Alsoufi Bahaaldin, Wolf Michael, Botha Phil, Kogon Brian, McCracken Courtney, Ehrlich Alexandra, Kanter Kirk, Deshpande Shriprasad
Division of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
Division of Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
World J Pediatr Congenit Heart Surg. 2015 Jan;6(1):9-17. doi: 10.1177/2150135114558072.
Hospital survival for infants who require extracorporeal membrane oxygenation (ECMO) following the Norwood operation is 30% to 60%. However, little is known about late outcomes of hospital survivors and their ability to progress through subsequent palliative stages.
Between 2002 and 2012, 38 (13.4%) of the 284 neonates with hypoplastic left heart syndrome or other single ventricle variants received ECMO support following Norwood. We examined factors affecting hospital death and compared postdischarge events between hospital survivors who received postoperative ECMO (n = 16 of 38) and a control of hospital survivors who did not receive ECMO (220 of 246).
Unplanned cardiac reoperation was the only predictor of postoperative ECMO requirement. Overall, 22 (58%) of the 38 patients were weaned from ECMO support and 16 (42%) of the 38 survived to hospital discharge. The ECMO duration was a significant factor for hospital mortality (odds ratio = 1.52 per 1-day increase [1.03-2.24], P = .035). Following discharge, 15 (94%) of the 16 underwent Glenn and 1 (6%) of the 16 had interstage mortality. In the control group, 194 (88%) of the 220 underwent Glenn and 26 (12%) of the 220 had interstage mortality or received transplantation (P = .499). Following Glenn, 3 (20%) of the 15 patients had interstage mortality or received transplantation and 12 (80%) of the 15 proceeded to Fontan or were alive awaiting Fontan. In the control group, 23 (12%) of the 194 had interstage mortality or received transplantation and 171 (88%) proceeded to Fontan or were alive awaiting Fontan (P = .357). Overall, 81% of hospital survivors were alive 5 years following discharge in both ECMO and non-ECMO groups.
ECMO support following Norwood is associated with high probability of hospital death. Nonetheless, interstage mortality, progression to subsequent palliative stages, intermediate survival, and freedom from heart transplantation are comparable to those in patients who did not require postoperative ECMO support.
在诺伍德手术后需要体外膜肺氧合（ECMO）支持的婴儿，其院内生存率为30%至60%。然而，对于院内幸存者的远期预后以及他们进入后续姑息治疗阶段的能力了解甚少。
在2002年至2012年期间，284例患有左心发育不全综合征或其他单心室畸形的新生儿中，有38例（13.4%）在诺伍德手术后接受了ECMO支持。我们研究了影响院内死亡的因素，并比较了接受术后ECMO的院内幸存者（38例中的16例）与未接受ECMO的院内幸存者对照组（246例中的220例）出院后的情况。
非计划性心脏再次手术是术后需要ECMO支持的唯一预测因素。总体而言，38例患者中有22例（58%）撤掉了ECMO支持，38例中有16例（42%）存活至出院。ECMO持续时间是院内死亡率的一个重要因素（比值比=每增加1天为1.52[1.03 - 2.24]，P = 0.035）。出院后，16例中有15例（94%）接受了格林手术，16例中有1例（6%）在过渡期死亡。在对照组中，220例中有194例（88%）接受了格林手术，220例中有26例（12%）在过渡期死亡或接受了移植（P = 0.499）。接受格林手术后，15例患者中有3例（20%）在过渡期死亡或接受了移植，15例中有12例（80%）进入了Fontan手术阶段或存活等待Fontan手术。在对照组中，194例中有23例（12%）在过渡期死亡或接受了移植，171例（88%）进入了Fontan手术阶段或存活等待Fontan手术（P = 0.357）。总体而言，ECMO组和非ECMO组中81%的院内幸存者在出院后5年仍存活。
诺伍德手术后的ECMO支持与较高的院内死亡概率相关。尽管如此，过渡期死亡率、进入后续姑息治疗阶段的进程、中期生存率以及免于心脏移植的情况与不需要术后ECMO支持的患者相当。
