Extracorporeal Membrane Oxygenation After Norwood Surgery in Patients With Hypoplastic Left Heart Syndrome: A Retrospective Single-Center Cohort Study From Brazil

Frontiers in Pediatrics

article

Rodrigo Freire Bezerra¹  Juliana Torres Pacheco²  Victor Hugo Volpatto¹  Sônia Meiken Franchi¹  Rosangela Fitaroni¹  Denilson Vieira da Cruz¹  Rodrigo Moreira Castro¹  Luciana da Fonseca da Silva³  José Pedro da Silva³ 

[1] Division of Congenital Heart Surgery, Hospital Beneficência Portuguesa de São Paulo;Cardiac Intensive Care Unit, Hospital Beneficência Portuguesa de São Paulo;Division of Cardiothoracic Surgery, University of Pittsburgh School of Medicine

关键词: extracorporeal membrane oxygenation (ECMO);    Norwood procedure;    hypoplastic left heart syndrome (HLHS);    cardiac arrest;    survival analysis;   

DOI  :  10.3389/fped.2022.813528

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background Extracorporeal membrane oxygenation (ECMO) is increasingly being used to support patients after the repair of congenital heart disease. Objective We report our experience with patients with a single functional ventricle who were supported by ECMO after the Norwood procedure, reviewing the outcomes and identifying risk factors for mortality in these patients. Methods In this single-center retrospective cohort study, we enrolled 33 patients with hypoplastic left heart syndrome (HLHS) who received ECMO support after the Norwood procedure between January 2015 and December 2019. The independent variables evaluated in this study were demographic, anatomical, and those directly related to ECMO support (ECMO indication, local of initiation, time under support, and urinary output while on ECMO). The dependent variable was survival. A p < 0.05 was considered statistically significant. Results The ECMO support was applied in 33 patients in a group of 120 patients submitted to Norwood procedure (28%). Aortic atresia was present in 72.7% of patients and mitral atresia in 51.5%. For 15% of patients, ECMO was initiated in the operating room; for all other patients, ECMO was initiated in the intensive care unit. The indications for ECMO in the cardiac intensive care unit were cardiac arrest in 22 (79%) of patients, low cardiac output state in 10 (18%), and arrhythmia in 1 patient (3%). The median time under support was 5 (2–25) days. The median follow-up time was 59 (4–150) days. Global survival to Norwood procedure was 90.9% during the 30-day follow-up, being 33.3% for those submitted to ECMO. Longer ECMO support ( p = 0.004) was associated with a higher risk of death in the group submitted to ECMO. Conclusions The mortality of patients with HLHS who received ECMO support after stage 1 palliation was high. Patients with low urine output were related to worse survival rates, and longer periods under ECMO support (more than 9 days of ECMO) were associated with 100% mortality. Earlier ECMO initiation before multiorgan damage may improve results.

【 授权许可】

CC BY