Original article
Cardiovascular
Extracorporeal Life Support in Neonates, Infants, and Children After Repair of Congenital Heart Disease: Modern Era Results in a Single Institution

Presented at the Fiftieth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 13–15, 2003.
https://doi.org/10.1016/j.athoracsur.2005.02.023Get rights and content

Background

Extracorporeal life support has assumed a very effective role in the support of patients with refractory heart failure after repair of congenital heart disease, with hospital survival between 37% and 42%. We reviewed our results of different applications of extracorporeal life support in the last 2 years.

Methods

Between January 2001 and October 2003, 671 patients underwent surgery for congenital heart disease at our institution. We retrospectively reviewed the hospital and clinic charts of the patients who required extracorporeal life support postoperatively, and studied the factors associated with survival.

Results

Thirty-six patients (5.36%) received extracorporeal life support after surgery, between 1 day and 8 years of age (age < 30 days, n = 34). We divided the patients into four groups. Group 1 consisted of 13 patients who were electively placed on ventricular support without an oxygenator (univentricular assist device) after repair of single-ventricle disease. Group 2 consisted of 16 patients who required extracorporeal membrane oxygenation after surgery for failed hemodynamics. Group 3 consisted of 2 patients who required left ventricle support (left ventricular assist device) after surgery for two-ventricle disease but who did not require biventricular (extracorporeal membrane oxygenation) support. Group 4 consisted of 5 patients who required conversion from ventricular assist device to extracorporeal membrane oxygenation. Overall, 28 patients were weaned successfully (78%), and 24 survived to discharge (67%). Hospital survival in groups 1, 2, 3, and 4 was 100%, 50%, 100%, and 20%, respectively. Univariate factors associated with survival were age, weight, ventricular assist device type, duration, single-ventricle disease, reexploration, number of complications, and specific complications such as sepsis, renal failure, and pulmonary failure.

Conclusions

Extracorporeal life support utilization was expanded to include different applications with different outcomes. The extracorporeal life support registry should be altered to reflect those changes.

Section snippets

Material and Methods

We conducted a retrospective review of neonates and children after repair of congenital heart disease in our institution between January 2001 and October 2003. Six hundred seventy-one patients underwent cardiac surgery during that period, with an overall hospital mortality of 2.83%. Extracorporeal life support was used in 36 patients (5.36%) postoperatively. The hospital records, operative reports, perfusion, intensive care unit (ICU), and clinic notes were used to collect the data of interest.

Results

Six hundred seventy-one patients underwent surgery for congenital heart disease during that time period. Thirty-six patients required ECLS postoperatively (5.36%). Overall, 28 patients (78%) were weaned off ECLS successfully, with 24 (67%) surviving to be discharged from the hospital. There were 21 boys and 15 girls in our series. Their ages ranged between 1 day and 8 years, with the majority (n = 34) of patients younger than 30 days (neonates). Their weight ranged between 1.7 and 26 kg, with a

Comment

Extracorporeal life support is an invaluable tool in the care of neonates and children after surgery for congenital heart disease. Indications for the use of ECLS in the pediatric population include cardiac support before surgical correction [4], severe myocardial dysfunction as a bridge to recovery [5, 6] or as bridge to transplantation [7, 8, 9], treatment of pulmonary hypertension [10], cardiac support after surgery for congenital heart disease [4, 7, 8, 11, 12, 13, 14, 15, 16], after

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    Copyright © 2005 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.