PMID- 37555056
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230810
IS  - 2666-2507 (Electronic)
IS  - 2666-2507 (Linking)
VI  - 20
DP  - 2023 Aug
TI  - Temporary venovenous extracorporeal membrane oxygenation after cardiopulmonary 
      bypass in minimally invasive cardiac surgery via right minithoracotomy.
PG  - 99-104
LID - 10.1016/j.xjtc.2023.04.008 [doi]
AB  - OBJECTIVES: In minimally invasive cardiac surgery, it can be difficult at times 
      to maintain adequate oxygenation with single-lung ventilation after weaning from 
      cardiopulmonary bypass (CPB), and intermittent double-lung ventilation is 
      required during hemostasis. Venovenous extracorporeal membrane oxygenation 
      (VV-ECMO) after weaning from CPB eliminates the necessity of overinflation of the 
      left lung and intermittent double-lung ventilation and enables secure and fast 
      hemostasis. We investigated the effectiveness and safety of temporary VV-ECMO in 
      MICS. METHODS: Between May 2018 and March 2021, 149 patients underwent temporary 
      VV-ECMO during minimally invasive cardiac surgery in our institutions. After 
      weaning from CPB, the arterial circuit was reconnected to the right internal 
      jugular venous cannula, the femoral venous cannula was pulled down by 20 cm, and 
      VV-ECMO was established using the CPB machine and cannulas. After starting 
      VV-ECMO, we administered protamine and performed hemostasis. Operative data and 
      outcomes were retrospectively reviewed. RESULTS: The mean VV-ECMO time and flow 
      were 26 +/- 13 minutes and 2.38 +/- 0.40 L/m(2), respectively. There was no thrombus 
      in the CPB circuit, including the oxygenator. The trans-oxygenator pressure 
      gradient index at the end of VV-ECMO significantly correlated with that at the 
      start of VV-ECMO (r = 0.88; 95% CI, 0.79-0.94; P = .01). The 30-day mortality 
      rate was 2.0%. The incidences of unilateral pulmonary edema, prolonged 
      ventilation, and re-exploration for bleeding were 2.7%, 5.4%, and 2.0%, 
      respectively. CONCLUSIONS: Temporary VV-ECMO is safe and useful to maintain 
      single-lung ventilation without overinflation after weaning from CPB for secure 
      and fast hemostasis in minimally invasive cardiac surgery. No thrombotic event 
      was found during temporary VV-ECMO without heparinization.
CI  - (c) 2023 The Author(s).
FAU - Nakanaga, Hiroshi
AU  - Nakanaga H
AD  - Department of Cardiovascular Surgery, Cardiovascular Center, Toranomon Hospital, 
      Tokyo, Japan.
AD  - Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan.
FAU - Kinoshita, Takeshi
AU  - Kinoshita T
AD  - Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan.
FAU - Fujii, Hiromi
AU  - Fujii H
AD  - Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 
      Chiba, Japan.
FAU - Nagashima, Kohei
AU  - Nagashima K
AD  - Department of Clinical Engineering, Toranomon Hospital, Tokyo, Japan.
FAU - Tabata, Minoru
AU  - Tabata M
AD  - Department of Cardiovascular Surgery, Cardiovascular Center, Toranomon Hospital, 
      Tokyo, Japan.
AD  - Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan.
AD  - Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, 
      Chiba, Japan.
LA  - eng
PT  - Journal Article
DEP - 20230425
PL  - United States
TA  - JTCVS Tech
JT  - JTCVS techniques
JID - 101768546
PMC - PMC10405151
OTO - NOTNLM
OT  - cardiopulmonary bypass
OT  - minimally invasive cardiac surgery
OT  - single-lung ventilation
OT  - venovenous extracorporeal membrane oxygenation
EDAT- 2023/08/09 06:43
MHDA- 2023/08/09 06:44
PMCR- 2023/04/25
CRDT- 2023/08/09 04:09
PHST- 2023/01/04 00:00 [received]
PHST- 2023/04/08 00:00 [revised]
PHST- 2023/04/16 00:00 [accepted]
PHST- 2023/08/09 06:44 [medline]
PHST- 2023/08/09 06:43 [pubmed]
PHST- 2023/08/09 04:09 [entrez]
PHST- 2023/04/25 00:00 [pmc-release]
AID - S2666-2507(23)00134-7 [pii]
AID - 10.1016/j.xjtc.2023.04.008 [doi]
PST - epublish
SO  - JTCVS Tech. 2023 Apr 25;20:99-104. doi: 10.1016/j.xjtc.2023.04.008. eCollection 
      2023 Aug.