Allan Catherine K, Thiagarajan Ravi R, del Nido Pedro J, Roth Stephen J, Almodovar Melvin C, Laussen Peter C
Department of Cardiology, Children's Hospital Boston and Harvard Medical School, Boston, Mass 02115, USA.
J Thorac Cardiovasc Surg. 2007 Mar;133(3):660-7. doi: 10.1016/j.jtcvs.2006.11.013.
The use of extracorporeal membrane oxygenation to support patients with shunted single-ventricle physiology has been controversial. Variable survivals are reported in a number of small case series. We sought to evaluate outcomes and identify predictors of survival for patients with shunted single-ventricle physiology who require extracorporeal membrane oxygenation support.
We retrospectively reviewed the medical records of all patients aged less than 1 year with shunted single-ventricle physiology who were supported with extracorporeal membrane oxygenation at Children's Hospital Boston between 1996 and 2005. Survivors and nonsurvivors were compared with respect to demographics, diagnosis, operative variables, indication for extracorporeal membrane oxygenation, and extracorporeal membrane oxygenation variables.
Forty-four infants with shunted single-ventricle physiology were supported with extracorporeal membrane oxygenation. Diagnoses included hypoplastic left heart syndrome (24), other single-ventricle lesions (12), and pulmonary atresia/intact ventricular septum or a variant (8). Overall survival to discharge was 48%. Indication for extracorporeal membrane oxygenation was the strongest predictor of survival to discharge, with 81% of patients cannulated for hypoxemia but only 29% of those cannulated for hypotension surviving to discharge. Specifically, patients cannulated for shunt obstruction had the highest survival (83%).
Overall survival to discharge for patients with shunted single-ventricle physiology is similar to survival reported in the Extracorporeal Life Support Organization registry for all infants supported with cardiac extracorporeal membrane oxygenation. Thus, shunted single-ventricle physiology should not be considered a contraindication to extracorporeal membrane oxygenation. Patients cannulated for hypoxemia, particularly shunt thrombosis, had markedly improved survival compared with those supported primarily for hypotension/cardiovascular collapse. Survival did not differ depending on anatomic diagnosis.
应用体外膜肺氧合支持单心室分流生理的患者一直存在争议。在一些小病例系列报道中，生存率各不相同。我们试图评估接受体外膜肺氧合支持的单心室分流生理患者的预后，并确定其生存的预测因素。
我们回顾性分析了1996年至2005年在波士顿儿童医院接受体外膜肺氧合支持的所有年龄小于1岁的单心室分流生理患者的病历。比较了存活者和非存活者在人口统计学、诊断、手术变量、体外膜肺氧合指征以及体外膜肺氧合变量方面的情况。
44例单心室分流生理的婴儿接受了体外膜肺氧合支持。诊断包括左心发育不全综合征（24例）、其他单心室病变（12例）以及肺动脉闭锁/室间隔完整或变异型（8例）。总体出院生存率为48%。体外膜肺氧合指征是出院生存的最强预测因素，因低氧血症插管的患者中有81%存活至出院，但因低血压插管的患者中只有29%存活至出院。具体而言，因分流梗阻插管的患者生存率最高（83%）。
单心室分流生理患者的总体出院生存率与体外生命支持组织登记处报道的所有接受心脏体外膜肺氧合支持的婴儿的生存率相似。因此，单心室分流生理不应被视为体外膜肺氧合的禁忌证。与主要因低血压/心血管衰竭接受支持的患者相比，因低氧血症尤其是分流血栓形成而插管的患者生存率明显提高。生存情况不因解剖学诊断而异。
