In SARS-CoV-2 patients with severe acute respiratory distress syndrome (ARDS), Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) was shown to provide valuable treatment with reasonable survival in large multi-centre investigations. However, in some patients, conversion to modified ECMO support forms may be needed. In this single-centre retrospective registry, all consecutive patients receiving V-V ECMO between 1 March 2020 to 1 May 2021 were included and analysed. The patient cohort was divided into two groups: those who remained on V-V ECMO and those who required conversion to other modalities. Seventy-eight patients were included, with fourteen cases (18%) requiring conversions to veno-arterial (V-A) or hybrid ECMO. The reasons for the ECMO mode configuration change were inadequate drainage (35.7%), inadequate perfusion (14.3%), myocardial infarction (7.1%), hypovolemic shock (14.3%), cardiogenic shock (14.3%) and septic shock (7.1%). In multivariable analysis, the use of dobutamine (p = 0.007) and a shorter ICU duration (p = 0.047) predicted the conversion. The 30-day mortality was higher in converted patients (log-rank p = 0.029). Overall, only 19 patients (24.4%) survived to discharge or lung transplantation. Adverse events were more common after conversion and included renal, cardiovascular and ECMO-circuit complications. Conversion itself was not associated with mortality in the multivariable analysis. In conclusion, as many as 18% of patients undergoing V-V ECMO for COVID-19 ARDS may require conversion to advanced ECMO support.

The current investigation aimed to evaluate long-term survival in patients undergoing isolated and combined coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Eleven thousand three hundred sixteen patients with baseline AF (72.4% men, mean age 69.6 ± 7.9) undergoing isolated and combined CABG surgery between 2006–2019 in 37 reference centers across Poland and included in the registry were analyzed. The median follow-up was four years (3.7 IQR 1.3–6.8). Over a 12-year study period, there was a significant survival benefit (Hazard Ratio (HR) 0.83; (95% Confidence Interval (CI): 0.73–0.95); p = 0.005) with concomitant ablation as compared to no concomitant ablation. After rigorous propensity matching (LOGIT model, 432 pairs), concomitant surgical ablation was associated with over 25% improved survival in the overall analysis: HR 0.74; (95% CIs: 0.56–0.98); p = 0.036. The benefit of concomitant ablation was maintained in the subgroups, yet the most benefit was appraised in low-risk patients (EuroSCORE < 2, p = 0.003) with the three-vessel disease (p < 0.001) and without other comorbidities. Ablation was further associated with significantly improved survival in patients undergoing CABG with mitral valve surgery (HR 0.62; (95% CIs: 0.52–0.74); p < 0.001) and in patients in whom complete revascularization was not achieved: HR 0.43; (95% CIs: 0.24–0.79); p = 0.006.

The main goal of minimally invasive surgery is to reduce the perioperative trauma, accelerate patient mobilization and reduce the length of hospital stay. Due to the development of modern technology, these treatments can be offered to a wider group of patients. For many years, aortic root surgery...

The primary goal of minimally invasive surgery is to reduce perioperative trauma, accelerate patient mobilization, and shorten hospitalization time. Thanks to advances in modern technology, these procedures can now be offered to an increasingly broader group of patients. For many years, aortic root surgery was associated with the necessity of implanting a mechanical conduit, which required long-term anticoagulation therapy. Currently, in patients with an aortic root aneurysm and significant aortic regurgitation, valve-sparing reimplantation procedures can be performed via a minimally invasive approach. In the following chapter, we present a holistic description of the surgical technique for aortic root aneurysm repair using the reimplantation technique procedure while preserving the patient’s native valve. We will focus on comprehensive imaging of the aorta prior to surgical intervention. This will allow us to present appropriate criteria for qualifying patients for the proposed surgical treatment, with particular emphasis on minimally invasive techniques. An essential part of the chapter will also include a detailed description of the entire procedure – starting from patient positioning on the operating table and the technique of chest opening, through the cannulation process for cardiopulmonary bypass, to a step-by-step explanation of the main procedure within the aortic root. The chapter will be rich in illustrations and photographs, making it a valuable resource for young cardiac surgeons, especially. It will provide a structured overview of minimally invasive cardiac surgery for aortic aneurysms, with a particular focus on aortic root surgery.