George Makdisi

Use of distal perfusion in peripheral extracorporeal membrane oxygenation

Extra corporeal membrane oxygenation (ECMO) is a life-saving technique to manage refractory cardiopulmonary failure. Its usage and indication continue to increase. Femoral venoarterial ECMO (VA ECMO) is relatively less invasive and the cardiac support may be more rapidly instituted in in these extremely tenuous patients. Vascular injuries and limb ischemia unfortunately occur in these emergent access settings. Here we will discuss the optimal techniques of preventing this complication which might affect patient survival and impact the patient quality of life.

Use of extracorporeal membranous oxygenator in transcatheter aortic valve replacement

The superiority of transcatheter aortic valve replacement (TAVR) compared with medical therapy for patients with aortic stenosis (AS) who are not suitable candidates for surgery had been proven. Cardiopulmonary bypass (CPB) is rarely used in TAVR. Reports of early use of extracorporeal membranous oxygenator (ECMO) have promising outcomes. ECMO offers the option of cardiac support rescue in case of intraoperative hemodynamic instability and can be instituted in advance when hemodynamic instability is expected. Here we review the English literature about the use of ECMO in TAVR procedures, and discuss the indications and rationale for its use as well as its advantages.

Ex vivo lung perfusion review of a revolutionary technology

Donor lung shortage has been the main reason to the increasing number of patients waiting for lung transplant. Ex vivo lung perfusion (EVLP) is widely expanding technology to assess and prepare the lungs who are considered marginal for transplantation. the outcomes are encouraging and comparable to the lungs transplanted according to the standard criteria. in this article, we will discuss the history of development, the techniques and protocols of ex vivo, and the logics and rationales for ex vivo use.

Primary extraskeletal pleural osteosarcoma: a rare pleural identity

A 69-year-old female with a history of a heart transplant 16 years prior, presented with a large left chest mass identified on fluoroscopy in the cardiac catheterization lab. The patient noted a 40 pound weight loss in one year. A chest X-ray (CXR) and chest computed tomography (CT) demonstrated a large complex cystic mass in the left chest. A CT guided aspiration was performed, and the cytology for the cyst fluid was negative for malignancy. The patient continued to have worsening shortness of breath, a repeat chest CT scan and magnetic resonance imaging (MRI) three months later, demonstrated a recurrence of the left pleural mass. Further, work-up was negative for tumor. A left video assisted thoracotomy exploration was performed and left thoracotomy was needed for the mass resection. The final pathology demonstrated a high grade osteosarcoma. The post-operative course was unremarkable.

Contemporary surgical management of thoracic empyema

In the USA, one million patients diagnosed with pneumonia are admitted each year and among these, 32,000 patients develop empyema (1,2). Empyema is associated with a high morbidity and mortality (2,3).

How to establish a successful destination therapy ventricular assist device program

Heart failure is one of the most important cardiovascular problems in the United States with 5.7 million adults afflicted in 2015 (1). This number is projected to increase to eight million (one out of every 33 adults) by the year 2030 (2,3). Overall treatment costs in 2012 were almost

Surgical Thoracic Transplant Training: Super Fellowship—Is It Super?

31 billion and are anticipated to reach almost

Ethical challenges in extra corporeal membrane oxygenation use

70 billion by 2030 (2). Currently, approximately 5,000 to 6,000 patients are treated annually with left ventricular assist devices (LVADs). However, projections range from 35,000 to 150,000 annual cases (4,5).

Extra corporeal membrane oxygenation support: ethical dilemmas

OBJECTIVE The quality of training provided to thoracic transplant fellows is a critical step in the care of complex patients undergoing transplant. The training varies since it is not an accreditation council for graduate medical education accredited fellowship. METHOD A total of 104 heart or lung transplant program directors throughout the United States were sent a survey of 24 questions focusing on key aspects of training, fellowship training content and thoracic transplant job satisfaction. Out of the 104 programs surveyed 45 surveys (43%) were returned. RESULTS In total, 26 programs offering a transplant fellowship were included in the survey. Among these programs 69% currently have fellows of which 56% are American Board of Thoracic Surgery board eligible. According to the United Network for Organ Sharing (UNOS) requirements, 46% of the programs do not meet the requirements to be qualified as a primary heart transplant surgeon. A total of 23% of lung transplant programs also perform less than the UNOS minimum requirements. Only 24% have extra-surgical curriculum. Out of the participating programs, only 38% of fellows secured a job in a hospital setting for performing transplants. An astounding 77% of replies site an unpredictable work schedule as the main reason that makes thoracic transplant a less than favorable profession among new graduates. Long hours were also a complaint of 69% of graduates who agreed that their personal life is affected by excessive work hours. CONCLUSION Annually, almost half of all thoracic transplant programs perform fewer than the UNOS requirements to be a primary thoracic surgeon. This results in a majority of transplant fellows not finding a suitable transplant career. The current and future needs for highly qualified thoracic transplant surgeons will not be met through our existing training mechanisms.

Outcomes of Induction Therapy with Rabbit Anti-Thymocyte Globulin in Heart Transplant Recipients: A Single Center Retrospective Cohort Study

The immense increase of patients treated with extra corporeal membrane oxygenation (ECMO) in the last few years, along with the uncertainty of outcomes as well as the lack of clarity on the intended treatment direction, these situations which are considered by some to be just delaying of death and even worse than death. These circumstances create disagreements among surrogates, and between health care providers and surrogates, and emerge unique ethical challenges about the use of this new technology. In this article we discuss these challenging questions.