patients listed on the HEWL came from the RWL in 48.5% of the cases and were new patients in 51.5%. Forty-nine were placed under invasive ventilation and, in 26 cases, extracorporeal membrane oxygenation (ECMO) prior to transplantation was necessary as a complementary treatment. ECMO for non-intubated patients was performed in 6 cases. Eighty-one bilateral and 14 single LTx were performed, with an overall in-hospital mortality rate of 29.4%. One- and 3-year survival rates were 67.5 and 59%, respectively. Multivariate analysis shows that the use of ECMO prior to transplantation was the sole independent mortality risk factor (hazard ratio = 2.77 [95% CI 1.26–6.11]). CONCLUSIONS The new allocation system aimed at lowering mortality on the RWL, but also offered an access to LTx for new patients with end-stage respiratory failure. The HEWL increased the likelihood of mortality after LTx, but permitted acceptable mid-term survival rates. The high mortality associated with the use of ECMO should be interpreted cautiously. [ABSTRACT FROM AUTHOR]

OBJECTIVES Outcomes of casualties with thoracic wounding at the deployed UK military field hospital (Role 3(R3)) have been previously described. The level of cardiothoracic specialist input required on repatriation to the UK is less clear. This study aimed to assess the outcomes of casualties with thoracic injuries repatriated to the UK (Role 4 (R4)) and evaluate the impact of specialist cardiothoracic care. METHODS Casualties were identified through the UK Joint Theatre Trauma Registry. Casualties coded for pulmonary contusions and/or thoracotomy between March 2006 and March 2011 were identified and case-notes reviewed. Subgroup analysis was performed for patients with a documented thoracic abbreviated injury score ≥3. RESULTS One hundred and eighty-two UK patients were admitted to UK R4 coded to have a thoracic injury; overall mortality 4.9%. Ninety-three were classified as a thoracic AIS of ≥3; mortality 6.5%. Sixty-four were coded for pulmonary contusions and/or thoracotomy; mortality 1.6, and 66% had thoracic AIS ≥3. Improvised explosive devices injured 54 and 62% had a penetrating injury. Pulmonary contusions were present in 70%; 43% developed a chest infection. Thoracotomy/sternotomy was performed in 13 casualties in R3; 3 re-explored in R4. Oscillatory ventilation and extracorporeal membrane oxygenation was required in 1 case. Cardiothoracic surgery was involved in managing 39% (n = 24) of cases; 11 (45%) required surgical intervention and 19 (79%) had cardiothoracic outpatient follow-up. CONCLUSION Morbidity and mortality associated with significant thoracic injury is low at UK R4. Follow-up is required to assess long-term outcomes. Specialist cardiothoracic support and intervention was required in the management of complex thoracic trauma. Early specialist support at R4 may improve morbidity and outcomes associated with life-threatening thoracic injury. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Acute pulmonary embolectomy" by C. He and colleagues in a 2013 issue.

Abstract: Objective: The aim of the study is to assess the surgical outcome of slide tracheoplasty in patients with congenital tracheal stenosis and single lung. Methods: Pre, intra- and postoperative data were collected. Anatomy and associated anomalies were described. Results: Seven patients (median age 5 months; range 39 days–1 year) with single lung underwent slide tracheoplasty. Single right lung was present in four patients. Associated anomalies were present in four patients (56%) including vascular ring, left pulmonary artery (LPA) sling, VACTERL (abnormalities of the vertebrae, anus, cardiovascular tree, trachea, oesophagus, renal system, and limb buds) syndrome, atrial septal defect (ASD) and aberrant left subclavian artery. Six patients (85%) needed preoperative ventilation and two (28%) needed preoperative extracorporeal membrane oxygenation (ECMO). Median postoperative ventilation was 7 days (6–35 days). Two patients needed postoperative ECMO, one of whom required preoperative ECMO. Complications occurred in five patients (71%): reintubation due to pneumothorax, pneumonia and several tracheal dilatations due to recurrent tracheal stenosis, which was eventually stented. There was one hospital death in a patient, who could not be weaned off ECMO due to severe distal malacia. At a median follow-up of 16 months (7 days–7 years), all survivors are in good clinical condition and without additional stenting. Conclusion: Slide tracheoplasty can be performed in patients with single lung and tracheal stenosis with a good surgical outcome. [Copyright &y& Elsevier]