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. 2022 Mar 2:10:813528.
doi: 10.3389/fped.2022.813528. eCollection 2022.

Extracorporeal Membrane Oxygenation After Norwood Surgery in Patients With Hypoplastic Left Heart Syndrome: A Retrospective Single-Center Cohort Study From Brazil

Rodrigo Freire Bezerra  1 , Juliana Torres Pacheco  2 , Victor Hugo Volpatto  1 , Sônia Meiken Franchi  1 , Rosangela Fitaroni  1 , Denilson Vieira da Cruz  1 , Rodrigo Moreira Castro  1 , Luciana da Fonseca da Silva  3 , José Pedro da Silva  3
Affiliations

Extracorporeal Membrane Oxygenation After Norwood Surgery in Patients With Hypoplastic Left Heart Syndrome: A Retrospective Single-Center Cohort Study From Brazil

Rodrigo Freire Bezerra et al. Front Pediatr. .

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) is increasingly being used to support patients after the repair of congenital heart disease.

Objective: We report our experience with patients with a single functional ventricle who were supported by ECMO after the Norwood procedure, reviewing the outcomes and identifying risk factors for mortality in these patients.

Methods: In this single-center retrospective cohort study, we enrolled 33 patients with hypoplastic left heart syndrome (HLHS) who received ECMO support after the Norwood procedure between January 2015 and December 2019. The independent variables evaluated in this study were demographic, anatomical, and those directly related to ECMO support (ECMO indication, local of initiation, time under support, and urinary output while on ECMO). The dependent variable was survival. A p < 0.05 was considered statistically significant.

Results: The ECMO support was applied in 33 patients in a group of 120 patients submitted to Norwood procedure (28%). Aortic atresia was present in 72.7% of patients and mitral atresia in 51.5%. For 15% of patients, ECMO was initiated in the operating room; for all other patients, ECMO was initiated in the intensive care unit. The indications for ECMO in the cardiac intensive care unit were cardiac arrest in 22 (79%) of patients, low cardiac output state in 10 (18%), and arrhythmia in 1 patient (3%). The median time under support was 5 (2-25) days. The median follow-up time was 59 (4-150) days. Global survival to Norwood procedure was 90.9% during the 30-day follow-up, being 33.3% for those submitted to ECMO. Longer ECMO support (p = 0.004) was associated with a higher risk of death in the group submitted to ECMO.

Conclusions: The mortality of patients with HLHS who received ECMO support after stage 1 palliation was high. Patients with low urine output were related to worse survival rates, and longer periods under ECMO support (more than 9 days of ECMO) were associated with 100% mortality. Earlier ECMO initiation before multiorgan damage may improve results.

Keywords: Norwood procedure; cardiac arrest; extracorporeal membrane oxygenation (ECMO); hypoplastic left heart syndrome (HLHS); survival analysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of HLHS patients receiving ECMO assistance.
Figure 2
Figure 2
Survival according to time under ECMO support. (A) Frequency of dead and alive patients submitted to different durations (2–25 days) of ECMO support. (B) Comparison of days under ECMO support for dead and alive patients. Tukey boxplot, whiskers represent 1.5 interquartile range. *Mann–Whitney U-test, p = 0.004.
Figure 3
Figure 3
Survival curves. (A) General and according to (B) location of ECMO initiation, (C) patient sex, and (D) patient weight. Error bars indicate standard error of mean.
Figure 4
Figure 4
Neurological findings in patients receiving ECMO assistance.
Figure 5
Figure 5
Kidney function according to urine output in patients receiving ECMO. Tukey boxplot, whiskers represent 1.5 interquartile range (p = 0.001).
See this image and copyright information in PMC

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