Peer Syed M, Emerson Dominic A, Costello John P, Shu Michael K, Zurakowski David, Jonas Richard A, Berger John T, Nath Dilip S
Division of Cardiovascular Surgery, Children's National Medical Center, Washington, DC, USA.
World J Pediatr Congenit Heart Surg. 2014 Apr;5(2):236-40. doi: 10.1177/2150135113515495.
Although there are considerable data regarding in-hospital results of congenital heart surgery (CHS) patients requiring postoperative extracorporeal membrane oxygenation (ECMO) support, there is limited information on intermediate-term outcomes.
A single-institution retrospective review of 25 consecutive postoperative CHS patients who required ECMO and survived to hospital discharge between January 2003 and June 2008. Survival was estimated by the Kaplan-Meier method.
At a median follow-up of 3.3 years (interquartile range: 1.2-5.9 years), there was one death which occurred at six months postsurgery. Kaplan-Meier-estimated survival at three years was 95% (95% confidence interval: 90%-100%). Indications for ECMO included extracorporeal cardiopulmonary resuscitation (48%), systemic hypoxia (4%), postoperative low-cardiac output syndrome (28%), and intraoperative failure to wean off cardiopulmonary bypass (20%). Following ECMO support, 65% of patients had unplanned cardiac reinterventions (three requiring operative interventions, six requiring percutaneous interventions, and four requiring both), and 47% of patients required unplanned hospitalizations. In all, 29% of patients developed neurological deficits and 12% of patients developed chronic respiratory failure. No patients developed renal failure. Overall, systemic ventricular (SV) function normalized in 83% of patients, whereas 17% of patients had persistent mild-to-moderate SV dysfunction.
Intermediate-term patient survival of ECMO following CHS is encouraging. However, neurological impairment and unplanned cardiac reinterventions remain significant concerns. Further delineation of risk factors to improve patient outcomes is warranted.
尽管有大量关于需要术后体外膜肺氧合（ECMO）支持的先天性心脏病手术（CHS）患者的院内结果的数据，但关于中期结果的信息有限。
对2003年1月至2008年6月期间连续25例需要ECMO且存活至出院的术后CHS患者进行单机构回顾性研究。采用Kaplan-Meier法估计生存率。
中位随访3.3年（四分位间距：1.2 - 5.9年），术后6个月有1例死亡。三年的Kaplan-Meier估计生存率为95%（95%置信区间：90% - 100%）。ECMO的适应证包括体外心肺复苏（48%）、全身性缺氧（4%）、术后低心排血量综合征（28%）和术中脱离体外循环失败（20%）。在接受ECMO支持后，65%的患者进行了非计划性心脏再次干预（3例需要手术干预，6例需要经皮干预，4例两者都需要），47%的患者需要非计划性住院。总体而言，29%的患者出现神经功能缺损，12%的患者出现慢性呼吸衰竭。无患者出现肾衰竭。总体上，83%的患者全身心室（SV）功能恢复正常，而17%的患者存在持续性轻度至中度SV功能障碍。
CHS术后ECMO的中期患者生存率令人鼓舞。然而，神经功能损害和非计划性心脏再次干预仍然是重大问题。有必要进一步明确危险因素以改善患者预后。
