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Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared to conventional CPR. After cardiac arrest, the overall ejection fraction is severely impaired; thus, weaning from ECMO is often prolonged or impossible. We hypothesized that early application of levosimendan in these patients facilitates ECMO weaning and survival. Methods: From 2016 until 2020, patients who underwent eCPR after cardiac arrest at our institution were analyzed retrospectively and divided into two groups: patients who received levosimendan during ICU stay (n = 24) and those who did not receive levosimendan (n = 84) and analyzed for outcome parameters. Furthermore, we used propensity‐score matching and multinomial regression analysis to show the effect of levosimendan on outcome parameters. Results: Overall, in‐hospital mortality was significantly lower in the group which received levosimendan (28% vs. 88%, p ≤ 0.01), and ECMO weaning was more feasible in patients who received levosimendan (88% vs. 20%, p ≤ 0.01). CPR duration until ECMO cannulation was significantly shorter in the levosimendan group (44 + 26 vs. 65 + 28, p = 0.002); interestingly, the rate of mechanical chest compressions before ECMO cannulation was lower in the levosimendan group (50% vs. 69%, p = 0.005). Conclusion: In patients after cardiac arrest treated with eCPR, levosimendan seems to contribute to higher success rates of ECMO weaning, potentially due to a short to mid‐term increase in inotropy. Also, the survival after levosimendan application was higher than patients who did not receive levosimendan. [ABSTRACT FROM AUTHOR]

Background: Percutaneous edge‐to‐edge mitral valve repair technique (MitraClip) is a widely used treatment for mitral regurgitation (MR) in patients assessed with high surgical risk or inoperability. Only limited experiences with this highest‐risk patient population exist. Procedural failure for MitraClip or recurrent MR is a strong predictor of 1‐year mortality. Open mitral valve surgery constitutes the last bailout for patients within this cohort. Methods: This retrospective single‐center cohort study analyzed 17 mitral valve surgery patients after failed MitraClip. We, therefore, analyzed a high‐risk patient population (EuroSCORE II = 10 ± 2.0) with persistent mitral valve regurgitation, which was mainly caused by detachment or dislocation of the MitraClip. Results: Symptomatic patients with failed MitraClip need a convenient operation (mean time to mitral valve surgery = 23 ± 44 days). The patient's collective showed many complex reoperations with the need for concomitant surgery. Considering the high‐risk patient population, we showed an average 30‐day all‐cause mortality (18%, n = 3) accompanied by typical postoperative complications related to prolonged mechanical ventilation (44 ± 48 h) and ICU stay (11 ± 11 days), reflecting high‐risk patients. Further, excellent valve‐related outcomes were shown regarding adverse cardiac events (valve‐related mortality 6%, n = 1) and postoperative echocardiographic results (moderate or severe paravalvular leak 6%, n = 1). Conclusion: Failure of MitraClip represents a challenging situation limited by high‐risk profiles of patients and limits the possibility of surgical valve repair, shown by a high rate of mitral valve replacement (94%, n = 16). Secondary surgery was associated with moderate 30‐day and postdischarge outcomes. Therefore, a careful evaluation of patients undergoing MitraClip is of paramount importance. [ABSTRACT FROM AUTHOR]

Objectives: Extracorporeal membrane oxygenation or extracorporeal life support (ECLS) in patients after cardiac surgery and postcardiotomy cardiogenic shock (PCS) is known to be associated with high mortality. Especially in patients after coronary artery bypass grafting (CABG) and PCS, ECLS is frequently established. The aim of this analysis was to evaluate factors associated with in‐hospital mortality in patients treated with ECLS due to PCS after CABG. Methods: Between August 2006 and January 2017, 92 consecutive patients with V‐A ECLS due to PCS after isolated CABG were identified and included in this retrospective analysis. Patients were divided into survivors (S) and non‐survivors (NS) and analyzed with risk factors of in‐hospital mortality. Results: In‐hospital mortality added up to 61 patients (66%). Non‐survivors were significantly older (60 ± 812 (S) vs. 67 ± 10 (NS); p = 0.013). Bilateral internal mammary artery graft was significantly more frequently used in S (23% (S) vs. 2% (NS); p = 0.001). After 24 h of ECLS support, median lactate levels were significantly higher in NS (1.9 (1.3; 3.5) mmol/L (S) vs. 3.5 (2.1; 6.3) mmol/L (NS); p = 0.001). NS suffered more often acute kidney injury requiring dialysis (42% (S) vs. 74% (NS); p = 0.002). Conclusion: Mortality in patients with refractory PCS after CABG and consecutive ECLS support remains high. Failing end‐organ recovery under ECLS despite optimized concomitant medical therapy is an indicator of adverse outcomes in this specific patient cohort. Moreover, total‐arterial revascularization might be beneficial for cardiac recovery in patients suffering PCS after CABG and following ECLS. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to increasing survival rates in selected patients. Additional left ventricular mechanical unloading, using a transfemoral micro‐axial blood pump (Impella® Denver, Massachusetts, USA), might improve patients' outcomes. In this regard, we sought to investigate patients who suffered OHCA (out‐of hospital cardiac arrest) or IHCA (in‐hospital cardiac arrest) with subsequent eCPR via VA‐ECMO (veno‐arterial extracorporeal membrane oxygenation) and concomitant Impella® implantation based on survival and feasibility of ECMO weaning. Methods: From January 2016 until December 2020, 108 patients underwent eCPR at our institution. Data prior to eCPR and early outcome parameters were analyzed comparing patients who were supported with an additional Impella® (2.5 or CP) (ECMO+Impella®, n = 18) and patients without additional (ECMO, n = 90) support during V‐A ECMO therapy. The primary endpoint was in‐hospital mortality; secondary endpoints were, among others: ECMO explantation, need for hemodialysis, stroke, and need for blood transfusions. Results: Low‐flow time was significantly lower in the ECMO+Impella group (60 min vs. 55 min, p =.01). All‐cause mortality was significantly lower in the ECMO+Impella® group (82% vs. 56%, p =.01). The time of circulatory support was shorter in the ECMO cohort (2.0 ± 1.73 vs. 4.76 ± 2.88 p =.05). ECMO decannulation was significantly more feasible in patients with ECMO+Impella® (72% vs. 32%, p =.01). Patients treated with additional Impella® showed significantly more acute kidney injury with the need for dialysis (72% vs. 18%, p ≤.01). Conclusion: Concomitant Impella® support might positively influence survival and ECMO weaning in eCPR patients. Treatment‐associated complications such as the need for dialysis were more common in this highly selected patient group. Further studies with larger numbers are necessary to evaluate the clinical relevance of concomitant LV‐unloading in eCPR patients using an Impella® device. [ABSTRACT FROM AUTHOR]

Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to significant improvement in selected patients' survival rates. Gender‐related differences might impact the outcome of therapeutic measures. Therefore, we sought to investigate patients with eCPR at our interdisciplinary extracorporeal membrane oxygenation center regarding sex‐related differences with the view to potentially adjusting current selection criteria. From January 2016 to December 2019, 71 patients underwent eCPR at our institution. Data before eCPR and early outcome parameters were analyzed comparing male and female patients. The cohort analyzed consisted of 60 male (84%) and 11 female (15%) patients. Comparing both groups, male patients significantly more frequently suffered out‐of‐hospital cardiac arrest (68% male vs. 36% female, P =.04), whereas female patients were associated with more in‐hospital cardiac arrest (32% male vs. 64% female, P =.04). Creatinine levels differed significantly (1.5 (1.1;2.1) mg/dL in male vs. 1.0 (0.7;1.5) mg/dL in female patients, P =.03). Also, several hepatic parameters showed a significant difference between the groups: aspartate aminotransferase 423 (249;804) U/L in male vs. 115 (61;408) U/L in female patients, P =.01; alanine aminotransferase 174 (102;446) U/L in male vs. 86 (36;118) U/L in female patients, P =.01). Renal failure requiring hemodialysis occurred more frequently in men than in women (P <.01). There is a significant effect of male sex regarding renal failure with subsequent continuous venovenous hemodialysis (CVVH) (R2 = 0.11, ANOVA P =.01, 95% CI = −0.79‐−0.079). However, in‐hospital mortality was comparable between the groups (78% in male vs. 72% in female patients, P =.68). Our retrospective study showed several gender‐related differences associated with different cardiac arrest scenarios. Male sex was associated with a significantly higher risk for renal failure requiring CVVH. Survival rates were comparable between the groups. Further investigations should include gender in the evaluation of risk stratification for eCPR‐related complications to further improve selection criteria for this demanding therapy. [ABSTRACT FROM AUTHOR]

Pulmonary embolism can be associated with paradox embolism requiring immediate surgical therapy regardless of hemodynamic status. Here we present images illustrating a giant transit thrombus as a concomitant finding in a patient with pulmonary artery embolism. [ABSTRACT FROM AUTHOR]