Alsoufi Bahaaldin, Shen Irving, Karamlou Tara, Giacomuzzi Carmen, Burch Grant, Silberbach Michael, Ungerleider Ross
Division of Cardiothoracic Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon 97239, USA.
Ann Thorac Surg. 2005 Jul;80(1):15-21; discussion 21. doi: 10.1016/j.athoracsur.2005.02.023.
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.
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.
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.
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.
体外生命支持在先天性心脏病修复术后难治性心力衰竭患者的支持治疗中发挥了非常有效的作用，医院生存率在37%至42%之间。我们回顾了过去2年中体外生命支持不同应用的结果。
2001年1月至2003年10月，671例患者在我们机构接受了先天性心脏病手术。我们回顾性地查阅了术后需要体外生命支持的患者的医院和临床病历，并研究了与生存相关的因素。
36例患者（5.36%）术后接受了体外生命支持，年龄在1天至8岁之间（年龄<30天，n = 34）。我们将患者分为四组。第1组由13例患者组成，他们在单心室疾病修复后选择性地接受了无氧合器的心室支持（单心室辅助装置）。第2组由16例患者组成，他们在术后因血流动力学衰竭需要体外膜肺氧合。第3组由2例患者组成，他们在双心室疾病手术后需要左心室支持（左心室辅助装置），但不需要双心室（体外膜肺氧合）支持。第4组由5例患者组成，他们需要从心室辅助装置转换为体外膜肺氧合。总体而言，28例患者成功撤机（78%），24例存活出院（67%）。第1、2、3和4组的医院生存率分别为100%、50%、1
