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Background: Venovenous extracorporeal membrane oxygenation (V-V ECMO) is recommended for the support of patients with severe COVID-19 pneumonitis. In this study we report the characteristics and outcome of COVID-19 patients treated with V-V ECMO in a Hungarian centre. Methods: We retrospectively collected data on all patients admitted with proven SARS CoV-2 infection who received V-V ECMO support between March 2021 and May 2022. Results: Eighteen patients were included in the analysis (5 women, age 44±10 years, APACHE II score 12 (IQR 10-14.5)). The patients had their first positive SARS-CoV-2 PCR test 9 (7-15) days before admission and were already hospitalised for 6 (4-11) days. Fifteen patients received non-invasive ventilation for 4 (2-8) days, two patients high flow nasal oxygen therapy each for one day. They were intubated 2.5 (1-6) days prior to ECMO initiation. Prone position was applied in 15 cases. The Lung Injury Score was 3.25 (3-3.26), the PaO2/FiO2 ratio was 71±19 mmHg. The duration of V-V ECMO support was 26±20 days, and the longest run lasted 70 days. Patients were mechanically ventilated for 34±23 days. Intensive care unit and hospital length of stay were 40±28 days and 45±31 days, respectively. 11 patients were successfully weaned from ECMO. ICU survival rate was 56%, in-hospital survival was 50%. All patients who were discharged from hospital reported a good health-related quality of life at the 5-16 month follow-up. Conclusions: We achieved comparable survival rate to that reported by the European Chapter of the Extracorporeal Life Support Organisation COVID-19 Survey.

Összefoglaló. Az extracorporalis membránoxigenizációt egyre gyakrabban alkalmazzák világszerte refrakter légzési és/vagy keringési elégtelenség kezelésében. Intézetünkben 2015-ben kezdtük meg a program előkészítését és felépítését. Célunk az extracorporalis membránoxigenizációs kezelés élettani alapjainak rövid ismertetése, különös tekintettel a venovenosus konfigurációra, és az eddig kezelt eseteink eredményeinek összefoglalása. Az irodalom szisztematikus áttekintése és a kezelt esetek adatainak retrospektív értékelése voltak a módszereink. 2016 óta összesen 14 beteg esetében használtunk extracorporalis membránoxigenizációt (8 férfi, 6 nő, életkor 51 ± 15 év, APACHE II. score 24 ± 7). Az indikáció 9 esetben súlyos refrakter hypoxaemiás légzési elégtelenség, 1 esetben tracheooesophagealis fistula és légzési elégtelenség, 1 esetben műtét alatti támogatás tervezett trachearekonstrukció során és 3 beteg esetében refrakter cardiogen shock volt. Az extracorporalis membránoxigenizáció 11 betegben a légzés, 3 betegben a keringés támogatását szolgálta, 13 venovenosus, 1 venoarteriosus konfigurációban. Az extracorporalis támogatás ideje légzéstámogatás esetében 14 ± 6 nap, a cardialis támogatások esetében 5 ± 4 nap volt. Az intenzív osztályos ápolási idő 27 ± 13, illetve 21 ± 17 nap volt a két betegcsoportban. 9 beteget jó funkcionális állapotban bocsátottunk el, 5 beteg halt meg osztályunkon, további 3 később a kórházi bennfekvés során. Az extracorporalis membránoxigenizációs program regionális centrumokban Magyarországon is megvalósítható. A nemzetközi ajánlások, oktatási módszerek alkalmazásával a nemzetközi irodalomban közölt túlélési eredményekhez hasonló eredmények érhetők el hazánkban is. Orv Hetil. 2021; 162(11): 425–431. Summary. Extracorporeal membrane oxygenisation is commonly used worldwide for refractory respiratory and circulatory failure. We started to organise the introduction of this therapeutic modality in 2015. Our aim is to give a short review about extracorporeal life support, especially veno-venous extracorporeal membrane oxygenation, and to present our first results. We provide a systematic review of the currently available literature and a summary of our first treatments. As of 2016, we supported 14 patients with extracorporeal membrane oxygenisation (8 men, age 51 ± 15 years, APACHE II score 24 ± 7). The indications were refractory hypoxaemic respiratory failure in 9, tracheo-oesophageal fistula and respiratory failure in 1, support during surgery for planned tracheal reconstruction in 1, and refractory cardiogenic shock in 3 patients. We provided respiratory support in 11, circulatory support in 3 cases, with 13 veno-venous and 1 veno-arterial configuration. The support lasted for 14 ± 6 days in respiratory, and for 5 ± 4 days in cardiac cases. Intensive care length of stay was 27 ± 13 and 21 ± 17 days in the two patient groups. We discharged 9 patients in good functional state, 5 patients died during intensive care and further 3 later, during the hospital stay. Our results show that the implementation of an extracoporeal membrane oxygenation program is feasible in Hungarian tertiary centers. In line with international recommendations and adapting international training courses, the survival is very similar to that reported in the literature. Orv Hetil. 2021; 162(11): 425–431.

Introduction Venovenous extracorporeal membrane oxygenation (V-V ECMO) is recommended for the support of patients with severe COVID-19 associated severe respiratory failure (SRF). We report the characteristics and outcome of COVID-19 patients supported with V-V ECMO in a Hungarian centre. Methods We retrospectively collected data on all patients admitted with proven SARS CoV-2 infection who received V-V ECMO support between March 2021 and May 2022. Results Eighteen patients were placed on ECMO during this period, (5 women, age (mean ± SD) 44 ± 10 years, APACHE II score (median (interquartile range)) 12 (10–14.5)). Before ECMO support, they had been hospitalised for 6 (4–11) days. Fifteen patients received noninvasive ventilation for 4 (2–8) days, two patients had high flow nasal oxygen therapy, for one day each. They had already been intubated for 2.5 (1–6) days. Prone position was applied in 15 cases. On the day before ECMO initiation the Lung Injury Score was 3.25 (3–3.26), the PaO2/FiO2 ratio was 71 ± 19 mmHg. The duration of V-V ECMO support was 26 ± 20 days, and the longest run lasted 70 days. Patients were mechanically ventilated for 34 ± 23 days. The intensive care unit (ICU) and the hospital length of stay were 40 ± 28 days and 45 ± 31 days, respectively. Eleven patients were successfully weaned from ECMO. The ICU survival rate was 56%, the in-hospital survival was 50%. All patients who were discharged from hospital reported a good health-related quality of life Rankin score (0–2) at the 5–16 months follow-up. Conclusions During the last three waves of the COVID-19 pandemic, we achieved a 56% ICU and a 50% hospital survival rate at our low volume centre.

Objectives Methane (CH4) breath test is an established diagnostic method for gastrointestinal functional disorders. Our aim was to explore the possible link between splanchnic circulatory changes and exhaled CH4 in an attempt to recognize intestinal perfusion failure. Design Randomized, controlled in vivo animal study. Setting University research laboratory. Subjects Anesthetized, ventilated Sprague-Dawley rats (280 ± 30 g) and Vietnamese minipigs (31 ± 7 kg). Interventions In the first series, CH4 was administered intraluminally into the ileum before 45 minutes mesenteric ischemia or before reperfusion in non-CH4 producer rats to test the appearance of the gas in the exhaled air. In the porcine experiments, the superior mesenteric artery was gradually obstructed during consecutive, 30-minute flow reductions and 30-minute reperfusions achieving complete occlusion after four cycles (n = 6), or nonocclusive mesenteric ischemia was induced by pericardial tamponade (n = 12), which decreased superior mesenteric artery flow from 351 ± 55 to 182 ± 67 mL/min and mean arterial pressure from 96.7 ± 18.2 to 41.5 ± 4.6 mm Hg for 60 minutes. Measurements and main results Macrohemodynamics were monitored continuously; RBC velocity of the ileal serosa or mucosa was recorded by intravital videomicroscopy. The concentration of exhaled CH4 was measured online simultaneously with high-sensitivity photoacoustic spectroscopy. The intestinal flow changes during the occlusion-reperfusion phases were accompanied by parallel changes in breath CH4 output. Also in cardiac tamponade-induced nonocclusive intestinal ischemia, the superior mesenteric artery flow and RBC velocity correlated significantly with parallel changes in CH4 concentration in the exhaled air (Pearson's r = 0.669 or r = 0.632, respectively). Conclusions we report a combination of in vivo experimental data on a close association of an exhaled endogenous gas with acute mesenteric macro- and microvascular flow changes. Breath CH4 analysis may offer a noninvasive approach to follow the status of the splanchnic circulation.

OBJECTIVES Extracorporeal circulation induces cellular and humoral inflammatory reactions, thus possibly leading to detrimental secondary inflammatory responses. Previous data have demonstrated the bioactive potential of methane and confirmed its anti-inflammatory effects in model experiments. Our goal was to investigate the in vivo consequences of exogenous methane administration on extracorporeal circulation-induced inflammation. METHODS Two groups of anaesthetized Vietnamese minipigs (non-treated and methane treated, n = 5 each) were included. Standard central cannulation was performed, and extracorporeal circulation was maintained for 120 min without cardiac arrest or ischaemia, followed by an additional 120-min observation period with haemodynamic monitoring. In the methane-treated group, 2.5% v/v methane–normoxic air mixture was added to the oxygenator sweep gas. Blood samples through the central venous line and tissue biopsies from the heart, ileum and kidney were taken at the end point to determine the whole blood superoxide production (chemiluminometry) and the activity of xanthine-oxidoreductase and myeloperoxidase, with substrate-specific reactions. RESULTS Methane treatment resulted in significantly higher renal blood flow during the extracorporeal circulation period compared to the non-treated group (63.9 ± 16.4 vs 29.0 ± 9.3 ml/min). Whole blood superoxide production (548 ± 179 vs 1283 ± 193 Relative Light Unit (RLU)), ileal myeloperoxidase (2.23 ± 0.2 vs 3.26 ± 0.6 mU/(mg protein)) and cardiac (1.5 ± 0.6 vs 4.7 ± 2.5 pmol/min/mg), ileal (2.2 ± 0.6 vs 7.0 ± 3.4 pmol/min/mg) and renal (1.2 ± 0.8 vs 13.3 ± 8.0 pmol/min/mg) xanthine-oxidoreductase activity were significantly lower in the treated group. CONCLUSIONS The addition of bioactive gases, such as methane, through the oxygenator of the extracorporeal circuit represents a novel strategy to influence the inflammatory effects of extracorporeal perfusion in cardiac surgical procedures.

Absztrakt: A pericardialis tamponad a szivsebeszeti ellatas egyik fontos surgőssegi korkepe, amelynek hattereben szamos koroki tenyező allhat. A pericardialis folyadekfelszaporodas diagnosztikaja es terapiaja a klinikai gyakorlatban ma mar sikeres, ugyanakkor a kialakulo kardiogen sokk kovetkezmenyeinek eredmenyes kezelese meg sok esetben kihivast jelent. Az akut pericardialis tamponad es a kronikus pericardialis folyadekgyulem hatekony kezelesi tervehez a korelettani folyamat megertese szukseges. A jelen kozlemeny celja, hogy a pericardialis tamponad jelensegeről es jelentősegeről is osszefoglalo kepet nyujtson, az orvostorteneti hatter es a fontosabb korelettani tenyezők ismertetesen at egeszen az allatkiserletes modellalkotas szerepeig. Orv Hetil. 2018; 159(5): 163–167.

Absztrakt: Bevezetés: A pericardialis tamponád az életet közvetlenül veszélyeztető, alacsony perctérfogatú kórállapot, amelynek keringési következményei minden szövet, köztük a vese és a bélnyálkahártya mikrokeringését is súlyosan érintik. Célkitűzés: Kísérletünk célja a pericardialis tamponád klinikai képének modellezésére alkalmas, hemodinamikailag stabil, kontrollálható állatmodell kifejlesztése volt. Módszerek: Altatott vietnami törpesertések két csoportjában laparotomiát követően a szívburokba a rekeszen keresztül, thoracotomia nélkül kanült helyeztünk. Az első, álműtött csoport kontrollként szolgált (n = 6), a második csoportban a pericardium saját vérrel való feltöltésével 60 perces tamponádot hoztunk létre (n = 6). Monitoroztuk a tamponád és az azt követő 180 perces reperfúzió alatt a makrohemodinamikát és a vékonybél mikrohemodinamikai változásait. Vizsgáltuk a fehérvérsejt-akkumulációt jelző mieloperoxidáz (MPO) -enzimaktivitást és pásztázó lézeres endomikroszkóppal a vékonybél in vivo szövettani elváltozásait. Eredmények: A tamponád következtében megemelkedett a centrális vénás nyomás és a szívfrekvencia, lecsökkent az artériás középnyomás, az arteria mesenterica superior (355,5 ± 112,4 vs. 182,0 ± 59,1 ml/min) és az arteria renalis (159,63 ± 50,7 vs. 35,902 ± 27,9 ml/min) áramlása, valamint az ileum mikrokeringése. Az MPO-aktivitás szignifikánsan megemelkedett (3,66 ± 1,6 vs. 7,01 ± 1,44 mU/mg fehérje) és romlott a vékonybél in vivo szövettani képe. Következtetések: Kísérleti modellünk alkalmas a szívtamponád jellegzetes keringési és biokémiai következményeinek vizsgálatára, reprodukálható, klinikailag releváns állatmodellnek tekinthető.

Absztrakt Célkitűzés: Vizsgálatunkkal áttekintjük az osztályunkon beültetett Sorin Perceval S öltés nélkül rögzíthető műbillentyűvel szerzett kezdeti tapasztalatainkat. Módszerek: Másfél év alatt 27 esetben ültettünk be Sorin Perceval S biológiai billentyűt aortabillentyű-betegség miatt. Az eszközt elsősorban nagy kockázatú betegek esetén alkalmaztuk, reoperációs környezetben, meszes aortagyök esetén, időskorban. Eredmények: A billentyű beültetési ideje rövidült, az átlagos aortalefogási idő 27 perc, így a műtéti terhelés csökkent, de a nagy kockázatú betegek súlyos társbetegségei miatt a kockázat nem szüntethető meg teljesen. (Három beteget vesztettünk el a postoperativ szakban, bár egyik beteget sem cardialis ok miatt.) Parciális sternotomia esetén a billentyű használata megkönnyíti a sebészi beavatkozást. A műtétet követő echokardiográfia minden esetben kitűnően működő, az anulusba jól illeszkedő műbillentyűt véleményezett, paravalvularis insufficientia nem volt. Következtetés: A Sorin Perceval S aorta biológiai műbillentyű biztonsággal alkalmazható nagy kockázatú betegek műtéte esetén, valamint parciális sternotomia esetén is megkönnyíti a műtétet.

Introduction: Minimal access aortic valve replacement plays a significant role in modern cardiac surgery. The technical evolution of aortic bioprostheses, particularly sutureless valves, leads to simplify minimal access aortic valve surgery and it allows easier implantation in a narrow work field with the need of less manipulation. Aim: The aim of this study is to summarize the historical and technical aspects of minimal access aortic valve replacement, especially concentrating on sutureless valves, and to present data of own patients of the authors. Method: Pre- and post-operative data of 13 minimal access aortic replacement cases who were operated at the Deparment of Cardiac Sugery at the University of Szeged are summarized. Results and conclusions: As compared to full sternotomy, minimal access aortic surgery is safe, and it does not require special instrumentation. It is technically more demanding but it can be learned quickly, and the overall pre- and post-operative results are not worse with the benefit of less pain and superior cosmetics. Orv. Hetil., 2016, 157(23), 901–904.

Acute pericardial tamponade is one of the most emergent clinical scenarios in cardiac surgery. With numerous causes in the background, pericardial tamponade can lead to cardiogenic shock and death. In modern diagnostic era, the recognition of pericardial tamponade is simple, but its management and the long-term effects can still be challenging. Without the detailed understanding of the pathophysiological pathways diagnostic and therapeutic management plans of pericardial tamponade is very difficult. The aim of this review was to give a complex picture of pericardial tamponade, from its role in medical history to pathophysiology and its significance in surgical experimental models. Orv Hetil. 2018; 159(5): 163-167.

Pericardial tamponade (PT) is a life-threatening condition, with low cardiac output. The hemodynamic consequences of PT can severely affect the circulation of all tissues, including the microcirculation of the kidneys and the intestinal mucosa. Our aim was to develop a hemodynamically stable and controllable large animal model of PT to study the consequences of cardiogenic shock.Two groups of anesthetized vietnamese minipigs (n = 6, both groups) were used. Following laparotomy, a cannula was fixed into the pericardium through the diaphragm without thoracotomy. A sham-operated group served as control, in the second group 60-min PT was induced by intrapericardial injection of heparinised own blood. Throughout PT and 180-min reperfusion, macrohemodynamics, renal circulation and mesenteric macro- and microcirculation were monitored. Myeloperoxidase (MPO) activity was measured and in vivo histology was performed by confocal laser scanning endomicroscopy.The PT increased central venous pressure, heart rate and decreased mean arterial pressure, mesenteric flow (from 355.5 ± 112.4 vs 182.0 ± 59.1 ml/min) and renal arterial flow (from 159.63 ± 50.7 vs 35.902 ± 27.9 ml/min) and the microcirculation of the ileum. Elevated MPO activity (3.66 ± 1.6 vs 7.01 ± 1.44 mU/mg protein) and injury of the ileal mucosa were present also.The reproducible large animal model is suitable for clinically relevant investigations of the hemodynamic and biochemical consequences of PT.

We examined the Sorin Perceval S artificial biological valve implantation techniques, and present the initial experiences in our unit.In the last 1.5 years, 27 patients had been implanted with Sorin Perceval S biological arteficial valve due to aortic valve disease. The device was mainly used in high-risk patients, in reoperative circumstances, in cases of calcified aortic root, and in elderly patients.The valve implantation time, aortic cross clamp time is shorter, but the risk of the operation cannot be eliminated entirely, because of the high risk patients' severe comorbidities. Furthermore, we performed echocardiography in the postoperative period, which demonstrated that the valve function is excellent, the valve fitted tightly in the anulus, and there was no paravalvular leakage.The Sorin Perceval S biological arteficial aortic valve is safe to use in high risk patients, and the surgical procedure is easier in case of partial sternotomy, too.

Minimal access aortic valve replacement plays a significant role in modern cardiac surgery. The technical evolution of aortic bioprostheses, particularly sutureless valves, leads to simplify minimal access aortic valve surgery and it allows easier implantation in a narrow work field with the need of less manipulation.The aim of this study is to summarize the historical and technical aspects of minimal access aortic valve replacement, especially concentrating on sutureless valves, and to present data of own patients of the authors.Pre- and post-operative data of 13 minimal access aortic replacement cases who were operated at the Deparment of Cardiac Sugery at the University of Szeged are summarized.As compared to full sternotomy, minimal access aortic surgery is safe, and it does not require special instrumentation. It is technically more demanding but it can be learned quickly, and the overall pre- and post-operative results are not worse with the benefit of less pain and superior cosmetics.

Background The relative value of off-pump coronary bypass (OPCAB) surgery as compared to conventional coronary artery bypass operation is still debated. We started a prospective study in 2000 with the aim of using exclusively OPCAB for surgical myocardial revascularization in a single center. The present report analyzes the 13-years results of this approach in a large consecutive patient population.