Subscribe to RSS
DOI: 10.1055/s-0031-1297419
Excellent midterm survival after rapid ECMO support after the modified Norwood Operation
Aims: Despite sophisticated perioperative management, some patients (pts.) need cardiopulmonary support (ECMO) after Norwood procedure (NP). We instituted a rapid deployement of (rECMO) within half an hour of circulatory instability.
Methods: Data of 68 consecutive neonates undergoing NP between 1/2007–12/2009 were retrospectively analyzed. Impact of rECMO support on survival until Glenn OP (SG) was evaluated, with pts. having an Aristoteles comprehensive score <20 (LRisk) and those ≥20 (HRisk). Minimal follow-up interval was 18 months.
Results: Overall hospital survival was 94.1%, 100% with LRisk (n=45) and 78.3% in HRisk (n=23). rECMO was required in 11 pts, due to low cardiac output (6), arrhythmia (3), pulmonary failure (1) and shunt closure (1). rECMO was more prevalent with HRisk 21.6%(6pts.) vs. 11.1%(5pts.), p=0.11. Successful weaning and survival midterm was achieved in all LRisk, 4/6 of HRisk pts could be weaned, 2 survived midterm.
Conclusion: Cardiopulmonary deterioration is common after Norwood operation. Rapid ECMO support therefore is an essential tool to achieve excellent survival after the modified Norwood procedure. All patients with low risk and one third of high risk candidates could be salvaged. Thus all units taking care of patients with HLHS should provide a rECMO service.