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These data suggest a trend towards long-term benefit in patients surviving high-risk surgery for LVFWR repair. Considering the high lethality of LVFWR, the urgency and complexity of the primary surgical intervention early diagnosis and prompt surgery play a key role in the management of this complication.

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Extracorporeal membrane oxygenation (ECMO) is often applied for acute cardiorespiratory failure. Left ventricular distension can compromise recovery of the failing heart. To overcome this complication, we describe a new technique to decompress the left heart through the insertion of a venting cannula in the pulmonary artery. A 43-year-old woman was connected to ECMO for refractory cardiogenic shock after left pneumonia and severe sepsis. Transesophageal echocardiography (TEE) revealed a large intraventricular clot. A 15F venous cannula was placed percutaneously in the pulmonary artery and connected to the venous limb of the ECMO circuit to decompress the left heart, and to prevent left ventricular ejection and potential embolization. After myocardial recovery, when the thrombus was judged as stable, the patient was weaned, and ECMO was removed on day 16. The patient was discharged from the cardiac surgery intensive care unit on day 30 and subsequently had an uneventful recovery. This new percutaneous approach represent a feasible and effective method to vent the left heart during ECMO, when it becomes necessary to reduce wall tension or to prevent ejection.

Adult patients supported on extracorporeal membrane oxygenation (ECMO) are very sick and many complications are often present in each single patient; therefore, it is not always easy to find some risk factors that can predict the early outcome. This retrospective study reports our experience in ECMO support treatment in adult cardiac patients suffering from cardiac failure (CF) in which one or more predictive factors of 30-day mortality were analyzed. Between January 2002 and August 2009, 42 consecutive adult cardiac patients with cardiogenic shock (mean age 64.3+/-11.3 years) were supported on ECMO for >2 days. They were divided into patients who had a survival <30 days (n=20) and patients who survived >30 days (n=22). Twenty-nine patients (69%) survived on ECMO. Sixteen patients were discharged with a survival rate of 38.1%. The overall mean ECMO duration was 7.9+/-5.3 days. The following variables were significantly different between the two groups: number of platelets and packed red blood cells (PRBCs) transfused per day during ECMO (P=0.002 and P=0.003), blood lactate levels 48 h and 72 h after the initiation of ECMO (P=0.01 and P=0.04), indexed blood flow after 48 h and 72 h (P=0.01 and P<0.0001), liver failure (P=0.001) and multiorgan failure (P=0.002). Stepwise logistic regression identified that blood lactate levels at 48 h and number of PRBCs transfused were associated with 30-day mortality [P=0.019, odds ratio (OR) =2.16; 95% confidence interval (CI)=1.13-4.14 and P=0.008, OR=1.08; 95% CI=1.02-1.14, respectively]. The predicted probability of mortality would be 52% when blood lactate levels are >3 mmol/l after 48 h. The blood lactate level at 48 h and PRBCs transfused per day can be considered as important parameters to predict the mortality in adult cardiac patients supported by ECMO for CF.