SARS-CoV-2 may cause severe respiratory failure due to massive alveolar damage. Currently, no adequate curative therapy for Coronavirus Disease 2019 (COVID-19) disease exists. By considering overall impact of COVID-19 pandemic outbreak, an increased need of extracorporeal membrane oxygenation (ECMO) support becomes evident. We report on our preliminary institutional experience with COVID-19 patients receiving venovenous ECMO support. ASAIO Journal XXX; XX:00-00.

Patent ductus arteriosus (PDA) is common among extremely preterm infants. In selected cases, surgical PDA ligation may be required. The timing for PDA ligation may depend upon a variety of factors, with potential clinical implications. We aimed to investigate the impact of different surgical PDA managements on ligation timing and neonatal outcomes. Inborn infants < 32 weeks of gestation and < 1500 g admitted at two tertiary Neonatal Intensive Care Units that underwent PDA ligation between 2007 and 2018 were enrolled in this retrospective cohort study and split into the following groups based on their surgical management: on-site bedside PDA ligation (ONS) vs. referral to an off-site pediatric cardiac surgery (OFS). Neonatal characteristics, surgical timing, and clinical outcomes of the enrolled infants were compared between the groups. Multivariate analysis was performed to evaluate the impact of PDA ligation timing on significantly different outcomes. Seventy-eight neonates (ONS, n = 39; OFS, n = 39) were included. Infants in the ONS group underwent PDA ligation significantly earlier than those in the OFS group (median age 12 vs. 36 days, p < 0.001) with no increase in postoperative mortality and complications. The multivariate analysis revealed a significant association between PDA ligation timing, late-onset sepsis prevalence (OR 1.045, 0.032), and oxygen need at discharge (OR 1.037, p = 0.025).Conclusions: Compared with off-site surgery, on-site bedside ligation allows an earlier surgical closure of PDA, with no apparent increase in mortality or complications. Earlier PDA ligation may contribute to reduced rates of late-onset sepsis and post-discharge home oxygen therapy, with possible cost-benefit implications. What is known:• Ineffective or contraindicated pharmacological closure of a hemodynamically significant PDA may require a surgical ligation.• Available literature comparing the effect of early vs. late PDA ligation on the main neonatal morbidities has yield contrasting results. What is new:• The availability of a cardiac surgery service performing bedside PDA ligation allows an earlier intervention compared to patient referral to an off-site center, with no difference in postoperative mortality and complications compared to off-site surgery.• Earlier PDA ligation was associated with a lower prevalence of late-onset sepsis and of oxygen need at discharge, with possible cost-benefit implications.

Minimal invasive aortic valve replacement (MI-AVR) is turning a routine surgical procedure, but still, many surgeons are reluctant because of perception of some technical difficulties like the annular suture placement and the legature. We present the surgical case of a MI-AVR by using novel suturing and knotting device that could facilitate surgery and diminish technical difficulties. This is the case of a 65 years old female patient with a pathologic bicuspid aortic valve, with stenosis and prevalent regurgitation. The patient was symptomatic for dyspnea (NYHA Class II) and referred to surgery for AVR, and after obtaining informed consent, we performed MI-AVR through upper hemisternotomy (UHS) by using two new surgical devices, particularly designed for minimal invasive surgery. The first device is composed by two handpieces: one is known as RAM ® , and it allows the passage of the suture, with the pledget in the ventricular side, through the native aortic valve anulus after the cusps have been removed and decalcification performed. Double "U" stitches are homogeneously and symmetrically placed. The second element, called SEW-EASY ® is used to pass equally the double needle suture through the sewing ring of the valvular prosthesis. To conclude, in this case we have also utilized a second device, a knotting one, known as COR-KNOT ® , giving rise to a quick and efficient suture ligature. Postoperative course was uneventful and the patient was on good conditions after 1 year of follow-up. The present case highlights the need and evolution of technology aimed to improve, simplify and increase safety in minimal invasive surgery.