Basgoze Serdar, Temur Bahar, Ozcan Zeynep Sila, Gokce Ibrahim, Guvenc Osman, Aydin Selim, Guzelmeric Fusun, Altan Kus Aylin, Erek Ersin
Department of Pediatric Heart Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey.
Department of Cardiovascular Surgery, Faculty of Medicine, Atakent Hospital, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey.
Front Pediatr. 2023 Apr 3;11:1131361. doi: 10.3389/fped.2023.1131361. eCollection 2023.
Extracorporeal membrane oxygenation (ECMO) is widely used after congenital heart surgery. The purpose of this study is to analyze the neurodevelopmental (ND) outcomes in patients who receivedECMO support after congenital cardiac surgery.
Between January 2014 and January 2021, 111 patients (5.8%) receivedECMO support after congenital heart operations, and 29 (26,1%) of these patients were discharged. Fifteen patients who met the inclusion criteria were included. A propensity score matching (PSM) analysis model was established using eight variables (age, weight, sex, Modified Aristotle Comprehensive Complexityscores, seizures, cardiopulmonary bypass duration, number of operations, and repair method) with 1:1 matching. According to the PSM model, 15 patients who underwent congenital heart operations were selected as the non-ECMO group. The Ages & Stages Questionnaire Third Edition (ASQ-3) was used for ND screening;it includes communication, physical skills (gross and fine motor), problem-solving, and personal-social skills domains.
There were no statistically significant differences between the patients' preoperative and postoperative characteristics. All patients were followed up for a median of 29 months (9-56 months). The ASQ-3 results revealed that communication, fine motor, and personal-social skills assessments were not statistically different between the groups. Gross motor skills (40 vs. 60), problem-solving skills (40 vs. 50), and overall scores (200 vs. 250) were better in the non-ECMO patients ( = 0.01, = 0.03, and = 0.03, respectively). Nine patients (%60) in the ECMO group and 3 patients (%20) in the non-ECMO group were with neurodevelopmental delay ( = 0,03).
ND delay may occur in congenital heart surgery patients who receivedECMO support. We recommend ND screening in all patients with congenital heart disease, especially those who receivedECMO support.
体外膜肺氧合（ECMO）在先天性心脏病手术后广泛应用。本研究旨在分析先天性心脏手术后接受ECMO支持患者的神经发育（ND）结局。
2014年1月至2021年1月期间，111例患者（5.8%）在先天性心脏手术后接受了ECMO支持，其中29例（26.1%）患者出院。纳入15例符合纳入标准的患者。使用八个变量（年龄、体重、性别、改良亚里士多德综合复杂性评分、癫痫发作、体外循环时间、手术次数和修复方法）建立倾向评分匹配（PSM）分析模型，进行1:1匹配。根据PSM模型，选择15例接受先天性心脏手术的患者作为非ECMO组。使用《年龄与发育阶段问卷第三版》（ASQ-3）进行ND筛查；该问卷包括沟通、身体技能（大运动和精细运动）、解决问题和个人社交技能领域。
患者术前和术后特征无统计学显著差异。所有患者的中位随访时间为29个月（9 - 56个月）。ASQ-3结果显示，两组之间的沟通、精细运动和个人社交技能评估无统计学差异。非ECMO患者的大运动技能（40分对60分）、解决问题技能（40分对50分）和总分（200分对250分）更好（分别为P = 0.01、P = 0.03和P = 0.03）。ECMO组9例患者（60%）和非ECMO组3例患者（20%）存在神经发育延迟（P = 0.03）。
接受ECMO支持的先天性心脏病手术患者可能发生ND延迟。我们建议对所有先天性心脏病患者进行ND筛查，尤其是那些接受ECMO支持的患者。
