Noninvasive measurements of blood pressure (BP) and cardiac output (CO) are crucial in the follow-up of continuous-flow left ventricular assist device (CF-LVAD) patients. For our pilot study, we sought to compare BP measurements between a tonometry blood pressure pulse analyzer (BPPA) (DMP-Life, DAEYOMEDI Co., Ltd., Gyeonggi-do, South Korea) and Doppler ultrasound in CF-LVAD patients, as well as to compare the BPPA estimated CO to LVAD calculated blood flow and to the patient's intrinsic CO estimated with transthoracic echocardiography (TTE). Ambulatory CF-LVAD patients (6 HeartMate, 26 HeartMate II), were included. According to TTE findings, patients were then subdivided in two groups: patients with an opening aortic valve (OAV) [n = 21] and those with an intermittent opening aortic valve (IOAV) [n = 11]. We found a very good correlation of systolic BP (SBP) measurements between the two methods, BPPA and Doppler ultrasound (r = 0.87, P < 0.0001). Bland-Altman plots for SBP revealed a low bias of -4.6 mm Hg and SD of ±4.7 mm Hg. In CF-LVAD patients with IOAV, the BPPA-CO had a good correlation with the LVAD-flow (r = 0.78, P < 0.0001), but in OAV patients, there was no correlation. After adding the patient's intrinsic CO, estimated from TTE in patients with OAV to the LVAD-flow, we found a very good correlation between the BPPA-CO and LVAD-flow + TTE-CO (r = 0.81, P = 0.002). Our study demonstrated that compared with the standard clinical method, Doppler ultrasound, the BPPA measured BP noninvasively with good accuracy and precision of agreement. In addition, tonometry BPPA provided further valuable information regarding the CF-LVAD patient's intrinsic CO.

loss leads to a broad spectrum of complications, from acute cardiac tamponade to subacute hemothorax. Boyle et al. described the need for new labels for post-surgical bleeding, including the acute, subacute, and chronic phases of bleeding, and proposed the term retained blood syndrome (RBS).3) The incidence of RBS is 13.8%-22.7% after cardiac surgery. 3) In acute RBS, early exploration within the first 48 postoperative hours via an emergency re-sternotomy is the gold standard. In subacute RBS (>48 hr), the remaining clots activate inflammatory mechanisms that cause increased postoperative atrial fibrillation, in-hospital mortality, and longer in-hospital stays. 4) In addition, a large number of clots cause mechanical compression of the lung and severe atelectasis. Furthermore, clot contamination can lead to pleural empyema. 5) Despite the consequences, proper management of subacute Purpose: Blood loss along with inadequate evacuation after cardiac surgery leads to retained blood syndrome (RBS) in the pleural and/or pericardial cavity. Re-sternotomy is often needed for clot evacuation. Video-assisted thoracoscopic surgery (VATS) evacuation is a less-invasive procedure. However, sufficient evidence on safety and outcomes is lacking. Methods: Thirty patients who developed hemothorax and/or hemopericardium after cardiac surgery and underwent VATS evacuation between April 2015 and September 2020 were included in this retrospective single-center analysis. Results: The median patient age was 70 (interquartile range: IQR 62-75) years, body mass index (BMI) was 24.7 (IQR 22.8-29) kg/m 2 , time between initial cardiac surgery and VATS was 17 (IQR 11-21) days, 30% of the patients were female, 60% resided in the ICU, and 17% were nicotine users. Coronary artery bypass graft was the most frequent initial cardiac procedure. Median operation time was 120 (IQR 90-143) min, 23% of the patients needed an additional VATS, and the median length of hospital stay after VATS was 8 (IQR 5-14) days. All patients survived VATS, and we experienced no mortality related to the VATS procedure. Conclusion: In our study, VATS for evacuation of RBS after cardiac surgery was a feasible, safe, and efficient alternative approach to re-sternotomy in selected patients.

A 75-year old patient with a right sided secondary pneumothorax and prolonged air leak showed upper lobe predominant bullous emphysema. Due to the patients extremely reduced general condition neither an open approach nor a thoracoscopic approach seemed possible. Hence, we performed an awake lung volume reduction surgery with perioperative single site veno-venous extracorporeal membrane oxygenation. No heparin was administered. The extracorporeal membrane oxygenation (ECMO) could be weaned up to the second postoperative day. The further postoperative course was uneventful. This current case suggests that combining awake surgery with extracorporeal membrane oxygenation could be a future concept in extremely compromised patients.