Extracorporeal life support in neonates, infants, and children after repair of congenital heart disease: Modern era results in a single institution

Bahaaldin Alsoufi, Irving Shen, Tara Karamlou, Carmen Giacomuzzi, Grant Burch, Gary (Michael) Silberbach, Ross Ungerleider

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background. Extracorporeal life support has assumed a very effective role in the support of patients with refractory heart failure after repair of congenital heart disease, with hospital survival between 37% and 42%. We reviewed our results of different applications of extracorporeal life support in the last 2 years. Methods. Between January 2001 and October 2003, 671 patients underwent surgery for congenital heart disease at our institution. We retrospectively reviewed the hospital and clinic charts of the patients who required extracorporeal life support postoperatively, and studied the factors associated with survival. Results. Thirty-six patients (5.36%) received extracorporeal life support after surgery, between 1 day and 8 years of age (age <30 days, n = 34). We divided the patients into four groups. Group 1 consisted of 13 patients who were electively placed on ventricular support without an oxygenator (univentricular assist device) after repair of single-ventricle disease. Group 2 consisted of 16 patients who required extracorporeal membrane oxygenation after surgery for failed hemodynamics. Group 3 consisted of 2 patients who required left ventricle support (left ventricular assist device) after surgery for two-ventricle disease but who did not require biventricular (extracorporeal membrane oxygenation) support. Group 4 consisted of 5 patients who required conversion from ventricular assist device to extracorporeal membrane oxygenation. Overall, 28 patients were weaned successfully (78%), and 24 survived to discharge (67%). Hospital survival in groups 1, 2, 3, and 4 was 100%, 50%, 100%, and 20%, respectively. Univariate factors associated with survival were age, weight, ventricular assist device type, duration, single-ventricle disease, reexploration, number of complications, and specific complications such as sepsis, renal failure, and pulmonary failure. Conclusions. Extracorporeal life support utilization was expanded to include different applications with different outcomes. The extracorporeal life support registry should be altered to reflect those changes.

Original languageEnglish (US)
Pages (from-to)15-21
Number of pages7
JournalAnnals of Thoracic Surgery
Volume80
Issue number1
DOIs
StatePublished - Jul 2005

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Extracorporeal Membrane Oxygenation
Heart Diseases
Newborn Infant
Heart-Assist Devices
Survival
Oxygenators
Heart Ventricles
Renal Insufficiency
Registries
Sepsis
Heart Failure
Hemodynamics
Weights and Measures
Equipment and Supplies
Lung

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Extracorporeal life support in neonates, infants, and children after repair of congenital heart disease : Modern era results in a single institution. / Alsoufi, Bahaaldin; Shen, Irving; Karamlou, Tara; Giacomuzzi, Carmen; Burch, Grant; Silberbach, Gary (Michael); Ungerleider, Ross.

In: Annals of Thoracic Surgery, Vol. 80, No. 1, 07.2005, p. 15-21.

Research output: Contribution to journalArticle

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abstract = "Background. Extracorporeal life support has assumed a very effective role in the support of patients with refractory heart failure after repair of congenital heart disease, with hospital survival between 37{\%} and 42{\%}. We reviewed our results of different applications of extracorporeal life support in the last 2 years. Methods. Between January 2001 and October 2003, 671 patients underwent surgery for congenital heart disease at our institution. We retrospectively reviewed the hospital and clinic charts of the patients who required extracorporeal life support postoperatively, and studied the factors associated with survival. Results. Thirty-six patients (5.36{\%}) received extracorporeal life support after surgery, between 1 day and 8 years of age (age <30 days, n = 34). We divided the patients into four groups. Group 1 consisted of 13 patients who were electively placed on ventricular support without an oxygenator (univentricular assist device) after repair of single-ventricle disease. Group 2 consisted of 16 patients who required extracorporeal membrane oxygenation after surgery for failed hemodynamics. Group 3 consisted of 2 patients who required left ventricle support (left ventricular assist device) after surgery for two-ventricle disease but who did not require biventricular (extracorporeal membrane oxygenation) support. Group 4 consisted of 5 patients who required conversion from ventricular assist device to extracorporeal membrane oxygenation. Overall, 28 patients were weaned successfully (78{\%}), and 24 survived to discharge (67{\%}). Hospital survival in groups 1, 2, 3, and 4 was 100{\%}, 50{\%}, 100{\%}, and 20{\%}, respectively. Univariate factors associated with survival were age, weight, ventricular assist device type, duration, single-ventricle disease, reexploration, number of complications, and specific complications such as sepsis, renal failure, and pulmonary failure. Conclusions. Extracorporeal life support utilization was expanded to include different applications with different outcomes. The extracorporeal life support registry should be altered to reflect those changes.",
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