Evaluate single center experience with use of extracorporeal membrane oxygenation (ECMO) support for stage I repair of hypoplastic left heart syndrome (HLHS). With stage I repair, there remains a significant operative and perioperative mortality with systemic hypoxemia and/or myocardial dysfunction as the main causes. If the causes of myocardial dysfunction are reversible, ECMO has been used for cardio-respiratory support. ELSO registry reports survival of 23% for neonatal HLHS after stage I repair placed on ECMO.
Between June 1999 and June 2000 35 patients underwent stage I repair. Charts were retrospectively reviewed. Eleven patients were placed on ECMO including three placed on in operating room. Patients clinical charachteristics in tableSURVIVALNON-SURVIVALCPB (min)83 (67–115)109 (101–125)cross–clamp (min)47 (37–72)46 (39–50)Circ. arrest (min)45 (34–69)43 (36–46Shunt size (mm)3.53.5CPR (min)28 (2–45)17 (0–33)ECMO (hr)76 (41–130)40 (2–76).
Six patients survived to time of hospital discharge (54%) and 5 died (46%). Two patients placed on ECMO in operating room survived. There was no statistically significant difference in length of cross-clamp, circulatory arrest time, shunt size, length of CPR or time on ECMO between groups. Statisticaly significant difference was between total cardiopulmonary bypass time (t-test, p=0.03), with longer run in nonsurvival group.CONCLUSIONS: Poor ECMO outcomes for perioperative support may discourage some centers from offering this modality to this patient population. With recent advancement in extracorporeal life support improved survival is possible.
Our experience suggest increased survival in patients with stage I repair for HLHS after early ECMO deployment.
M.J. Grzeszczak, None.