King Faisal Specialist Hospital and Research Center, Saudi Arabia
Title: Extracorporeal membrane oxygenation in post-cardiotomy pediatric patients — Do biventricular hearts show better outcome?
Biography: Ahmed F. Elmahrouk
Background: The increasing complexity of congenital cardiac surgery has resulted in the increased use of extracorporeal membrane oxygenation (ECMO) support for children who cannot be weaned from cardiopulmonary bypass (CPB). In single ventricle morphology, many challenges were reported to worsen the outcome with ECMO. Single ventricle was exposed more to volume overload, besides the imbalance between systemic and pulmonary circulation with decreasing coronary perfusion due to diastolic run-off into the pulmonary circulation. The purpose of this research was to compare the outcome in children with uni-ventricular repair underwent ECMO support, versus children with biventricular repair.
Methods: The hospital records of all patients with CHD who required ECMO after a cardiac surgical procedure between January 2001 and December 2016, were retrospectively reviewed. Various outcomes were reported and tested for any association with hospital death. Children were divided into two groups, Group A: Children with uni-ventricular repair (51 children) and Group B: Children with biventricular repair (62 children).
Results: A total of 113 children required ECMO for cardiopulmonary support after congenital cardiac surgery; 88 (77.9%) were placed on ECMO in the operating room. Median age of the patients was three months (range, 4 days-15 years) and median weight was 3.5 kg (range, 2.2-42.5). 42 (37.2%) survived to hospital discharge. In children with single-ventricle physiology, survival to discharge was 37.3% (19/51 patients) and for biventricular physiology it was 37.1% (23/62 patients). There was no difference in hospital survival between both groups. Univariate analysis revealed that number of days on ECMO support, renal failure and stroke as risk factors for hospital mortality, while age and cross-clamp time were found to be statistically non-significant.
Conclusion: Satisfactory results can be achieved in pediatric patients by using ECMO support for postoperative cardiac and pulmonary failure refractory to medical management. The outcome in children with biventricular hearts is not superior the uni-ventricular ones. Prolonged ECMO support, renal failure and stroke are risk of mortality.