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BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO during the first wave of COVID-19 and to describe the status of patients 6 months after ECMO initiation.METHODS: EuroECMO-COVID is a prospective, multicentre, observational study developed by the European Extracorporeal Life Support Organization. This study was based on data from patients aged 16 years or older who received ECMO support for refractory COVID-19 during the first wave of the pandemic-from March 1 to Sept 13, 2020-at 133 centres in 21 countries. In-hospital mortality and mortality 6 months after ECMO initiation were the primary outcomes. Mixed-Cox proportional hazards models were used to investigate associations between patient and management-related variables (eg, patient demographics, comorbidities, pre-ECMO status, and ECMO characteristics and complications) and in-hospital deaths. Survival status at 6 months was established through patient contact or institutional charts review. This study is registered with ClinicalTrials.gov, NCT04366921, and is ongoing.FINDINGS: Between March 1 and Sept 13, 2020, 1215 patients (942 [78%] men and 267 [22%] women; median age 53 years [IQR 46-60]) were included in the study. Median ECMO duration was 15 days (IQR 8-27). 602 (50%) of 1215 patients died in hospital, and 852 (74%) patients had at least one complication. Multiorgan failure was the leading cause of death (192 [36%] of 528 patients who died with available data). In mixed-Cox analyses, age of 60 years or older, use of inotropes and vasopressors before ECMO initiation, chronic renal failure, and time from intubation to ECMO initiation of 4 days or more were associated with higher in-hospital mortality. 613 patients did not die in hospital, and 547 (95%) of 577 patients for whom data were available were alive at 6 months. 102 (24%) of 431 patients had returned to full-time work at 6 months, and 57 (13%) of 428 patients had returned to part-time work. At 6 months, respiratory rehabilitation was required in 88 (17%) of 522 patients with available data, and the most common residual symptoms included dyspnoea (185 [35%] of 523 patients) and cardiac (52 [10%] of 514 patients) or neurocognitive (66 [13%] of 512 patients) symptoms.INTERPRETATION: Patient's age, timing of cannulation (FUNDING: None.

Background: To assess the impact of diagnostic procedures in identifying residual lesions during extracorporeal membrane oxygenation (ECMO) on survival after pediatric cardiac surgery. Methods: Between January 2012 and December 2017, 74 patients required postcardiotomy ECMO. Patients were retrospectively divided into 2 groups: Group I underwent only echocardiography ([echo only] 46 patients, 62.2%) and group II (echo+) underwent additional diagnostic tests (ie, computed tomography [CT] or cardiac catheterization; 28 patients, 37.8%). Propensity score matching was used to balance the 2 groups by baseline characteristics. Results: Two equal groups (28 patients in each group) were formed by propensity score matching. Fourteen (50%) patients in the echo-only group and 20 (71%) patients in the echo+ group were successfully weaned from ECMO ( P = .17). Four (14.3%) patients survived in the echo-only group and 15 (53.5%) patients survived in the echo+ group ( P = .004). Patients in the echo+ group had a lower chance of dying compared to the echo-only group (odds ratio, 0.14.6; 95% CI, 0.039-0.52; P = .003). The residual lesions, which may have served as a mortality factor, were found by autopsy in 8 (40%) patients in the echo-only group, while none were found in the echo+ group ( P = .014). Conclusions: The autopsies of patients who died despite postcardiotomy ECMO support showed that in 40% of cases that had been investigated by echo only, residual lesions that had not been detected by echocardiography were present. The cardiac catheterization and CT during ECMO are effective and safe for identifying residual lesions. Early detection and repair of residual lesions may increase the survival rate of pediatric cardiac patients on ECMO.

In cases of severe cardiopulmonary deterioration, quick establishment of venoarterial extracorporeal membrane oxygenation (ECMO) represents a support modality. After successful arterial peripheral cannulation, a certain grade of peripheral limb malperfusion is a fairly common phenomenon. Detection of peripheral malperfusion is vital, since it can result in compartment syndrome or even loss of the affected limb. To prevent or resolve emerging lower limb ischaemia, a newly designed perfusion catheter is placed into the superficial femoral artery, distal to the arterial cannula via ECMO. The aim of our study was to evaluate flow and haemodynamic characteristics of this novel distal limb perfusion cannula for ECMO therapy and present these important findings for the first time. The distal perfusion cannula blood flow increases in linear correlation with ECMO blood flow The variability of distal perfusion cannula blood flow with a 15 Fr cannula ranges between 160 ± 0.40 mL min−1 at 1.5 L min−1 ECMO flow rate and 480 ± 80 mL min−1 at 5.0 L min−1 ECMO blood flow, respectively. Comparatively, the 17-Fr-sized cannula performs on a scale of 140 ± 20 to 390 ± 60 mL distal perfusion cannula blood flow at 1.5-5.0 L min−1 ECMO blood flow, respectively. The quantitative assessment of the distal perfusion cannula blood flow has revealed that distal perfusion cannula blood flow can measure up to 10% of the ECMO blood flow. Furthermore, it has been also well demonstrated that the novel distal perfusion cannula is sufficient to compensate peripheral limb ischaemia.

Cardiac surgery in patients with hemophilia remains a serious problem due to the risk of bleeding complications. Here, we report successful treatment of mitral valve insufficiency and concomitant atrial fibrillation in a patient with severe hemophilia A.

Importance Corticosteroids are widely used in pediatric cardiac surgery to blunt systemic inflammatory response and to reduce complications; nevertheless, their clinical efficacy is uncertain. Objective To determine whether intraoperative administration of dexamethasone is more effective than placebo for reducing major complications and mortality during pediatric cardiac surgery. Design, Setting, and Participants The Intraoperative Dexamethasone in Pediatric Cardiac Surgery was an investigator-initiated, double-blind, multicenter randomized trial that involved 4 centers in China, Brazil, and Russia. A total of 394 infants younger than 12 months, undergoing cardiac surgery with cardiopulmonary bypass were enrolled from December 2015 to October 2018, with follow-up completed in November 2018. Interventions The dexamethasone group (n = 194) received 1 mg/kg of dexamethasone; the control group (n = 200) received an equivolume of 0.9% sodium chloride intravenously after anesthesia induction. Main Outcomes and Measures The primary end point was a composite of death, nonfatal myocardial infarction, need for extracorporeal membrane oxygenation, need for cardiopulmonary resuscitation, acute kidney injury, prolonged mechanical ventilation, or neurological complications within 30 days after surgery. There were 17 secondary end points, including the individual components of the primary end point, and duration of mechanical ventilation, inotropic index, intensive care unit stay, readmission to intensive care unit, and length of hospitalization. Results All of the 394 patients randomized (median age, 6 months; 47.2% boys) completed the trial. The primary end point occurred in 74 patients (38.1%) in the dexamethasone group vs 91 patients (45.5%) in the control group (absolute risk reduction, 7.4%; 95% CI, −0.8% to 15.3%; hazard ratio, 0.82; 95% CI, 0.60 to 1.10;P = .20). Of the 17 prespecified secondary end points, none showed a statistically significant difference between groups. Infections occurred in 4 patients (2.0%) in the dexamethasone group vs 3 patients (1.5%) in the control group. Conclusions and Relevance Among infants younger than 12 months undergoing cardiac surgery with cardiopulmonary bypass, intraoperative administration of dexamethasone, compared with placebo, did not significantly reduce major complications and mortality at 30 days. However, the study may have been underpowered to detect a clinically important difference. Trial Registration ClinicalTrials.gov Identifier:NCT02615262

Aim: To compare the rate of neurologic complications in infants with aortic coarctation and aortic arch hypoplasia undergoing aortic arch repair under deep hypothermic circulatory arrest or full-flow perfusion with double arterial cannulation. Material and Methods: This pilot single-center simple blinded prospective study assessed the early postoperative outcomes in infants with aortic arch obstruction. Patients underwent on-pump repair under deep hypothermic circulatory arrest (I group, 20 patients) or full-flow perfusion with double arterial cannulation (II group, 20 patients). Results: In-hospital mortality was 5% (1 patient) in each group (p>0.05). Neurologic complications occurred in 14 (70%) patients of the 1st group and 6 patients (30%) of the 2nd group (p=0.025). The only significant risk factor was head tissue saturation according to near-infrared spectroscopy. Each percent decreased the risk of neurologic event by 6%. Conclusion: Aortic arch repair under full-flow perfusion reduces the rate of neurologic events in infants compared to deep hypo- thermic circulatory arrest. Head tissue saturation was the risk factor of neurologic complications. Each percent decreased the risk of neurologic event by 6%.

Objective To investigate the 1-year survival in cardiac surgical patients with lung disease, including previously undiagnosed cases. Design Prospective cohort study. Setting Tertiary hospital. Participants Patients scheduled for elective coronary artery bypass graft (CABG) surgery. Interventions None. Measurements and Main Results Pulmonary function tests (PFTs) were performed in 454 patients before surgery. Abnormal respiratory patterns were defined as follows: obstructive (forced expiratory volume in 1 second/forced vital capacity Conclusions Combination of confirmed preexisting lung disease and newly diagnosed cases provides a clear link to mid-term mortality.

Congenital aneurysms and diverticula of the left ventricle represent a rare group of anomalies in the spectrum of congenital heart disease. Although natural histories of these anomalies are considerably different and characterized by different rates of life-threatening events, similarity of their clinical presentation and diagnostic criteria do not allow to differentiate this anomalies at routine examination. Data on etiology, methods of diagnosis and treatment published by various authors is controversial. In this review we present relevant aspects of etiology, pathophysiology and treatment strategy of patients with left ventricular diverticula and congenital aneurysms.

Right pulmonary artery agenesis combined with tetralogy of Fallot is a rare congenital heart disease. Infants with this anomaly are in a high-risk group and often undergoe staged surgical repair with initial systemic-to-pulmonary shunt placement. While the shunt thrombosis may occur, a repeat open surgery could be associated with high risk of unfavorable outcome. In this case, an endovascular repair should be an appropriate option. We present the case of right ventricular outflow tract stenting in an 8-month girl with tetralogy of Fallot and right pulmonary artery agenesis after late thrombosis of the left-sided modified Blalock-Taussig shunt.

Congenital left ventricular diverticulum is an extremely rare heart defect. Here, we report a case of successful endoventriculoplasty using a Dacron patch in an infant who was followed up for one year.

Pulmonary artery rupture during pulmonary balloon valvuloplasty is a rare and life-threatening complication. Here, we present a pulmonary artery rupture in a 10-month-old infant. The patient had a tamponade, ineffective cardiac massage for 40 minutes and extreme hemodilution due to blood loss. Extracorporeal life support was used for three days. The patient was discharged without any neurological sequelae.

Results of surgical treatment in 31 patients with different congenital aortic arch pathologies are presented. Two intraoperative methods of cerebral protection: deep hypothermia (n = 15), antegrade perfusion (n = 16) were used over a period from 2008 to 2012. Hospital mortality and neurologic complications in the antegrade perfusion group were significantly lower than those in the deep hypothermia group. However, a high rate of renal complications requires further investigation of this problem, identification of possible causes and improvement of the method.

We present a case of 7-hour ventricular fibrillation with successful use of veno-arterial extracorporeal membrane oxygenation as a bridge to recovery in a 30-year-old patient with grown-up congenital heart disease who underwent pulmonary valve replacement.

Kawasaki disease is usually a limited illness of early childhood. However, life-threatening cardiac manifestations can occur, either at acute presentation or as a consequence of coronary arterial involvement. We report the successful use of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for cardiac support in two children with Kawasaki disease: one with acute Kawasaki disease shock syndrome, the other with complications of coronary arteritis and subsequent surgery. We also reviewed the reported experience in the ELSO database and available literature.

OBJECTIVES The aim of our prospective randomized study was to compare modified reverse aortoplasty (MRA) and extended end-to-end anastomosis (EEA). METHODS We have assessed the operative correction results in 54 infants with coarctation of the aorta and distal aortic arch hypoplasia who underwent primary repair in our institute between July 2013 and February 2014. All of the patients were

Anatomical correction of transposition of the great arteries (TGA) with an intramural coronary artery is associated with high risk of coronary complications such as vessel injury and stenosis. Here, we report on a case of left main coronary artery stenting in a neonate with single coronary artery after repair for TGA.

Pulmonary haemorrhage is one of the most severe complications of pulmonary endarterectomy. To the most effective methods of combating this potentially fatal complication belongs extracorporeal membrane oxygenation (ECMO). In this article we describe a clinical case report regarding intraoperative use of central veno-arterial ECMO for pulmonary haemorrhage following thromboendarterectomy from the pulmonary arteries. According to the data of some authors, long-term ECMO support (for more than 4 days) may lead to such severe consequences as rethrombosis of pulmonary arteries and impairment of cerebral circulation. In our case we managed to avoid such complications, taking into consideration that the duration of ECMO amounted to 21 days. Resulting from the carried out comprehensive therapeutic measures by the time of discharge from hospital, a significant decrease in pulmonary artery pressure was achieved, with events of residual pulmonary hypertension.Одним из самых тяжелых осложнений легочной эндартерэктомии является легочное кровотечение. К наиболее эффективным методам борьбы с этим фатальным осложнением относится экстракорпоральная мембранная оксигенация. В данной работе описывается клинический случай интраоперационного применения ЭКМО в центральном вено- артериальном варианте при легочном кровотечении после тромбэндартерэктомии из легочных артерий. По данным ряда авторов, длительное применение ЭКМО (более 4 суток) может привести к таким тяжелым последствиям как ретромбоз легочных артерий, нарушение мозгового кровотока. В нашем случае удалось избежать подобных осложнений, учитывая, что продолжительность ЭКМО составила 21 день. В результате проведенного комплекса лечебных мероприятий к моменту выписки из стационара было достигнуто значимое снижение давления в легочной артерии, с явлениями резидуальной легочной гипертензии.

The objective of this study was to investigate the effect of the perioperative use of methylprednisolone in medium doses on markers of endothelial cell activation in patients with coronary artery disease undergoing cardiopulmonary bypass.In this prospective, double-blinded, placebo-controlled, randomised study, 44 patients, undergoing a coronary artery bypass graft surgery received either methylprednisolone 20 mg/kg or a placebo intraoperatively after anaesthesia induction. The primary endpoint was endothelin-1, and secondary endpoints were E-selectin, interleukin (IL)-6 and IL-10, PaO(2)/FiO(2) coefficient, and microalbuminuria.Endothelin-1 was higher in the study group postoperatively at 10 min (p=0.0008), 2 h (p=0.02), 4 h (p=0.005), and 24 h (p=0.004). IL-6 was lower in the study group postoperatively at 2 h (p=0.03), 4 h (p=0.04), and 24 h (p0.0001). IL-10 was higher in the study group postoperatively at 10 min (p0.0001), 2 h (p=0.009), and 4 h (p=0.001). PaO(2)/FiO(2) was lower in the study group at 24 h after surgery (p=0.03). Microalbuminuria was similar in both groups.Despite an obvious anti-inflammatory effect, methylprednisolone causes endothelial cell activation in patients undergoing cardiopulmonary bypass.

Objective: To investigate the prevalence and impact of abnormal respiratory patterns in cardiac surgery patients. Design: Prospective cohort study. Setting: Tertiary hospital. Participants: Patients scheduled for elective coronary artery bypass graft surgery. Interventions: None. Measurements and Main Results: Pulmonary function tests were performed in 454 patients before surgery. Abnormal respiratory patterns were defined as follows: obstructive (forced expiratory volume in 1 s [FEV1]/forced vital capacity [FVC]

This case report documents the successful surgical repair of an aorto-bronchial fistula and a giant aortic pseudoaneurysm at the proximal anastomosis of a dacron interposition tube graft that was balloon dilated for recurrent coarctation. Balloon dilation for recoarctation of a dacron interposition tube graft may lead to serious complications.

Objectives This study aimed to evaluate the influence of preserved additional pulmonary blood flow (APBF) on survival after bidirectional cavopulmonary shunt (BCPS) and completion of Fontan circulation. Methods From March 2003 and April 2015, 156 patients with a single ventricle underwent BCPS. After performing propensity score analysis (1:1) for the entire sample, 50 patients with APBF (APBF group) were matched with 50 patients without APBF (no-APBF group). Results Age ( P = 0.90), sex ( P = 0.57), weight ( P = 0.75), single ventricle morphology ( P = 0.87), type of neonatal palliative procedure ( P = 0.52), saturation ( P = 0.35), ejection fraction ( P = 0.90), Nakata index ( P = 0.70) and mean pulmonary artery pressure ( P = 0.72) were not significantly different between the groups. No significant survival difference was demonstrated ( P = 0.54). One and 4-year survival rates were both 89.1% ± 4.6% in the APBF group and 87.2% ± 4.9% and 83.4% ± 5.9%, respectively, in the no-APBF group. There was no significant difference in rates of Fontan completion ( P = 0.24), which was achieved in 22 patients from the APBF group (55.0%) and 26 patients from the no-APBF group (65.0%). However, Fontan completion occurred significantly earlier in the no-APBF group ( P

Described in the article is a clinical case report concerning surgical treatment of a 65-year-old male patient presenting with a ruptured infectious aortic arch aneurysm. He was subjected to an operation consisting in prosthetic repair of the ascending portion of the aorta and aortic arch with a homograft under conditions of artificial circulation, deep hypothermia, and antegrade cerebral perfusion.

Objective The aim of this study was to test the hypothesis that normothermic cardiopulmonary bypass (CPB) is as effective as hypothermic CPB in terms of cardiac protection (cTnI level) and outcome in patients with valvular heart disease. Design Prospective randomized study. Setting A tertiary cardiothoracic referral center. Participants 140 patients who had valvular heart disease, with/without coronary artery disease, surgically treated under CPB. Interventions The patients were allocated randomly to undergo either hypothermic (temperature [T], 31°C–32°C) or normothermic CPB (T>36°C). Measurements and Main Results The primary endpoint was the dynamics of troponin I. The secondary endpoints were ventilation time, the need for inotropic support, intensive care unit (ICU) and hospital stay durations, complications, and mortality. There were no significant intergroup differences in dynamics of troponin I. Ventilation time was significantly lower in the hypothermic group (6 (5-9) and 8 (5-12); p = 0.01). Conclusions Normothermic CPB in patients with valvular heart disease was as effective as hypothermic perfusion in terms of myocardial protection after the surgery assessed by cTnI release. The short ventilation duration in patients who underwent hypothermic CPB needs to be confirmed in a future investigation.

Objective: To test the hypothesis that levosimendan is more effective than intra-aortic balloon pump (IABP) support in cardiac surgical patients with low left ventricular ejection fraction to decrease cardiac troponin I levels (primary endpoint) and improve hemodynamics. Design: Prospective randomized trial. Setting: Tertiary cardiothoracic referral center. Participants: Ninety patients with coronary artery disease and left ventricular ejection fraction

The purpose of our study was to compare the efficiency of levosimendan and preventive intra-aortic balloon pump in high-risk cardiac patients (left ventricular ejection fraction −1 for 10 min, followed by 0.1 µg·kg−1·min−1 for 24 h. Postoperative complications, hemodynamics, and markers of cardiac damage were analyzed. In the levosimendan group, cardiac index was significantly higher 5 min after cardiopulmonary bypass, at the end of the operation, 2 and 4 h after perfusion, compared to the intra-aortic balloon pump group. The level of troponin I in the levosimendan group was significantly lower at 6 h after the operation. Intensive care unit stay was significantly shorter in the levosimendan group. It was concluded that the use of levosimendan in high-risk cardiac patients is as effective as intra-aortic balloon pump, in terms of maintaining stable hemodynamic during and after operations under cardiopulmonary bypass. The lower level of troponin I at 6 h postoperatively suggests cardioprotective properties of levosimendan, but requires further investigation.

Aortobronchial fistula is a rare but potentially fatal complication after balloon plasty of aortic coarctation. We present a case of successful single-stage correction of giant pseudoaneurysm of the aortic arch with aortobronchial fistula in a 6-year-old patient after aortic arch replacement, which developed as a result of avulsion of the synthetic graft from the aortic wall when performing balloon angioplasty of a narrowed part of the aorta. Received 15 April 2015. Accepted 30 April 2015.

Introduction. The choice of a method of haemodynamic support in patients with low ejection fraction of the left ventricle (LVEF) is the crucial moment in the management of high risk cardiac patients. The purpose of our study was to compare the efficiency of levosimendan and intra-aortic balloon pump (IABP) in high risk patients (LVEF 35%) operated under cardiopulmonary bypass (CPB). Method. From August 2009 to September 2010 40 patients with coronary artery disease, operated under CPB were randomized in two groups. In the first group levosimendan (L) infusion (0.1 mcg·kg1·min-1 for 24 hours with initial 12 mcg·kg-1 bolus) was started after anaesthesia induction. In the second group IABP was started one day before surgery. Groups were comparable in preoperative status, duration of CPB and number of graft performed. The level of troponin-I and haemodynamics (thermodilution technique) were assessed perioperatively. Blood loss, duration of ventilation, need for inotropic support, rate of complications and intensive care unit (ICU) stay were also analysed. Data are presented as mean SD, P 0.05 was considered to be significant. Results. Cardiac index (CI) in the L group was significantly higher from 5 min after CPB to 6 hours postoperatively compared to the IABP group. The increase of CI in the L group was accompanied by an increase in stroke index 30 min after CPB (32.0 8.9 vs. 28.7 4.8 ml·m-2, P 0.05) and at the end of operation (31.5 9.7 vs. 27.3 4.6 ml·m-2, P 0.05) There were no differences between groups in the duration of ventilation and rate of complications. The level of troponin-I 6 hours after operation was lower in the L group (2.74 2.0 vs. 6.7 5.9 respectively, P 0.05). Duration of ICU-stay was significantly lower in the L group. Conclusion. The use of L in high risk cardiac patients is superior to IABP in terms of maintaining stable haemodynamics during and after operation under CPB and reduction of ICU-stay. Low level of troponin-I 6 hours after the operation suggests cardioprotective properties of levosimendan.