Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.
Department of Pediatric Cardiac Surgery, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Halkali, 34303, Istanbul, Turkey.
Pediatr Cardiol. 2022 Dec;43(8):1811-1821. doi: 10.1007/s00246-022-02918-9. Epub 2022 May 9.
Extracorporeal membrane oxygenation (ECMO) is widely used after congenital heart surgery. The purpose of this study is to analyze the factors influencing mortality and morbidity in patients who require ECMO support after congenital cardiac surgery. All 109 patients (5.8% of total cases) who underwent ECMO support after congenital heart surgery between January 2014 and 2021 were included in this single-center study. The mean age was 10.13 ± 20.55 months, and the mean weight was 6.41 ± 6.79 kg. 87 (79.8%) of the patients were under 1 year of age. A total of 54 patients (49.5%) were weaned successfully from ECMO support, and 27 of them (24.8%) were discharged. The childhood age group had the best outcomes. Seventy-seven percent of the children were weaned successfully, and 50% were discharged. 69 patients (63.3%) had biventricular physiology; weaning and survival outcomes were better than single ventricle patients (P-value 0.002 and < 0.001, respectively). Low cardiac output (n = 49; 44.9%) as an ECMO indication had better outcomes than extracorporeal cardiopulmonary resuscitation (n = 31; 28.4%) (P = 0.05). Most of the patients had ≥ 4 Modified Aristotle Comprehensive Complexity (MACC) levels, and higher MACC levels were associated with a higher mortality rate. The most common procedure was the Norwood operation (16.5%), with the worst outcome (5.5% survival). Bleeding and renal complications were the most common complications affecting outcomes. Results were more satisfactory in patients with biventricular repair, childhood, and lower MACC levels. Early initiation of ECMO in borderline patients without experiencing cardiac arrest or multiorgan failure may improve outcomes.
体外膜肺氧合（ECMO）在先天性心脏手术后广泛应用。本研究旨在分析先天性心脏手术后需要 ECMO 支持的患者死亡率和发病率的影响因素。
这项单中心研究纳入了 2014 年 1 月至 2021 年期间因先天性心脏病手术后接受 ECMO 支持的 109 例患者（占总病例的 5.8%）。患者的平均年龄为 10.13±20.55 个月，平均体重为 6.41±6.79kg。87 例（79.8%）患者年龄小于 1 岁。共有 54 例（49.5%）患者成功撤离 ECMO 支持，其中 27 例（24.8%）出院。儿童组的结果最好。77%的儿童成功撤离，50%出院。69 例（63.3%）患者有双心室生理学，撤离和生存结果均优于单心室患者（P 值分别为 0.002 和<0.001）。作为 ECMO 适应证的低心输出量（n=49；44.9%）的结果优于体外心肺复苏（n=31；28.4%）（P=0.05）。大多数患者有≥4 个改良 Aristotle 综合复杂性（MACC）水平，较高的 MACC 水平与更高的死亡率相关。最常见的手术是 Norwood 手术（16.5%），结果最差（5.5%存活）。出血和肾脏并发症是影响结果的最常见并发症。双心室修复、儿童和较低 MACC 水平的患者结果更令人满意。在没有经历心脏骤停或多器官衰竭的临界患者中尽早开始 ECMO 可能会改善结果。
