CDH-ECMO Routine Patient Preoperative Workup, Timing, Technique: Update...

Echocardiography and TR jet measurement are essential to assess pulmonary hypertension in CDH patients, as pre- and post-ductal saturations alone are insufficient.

Jason waits until pulmonary pressures are subsystemic, at least 70% systemic and ideally 50% systemic, before proceeding to CDH repair.

Jason uses serial echocardiography aggressively to monitor pulmonary pressures before surgery, typically waiting around 2 days.

Jason performs thoracoscopic CDH repair in well-managed patients.

Jason tried laparoscopic CDH repair early on and found it quite nice, but considers thoracoscopy an easier operation.

Jason has started dissecting out the pleura to create a raw edge around the CDH defect.

Sewing pleura to pleura without creating a raw edge may have a high failure rate analogous to laparoscopic inguinal hernia repair (sewing peritoneum to peritoneum).

Scoring the pleura all the way around and unfurling it so that it comes together with more of a scar may reduce recurrence.

A lamb model for studying CDH repair techniques would cost $5000 per lamb, making formal study prohibitively expensive.

The speaker has a high degree of suspicion that pleural dissection will reduce CDH recurrence, but this has not been formally studied.