Obesity and Extracorporeal Membrane Oxygenation (ECMO): Analysis of Outcomes.

Traditionally, patients with obesity have been deemed ineligible for extracorporeal life support (ELS) therapies such as extracorporeal membrane oxygenation (ECMO), given the association of obesity with chronic health conditions that contribute to increased morbidity and mortality. Nevertheless, a growing body of literature suggests the feasibility, efficacy, and safety of ECMO in the obese population. This review provides an in-depth analysis of the current literature assessing the effects of obesity on outcomes among patients supported with ECMO (venovenous [VV] ECMO in noncoronavirus disease 2019 and coronavirus disease 2019 acute respiratory distress syndrome, venoarterial [VA] ECMO, and combined VV and VA ECMO), offer a possible explanation of the current findings on the basis of the obesity paradox phenomenon, provides a framework for future studies addressing the use of ELS therapies in the obese patient population, and provides guidance from the literature for many of the challenges related to initiating, maintaining, and weaning ELS therapy in patients with obesity.

Outcomes of Tricuspid Valve Operation at the Time of Pericardiectomy for Constrictive Pericarditis.

BACKGROUND: This study sought to determine the outcome effect of concomitant tricuspid valve operation for regurgitation during pericardiectomy for constrictive pericarditis. METHODS: This cohort study included 310 patients with mild or greater tricuspid valve regurgitation who underwent pericardiectomy for constrictive pericarditis from 2000 to 2016 at the Mayo Clinic in Rochester, Minnesota. Patients were divided into 2 treatment groups: tricuspid valve operation (n = 68) and no tricuspid operation (n = 242). Survival analysis, proportional odds models, and landmark analysis were carried out to estimate the treatment effects of tricuspid valve operation. RESULTS: Tricuspid valve regurgitation was graded mild in 203 (65%) patients, moderate in 69 (22%), and severe in 38 (12%). Tricuspid valve operation included repair in 54 patients (17%) and replacement in 14 (5%). Mechanical circulatory support was used more commonly in the intervention group (15% vs 5%; P = .009), but rates of stroke (3% vs 2%; P = .210) and mortality (9% vs 6%; P = .422) were similar. Tricuspid valve intervention resulted in a reduced risk of long-term mortality (hazard ratio, 0.68; 95% confidence interval [CI], 0.38 to 1.21; P = .192), less than moderate tricuspid valve regurgitation at follow-up (odds ratio vs moderate or severe, 0.093; 95% CI, 0.04 to 0.19), and less than moderate right ventricular enlargement at follow-up (odds ratio vs moderate or severe, 0.67; 95% CI, 0.35 to 1.24). Remnant severe right ventricular dysfunction resulted in increased risk of mortality (hazard ratio vs none or trivial, 4.87; 95% CI, 1.10 to 21.65; P = .037). CONCLUSIONS: Concomitant tricuspid valve operation for regurgitation can be performed without increased operative mortality during pericardiectomy for constrictive pericarditis. Operation appears protective against long-term mortality, residual tricuspid regurgitation, and right ventricular enlargement.

Outcomes of Duodenal Switch with a Moderate Common Channel Length and Roux-en-y Gastric Bypass: Does One Pose More Risk?

BACKGROUND: Traditional duodenal switch (DS) typically leaves a short common channel and is infrequently performed in part due to increased risk of malnutrition. We compared nutritional deficiencies between DS with a moderate channel length and standard proximal Roux-en-Y gastric bypass (RYGB). METHODS: We conducted a retrospective review of 61 matched pairs who underwent DS or RYGB using our institutional database; patients were matched on sex, age, race, and BMI. DS was performed with a common channel length between 120 and 150 cm. Thirty-day complications, total body weight loss (TBWL) %, and nutritional labs up to 24 months were compared using paired t test and Wilcoxon rank sum tests. RESULTS: Weight loss was similar at each time point (all p > 0.1). DS patients had lower vitamin D levels at 6 months, lower calcium levels at 6 and 12 months, and lower hemoglobin at 12 months and otherwise equivalent (all p < 0.05). Revision was rare (1 DS; 0 RYGB). There were no differences in short-term complications (p = 0.28). CONCLUSION: DS with a moderate common channel length is safe with a low revision rate. Weight loss and nutritional outcomes appear to be comparable to RYGB, and it may be considered an effective RYGB alternative.