The use of extracorporeal membrane oxygenator instead of standard cardiopulmonary bypass during lung transplantation is debatable. Moreover, recently, the concept of prolonged postoperative extracorporeal membrane oxygenator (ECMO) support has been introduced in many transplant centers to prevent primary graft dysfunction (PGD) and improve early and long-term results.The objective of this study was to review the results of our extracorporeal life support strategy during and after bilateral sequential lung transplantation (BSLT) for pulmonary artery hypertension. We review retrospectively our experience in BSLT A total of 38 patients were identified. Nine patients were transplanted using cardiopulmonary bypass (CPB), in eight cases CPB was followed by a prolonged ECMO (pECMO) support, 14 patients were transplanted on central ECMO support, and seven patients were transplanted with central ECMO support followed by a pECMO assistance. The effects of different support strategies were evaluated, in particular in-hospital morbidity, mortality, incidence of PGD, and long-term follow-up. The use of CPB was associated with poor postoperative results and worse long-term survival compared with ECMO-supported patients. Predictive preoperative factors for the need of intraoperative CPB instead of ECMO were identified. The pECMO strategy had a favorable effect to mitigate postoperative morbidity and mortality, not only in intraoperative ECMO-supported patients, but even in CPB-supported cases. In our experience, ECMO may be considered as the first choice circulatory support for lung transplantation. Sometimes, in very complex cases, CBP is still necessary. The pECMO strategy is very effective to reduce incidence of PGD even in CPB-supported patients. K E Y W O R D S cardiopulmonary bypass, extracorporeal membrane oxygenation, extracorporeal support technique, lung transplantation, pulmonary hypertension 630 | DELL'AMORE Et AL. F I G U R E 1 Examples of clear indication for CPB instead of ECMO. A, extreme cardiomegaly. B, severe dilatation of the right and left pulmonary artery branches. C, severe aneurysm of the main pulmonary artery. D, over-systemic pulmonary artery hypertension (pulmonary artery pressure shown in yellow and systemic pressure shown in red) [Color figure can be viewed at wiley onlin elibr ary.com] F I G U R E 2 ECLS techniques. A, aorto-bicaval CPB cannulation. B, aorto-bicaval CPB cannulation with pulmonary artery vent (black arrow). C, central aorto-right atrium ECMO cannulation. D, prolonged ECMO setting with peripheral femoro-femoral cannulation with distal leg perfusion [Color figure can be viewed at wiley onlin elibr ary.com] How to cite this article: Dell'Amore A, Campisi A, Congiu S, et al. Extracorporeal life support during and after bilateral sequential lung transplantation in patients with pulmonary artery hypertension.

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Pulmonary sequestration (PS) is a rare congenital malformation of the respiratory tract. Two main variants are described, the intralobar and the extralobar PS. Clinical manifestations vary from accidental findings to life threatening complications. Surgical resection is the definitive and indicated treatment of PS. The operation could be performed through an open thoracotomy or video-assisted thoracic surgery approach. We report the management of two patients with diagnosis of extralobar PS in the first case and intralobar PS in the second case. Both patients underwent uniportal video-assisted thoracic surgery resection of PS with success. In our experience, we confirm that uniportal video-assisted thoracic surgery is a safe and feasible approach for extralobar and intralobar PS. both reported cases MRI and angiography were not necessary because the angio-CT scan images were considered optimal for the identification of the aberrant vessels and surgical planning. Patient 1 (Figure 1)A 26-year-old female was admitted to our hospital because of left lower lobe pneumonia. At the clinical history the patient reports recurrent episodes of respiratory infection since childhood, much more frequent in the last 5 years. A computed tomography (CT) scan of the thorax was performed documenting the presence of a lesion in the basal segments of left lower lobe, with a diameter about 8.6 cm × 4.4 cm × 3.2 cm ( Figure 1A). The angio-CT-scan showed the presence of an aberrant arterial branch of the descending thoracic aorta measuring 9 mm in diameter connected to the lesion ( Figure 1B,C). Findings matched with intra-lobar sequestration. Further pre-operative investigations comprising bronchoscopy, pulmonary function test and echocardiography were strictly normal. Patient was recommended for surgery and she was referred to our department. Patient 2 (Figure 2)The patient was a 56-year-old woman with history recurrent respiratory infection and a recent endocarditis of the aortic valve with brain embolisms. After treatment of the endocarditis, the following cardiological, vascular and neurological evaluations were negative. Thus she underwent total body angio-CT-scan which showed an anomalous area of left lower lobe parenchyma separated with the normal one by an accessory fissure (Figure 2A,B) with two separate feeding arteries arising from the descending thoracic aorta suggestive for extralobar lung sequestration ( Figure 2C). Further, pre-operative investigations comprising bronchoscopy, pulmonary function test and echocardiography were strictly normal. The patient was recommended for surgery and she was referred to our department. Pre-operative preparationRoutine laboratory tests, chest X-ray, electrocardiography (EKG).Equipment preference card: all surgical instruments used were exactly the same for both patients. Patients positioningA double-lumen endotracheal tube is inserted, then, the patients are placed in a lateral decubitus on the table next to its anterior edge with the arm in the swimming position. The table ...

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