We hypothesized that cardiovascular performance during the first 24 postoperative hours would be better in patients after off pump coronary artery bypass grafting compared to conventional on pump surgery. Fifty-nine patients were randomized to on or off pump coronary artery bypass grafting. Hemodynamic parameters, including cardiac index and systemic vascular resistance index were measured before and at 1, 4, and 20 h after surgery. Troponin T and creatine kinase-MB (CK-MB) were measured before and at 1, 6, and 20 h after surgery. There was no difference in age, sex, ejection fraction or number of grafts between groups. Cardiac index was higher (p=0.05) and systemic vascular resistance index was lower (p=0.007) in the off pump group 1 h after arrival in the intensive care unit. CK-MB and troponin T were significantly lower in the off pump group after 1 h (CK-MB p<0.001, troponin T p<0.001) and after 6 h (CK-MB p=0.02, troponin T p<0.001). After 24 h there was no difference between the two groups. In conclusion, immediately after surgery there was better cardiovascular performance and less release of markers of myocardial damage after off pump coronary surgery. After 24 h all differences were eliminated.

Pulmonary endarterectomy is the guideline recommended treatment for chronic thromboembolic pulmonary hypertension, in addition to life-long anticoagulation therapy. The aim was to analyze long-term relative survival after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension. We included all patients who underwent pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension at Karolinska University Hospital between 1997 and 2018 (n = 100). We obtained baseline characteristics and vital status from patient charts and national health-data registers. The expected survival from the general Swedish population matched by age, sex, and year of surgery was obtained from the Human Mortality Database. The relative survival was used as an estimate of cause-specific mortality. The mean age of the patients was 62 years and 39% were women. Most patients were severely symptomatic (95% in New York Heart Association functional class III–IV), and mean preoperative systolic/diastolic (mean) pulmonary artery pressure was 78/27 (45) mmHg. The mean and maximum follow-up time was 7.2 and 22.1 years, respectively. Early (30-day) mortality was 7%. The 15-year observed, expected, and relative survival was 55% (95% confidence interval, 40%–68%), 71%, and 77% (95% confidence interval, 56%–95%), respectively. The 15-year relative survival conditional on 30-day survival was 83% (95% confidence interval, 60%–100%). Although the life expectancy following pulmonary endarterectomy was shorter compared to the general population, the difference was small in those who survived the operation and the early postoperative period. Patients with chronic thromboembolic pulmonary hypertension who are surgical candidates should undergo pulmonary endarterectomy to improve prognosis.

Extracorporeal membrane oxygenation (ECMO) systems have undergone rapid technological improvements and are now feasible options for medium-term support of severe cardiac or pulmonary failure. Intractable ventricular arrhythmia is a rare but well-established indication for heart transplantation. We report a case of persistent ventricular fibrillation (VF) that was rescued by insertion of peripheral veno-arterial ECMO during cardiopulmonary resuscitation, which provided support for 30 h of continuous VF and subsequently permitted urgent heart transplantation.- KeywordsExtracorporeal membrane oxygenation † Ventricular fibrillation † Heart transplantation † Bridge to transplantation Case reportA 39-year-old man with a history of idiopathic ventricular tachycardia (VT) presented to the Emergency Department due to repetitive implantable cardioverter-defibrillator (ICD) discharges.The patient first presented at age 29 with cardiac arrest secondary to ventricular fibrillation (VF) and was successfully resuscitated without sequelae. Echocardiography and coronary angiography were normal and he was diagnosed with idiopathic VT. He was started on sotalol and received an ICD. He was subsequently asymptomatic, but at ICD interrogation at age 36, several asymptomatic episodes of non-sustained VT were detected. From ages 37 to 39, he had increasing frequency of appropriate ICD discharges and sotalol was changed to amiodarone with further progression of arrhythmias. These were preceded by palpitations and triggered by a ventricular extrasystole. Echocardiography, electrocardiogram (ECG), and electrolytes remained normal.Over the month prior to admission, ICD discharges increased in frequency and numerous interventions were attempted without effect. Invasive electrophysiology was performed twice. Ventricular extrasystoles were mapped to an apical -septal area and ablated without improvement. The pacemaker was programmed to AAI 80 for overdrive pacing and to DDD 80 with short atrioventricular time to promote ventricular pacing and alter depolarization and repolarization vectors. Sotalol, metoprolol, flecainide, and amiodarone were tried alone or in combinations with if anything exacerbation of arrhythmias.On presentation, blood pressure was 125/75 mmHg and ECG revealed ventricular pacing at 75 b.p.m. Shortly after presentation, the patient had an additional 10 ICD discharges. He was transferred to the intensive care unit (ICU) and sedated with propofol and oxazepam in an attempt to reduce sympathetic tone. This strategy was initially successful but VT and VF recurred with continuous ICD discharges, and the patient was sedated and intubated. Intravenous amiodarone and lidocaine were given to no avail. Chest compressions were begun manually and subsequently with the Lund University Cardiac Assist System (LUCAS) external compressor (Jolife Corp., Sweden).During ongoing VF and LUCAS chest compressions, peripheral veno-arterial extracorporeal membrane oxygenation (ECMO) with the Centrimag magnetically levitated centrifugal pump (Levitr...

Addition of the Cardiac Support Device to conventional cardiac surgery improves patient status and decreases left ventricular size in heart failure patients with dilated cardiomyopathy. The positive effect on left ventricular dimensions is not accompanied by any improvement in cardiac output but rather right ventricular dysfunction, although the functional significance of this is unclear.