Advanced Age as a Predictor of Survival and Weaning in Venoarterial Extracorporeal Oxygenation: A Retrospective Observational Study.

Background. In most reports on ECMO treatment, advanced age is classified as a contraindication to VA ECMO. We attempted to investigate whether advanced age would be a main risk factor deciding VA ECMO application and performing VA ECMO support. We determined whether advanced age should be regarded as an absolute or relative contraindication to VA ECMO and could affect weaning and survival rates of VA ECMO patients. Methods. VA ECMO was performed on 135 adult patients with primary cardiogenic shock between January 2010 and December 2014. Successful weaning was defined as weaning from ECMO followed by survival for more than 48 hours. Results. Among the 135 patients, 35 survived and were discharged uneventfully, and the remaining 100 did not survive. There were significant differences in survival between age groups, and older age showed a lower survival rate with statistical significance (P = .01). By multivariate logistic regression analysis, age was not significantly associated with in-hospital mortality (P = .83) and was not significantly associated with VA ECMO weaning (P = .11). Conclusions. Advanced age is an undeniable risk factor for VA ECMO; however, patients of advanced age should not be excluded from the chance of recovery after VA ECMO treatment.

Relationship between bicuspid aortic valve phenotype, valvular function, and ascending aortic dimensions.

BACKGROUND AND AIM OF THE STUDY: Bicuspid aortic valve (BAV) is known to be associated with aortic valve dysfunction and ascending aorta (AA) dilatation. However, the relationship between BAV morphology and AA dimensions remains unclear. Thus, the study aim was to characterize the aortic valve function and AA dimensions according to the presence of raphe and BAV phenotype. METHODS: A total of 164 patients with BAV who underwent aortic valve surgery between October 2007 and November 2012 was investigated. BAV was classified as either type I (anterior-posterior orientation) or type II (right-left orientation), and subdivided as raphe+ (presence of raphe) and raphe-(no raphe). RESULTS: Type I BAV was present in 103 patients (62.8%), and raphe+ in 100 (61.0%). Patients with raphe+ were typically younger than those with raphe-, and male gender was more predominant (88.0% and 53.1%, respectively, p < 0.05). Aortic regurgitation was more common in patients with type I and raphe+ BAV, and aortic stenosis in patients with type II and raphe- BAV. In patients with raphe+, the diameters of aortic annulus related to the body surface area (BSA) were larger, and the diameters of the tubular portion of AA indexed to BSA were smaller than in patients with raphe- (p < 0.05). CONCLUSION: BAV morphology is helpful for predicting the type of aortic valve dysfunction and the location of AA dilatation.

Surgical correction of cor triatriatum associated with pulmonary artery thrombosis in an adult.

We herein present a case of a successful correction of cor triatriatum associated with thrombotic pulmonary hypertension diagnosed in an adult female patient. We confirmed diagnosis using transthoracic and transesophageal echocardiography in addition to cardiac computed tomography and magnetic resonance imaging. Surgical repair comprised excision of the fibromuscular membranous septum in the left atrium, patch closure of an atrial septal defect, and reconstruction of the pulmonary arteries with a vascular graft. Cor triatriatum complicated pulmonary thrombotic hypertension with atrial septal defect is amenable to surgical correction with satisfactory results.

Anthropometric estimation of femoral venous cannula length for cardiovascular surgery.

BACKGROUND: Femoral vein cannulation is an alternative method for central cannulation. However, no clinical guidelines have been established for optimal insertion length of femoral venous cannula. The purpose of the present study was to evaluate the correlation between the insertion length of femoral venous cannula (L), and the sum of the length from femoral artery (FA) puncture site to umbilicus (P-U) and the length from umbilicus to lower border of the sternum (U-S) as an anthropometric estimation for adult patients undergoing cardiovascular surgery using femoral vein cannulation. We also attempted to determine the insertion length of femoral venous cannula by the patient's height and weight. METHODS: P-U and U-S were measured after anesthesia induction. L was measured after femoral venous cannula tip was positioned at the junction of inferior vena cava and right atrium using transesophageal echocardiography. The relationship between the sum of P-U and U-S (P-U-S), and L was analyzed by Pearson's correlation analysis. Bland-Altman analysis was used to compare the agreement between P-U-S and L. Multiple linear regression analysis was performed to identify the height and weight factors capable of predicting L. RESULTS: One-hundred study patients were enrolled. P-U-S was highly correlated with L (r = 0.95). The bias and precision were -2.60 ± 8.57 mm. L was predicted from height and weight: L (mm) = 0.82 × height (cm) + 1.18 × weight (kg) + 188.46. CONCLUSIONS: P-U-S can be used as a reliable anthropometric estimation of L during adult cardiovascular surgery using femoral vein cannulation.