Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn.
ECMO Division, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn.
J Thorac Cardiovasc Surg. 2014 Jan;147(1):434-41. doi: 10.1016/j.jtcvs.2013.03.021. Epub 2013 Apr 15.
The objective of this study was to examine the incidence and clinical outcomes of residual lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation (ECMO) support.
A retrospective observational study was undertaken at a pediatric heart institution. Postoperative pediatric cardiac surgery patients receiving ECMO support within 7 days of surgery during the past 7 years (2005-2011) were studied. A hemodynamically significant cardiac lesion on ECMO support that required intervention to decannulate successfully was defined as a residual lesion. Demographic data, complexity of cardiac defect, surgical data, indications for ECMO, echocardiographic findings, and cardiac catheterization results were studied. Evaluation of residual lesions based on duration of ECMO support, interventions undertaken, and clinical outcomes were also examined.
Residual lesions were evaluated in 43 of 119 postoperative patients placed on ECMO support. Lesions were detected in 35 patients (28%), predominantly in branch pulmonary arteries (n = 10), shunts (n = 7), and ventricular outflow tracts (n = 9). Echocardiography detected 7 residual lesions (20%) and cardiac catheterization detected 28 residual lesions (80%). Earlier detection of residual lesions during the first 3 days of ECMO support in 24 patients improved their rate of decannulation significantly (P = .004) and survival to hospital discharge (P = .035), compared with later detection (after 3 days of ECMO support) in 11 patients.
Residual lesions are present in approximately one-quarter of postoperative cardiac surgery patients requiring ECMO support. All postoperative pediatric cardiac surgery patients unable to be weaned off ECMO successfully should be evaluated actively for residual lesions, preferably by cardiac catheterization imaging. Earlier detection of residual lesions and reintervention are associated with improved clinical outcome.
本研究旨在探讨体外膜肺氧合（ECMO）支持术后儿科心脏手术患者残留病变的发生率和临床结局。
采用回顾性观察性研究方法，对过去 7 年（2005-2011 年）术后 7 天内接受 ECMO 支持的儿科心脏手术患者进行研究。ECMO 支持期间出现需要干预以成功拔管的有意义的心脏病变定义为残留病变。研究了患者的人口统计学数据、心脏缺损的复杂性、手术数据、ECMO 适应证、超声心动图发现和心导管检查结果。还评估了基于 ECMO 支持时间、干预措施和临床结局的残留病变。
在 119 例接受 ECMO 支持的术后患者中，有 43 例评估了残留病变。35 例（28%）患者存在病变，主要为分支肺动脉（n=10）、分流（n=7）和心室流出道（n=9）。超声心动图检测到 7 处残留病变（20%），心导管检查检测到 28 处残留病变（80%）。24 例患者在 ECMO 支持的前 3 天内较早发现残留病变，与 11 例患者在 ECMO 支持 3 天后较晚发现残留病变相比，拔管率显著提高（P=0.004），且住院存活率也有所提高（P=0.035）。
约四分之一需要 ECMO 支持的术后心脏手术患者存在残留病变。所有无法成功撤离 ECMO 的术后儿科心脏手术患者均应积极评估残留病变，最好通过心导管成像进行评估。较早发现残留病变和再次干预与改善临床结局相关。
