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Interstage Survival for Patients with Hypoplastic Left Heart Syndrome After ECMO

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Abstract

There is a reported 5–20 % incidence of extracorporeal membrane oxygenation (ECMO) following stage I palliation for hypoplastic left heart syndrome (HLHS). This study compares the interstage mortality of HLHS patients supported with ECMO (HLHS-ECMO) to those who were not supported with ECMO (HLHS-nECMO) using the National Pediatric Cardiology Quality Improvement Initiative database. Patients with HLHS who survived to hospital discharge after stage I palliation were analyzed. HLHS-ECMO patients were compared to HLHS-non-ECMO patients with respect to demographics, surgical variables, and interstage survival. A total of 931 patients were identified in the database. Sixty-six (7.1 %) patients were supported with ECMO during their stage I palliation admission. There were no statistically significant differences between the groups with respect to demographics or anatomic subtype. HLHS-ECMO patients were more likely to have a preoperative risk factor identified (62 vs. 48 %, p = 0.03) or require ECMO prior to stage I palliation (3 vs. 0.5 %, p = 0.03). HLHS-ECMO patients had a significantly higher incidence of death or transplant versus the HLHS-nECMO group (18 vs. 9 %, p = 0.03). Despite survival to discharge, patients with HLHS requiring ECMO after their palliation continue to have an increased risk of death/cardiac transplant versus patients that do not require ECMO. ECMO use is likely a marker for a high-risk patient group. These patients may benefit from closer follow-up during the interstage period.

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References

  1. Feinstein JA, Benson DW, Dubin AM et al (2012) Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 59:S1–42

    Article  PubMed  Google Scholar 

  2. Azakie A, Merklinger SL, McCrindle BW et al (2001) Evolving strategies and improving outcomes of the modified Norwood procedure: a 10-year single-institution experience. ATS 72:1349–1353

    CAS  Google Scholar 

  3. Cua CL, Thiagarajan RR, Gauvreau K et al (2006) Early postoperative outcomes in a series of infants with hypoplastic left heart syndrome undergoing stage I palliation operation with either modified Blalock–Taussig shunt or right ventricle to pulmonary artery conduit. Pediatr Crit Care Med 7:238–244

    Article  PubMed  Google Scholar 

  4. Ohye RG, Sleeper LA, Mahony L et al (2010) Comparison of shunt types in the norwood procedure for single-ventricle lesions. N Engl J Med 362:1980–1992

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Jolley M, Yarlagadda VV, Rajagopal SK, Almodovar MC, Rycus PT, Thiagarajan RR (2014) Extracorporeal membrane oxygenation-supported cardiopulmonary resuscitation following stage 1 palliation for hypoplastic left heart syndrome. Pediatr Crit Care Med 15:538–545

    Article  PubMed  Google Scholar 

  6. DeBrunner MG, Porayette P, Breinholt JP, Turrentine MW, Cordes TM (2012) Midterm survival of infants requiring postoperative extracorporeal membrane oxygenation after norwood palliation. Pediatr Cardiol 34:570–575

    Article  PubMed  Google Scholar 

  7. Roeleveld PP, Wilde RD, Hazekamp M, Rycus PT, Thiagarajan RR (2014) Extracorporeal membrane oxygenation in single ventricle lesions palliated via the hybrid approach. World J Pediatr Congenit Heart Surg 5:393–397

    Article  PubMed  Google Scholar 

  8. Allan CK, Thiagarajan RR, del Nido PJ, Roth SJ, Almodovar MC, Laussen PC (2007) Indication for initiation of mechanical circulatory support impacts survival of infants with shunted single-ventricle circulation supported with extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 133:660–667

    Article  PubMed  Google Scholar 

  9. Alsoufi B, Al-Radi OO, Nazer RI et al (2007) Survival outcomes after rescue extracorporeal cardiopulmonary resuscitation in pediatric patients with refractory cardiac arrest. J Thorac Cardiovasc Surg 134(952–959):e2

    Google Scholar 

  10. Friedland-Little JMMD, Aiyagari RMD, Yu SMS, Donohue JEMPH, Hirsch-Romano JCMD (2014) Survival through staged palliation: fate of infants supported by extracorporeal membrane oxygenation after the Norwood operation. ATS 97:659–665

    Google Scholar 

  11. Polimenakos AC, Wojtyla P, Smith PJ et al (2011) Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes. Eur J Cardio-Thorac Surg

  12. Kugler JD, Beekman RH III, Rosenthal GL et al (2009) Development of a pediatric cardiology quality improvement collaborative: from inception to implementation. From the Joint Council on Congenital Heart Disease Quality Improvement Task Force. Congenital Heart Dis 4:318–328

    Article  Google Scholar 

  13. Baker Smith CM, Goldberg SW, Rosenthal GL (2015) Predictors of prolonged hospital length of stay following stage ii palliation of hypoplastic left heart syndrome (and variants): analysis of the national pediatric cardiology quality improvement collaborative (NPC-QIC) database. Pediatr Cardiol 36:1630–1641

    Article  PubMed  Google Scholar 

  14. Friedland-Little JM, Hirsch-Romano JC, Yu S et al (2014) Risk factors for requiring extracorporeal membrane oxygenation support after a Norwood operation. J Thorac Cardiovasc Surg 148:266–272

    Article  PubMed  Google Scholar 

  15. Sherwin ED, Gauvreau K, Scheurer MA et al (2012) Extracorporeal membrane oxygenation after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 144:1337–1343

    Article  PubMed  Google Scholar 

  16. Hoskote A, Bohn D, Gruenwald C et al (2006) Extracorporeal life support after staged palliation of a functional single ventricle: subsequent morbidity and survival. J Thorac Cardiovasc Surg 131:1114–1121

    Article  PubMed  Google Scholar 

  17. Ghanayem NSMD, Allen KR, PhD Tabbutt S MD et al (2012) Interstage mortality after the Norwood procedure: results of the multicenter single ventricle reconstruction trial. J Thorac Cardiovasc Surg 144:896–906

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alsoufi B, Manlhiot C, Awan A et al (2012) Current outcomes of the Glenn bidirectional cavopulmonary connection for single ventricle palliation. Eur J Cardiothorac Surg 42:42–49

    Article  PubMed  Google Scholar 

  19. Alsoufi B, Wolf M, Botha P et al (2015) Late outcomes of infants supported by extracorporeal membrane oxygenation following the Norwood operation. World J Pediatr Congenital Heart Surg 6:9–17

    Article  Google Scholar 

  20. Mitchell EA, Gomez D, Joy BF et al (2016) ECMO: incidence and outcomes of patients undergoing the hybrid procedure. Congenital Heart Dis 11:169–174

    Article  Google Scholar 

  21. Luce WA, Schwartz RM, Beauseau W et al (2011) Necrotizing enterocolitis in neonates undergoing the hybrid approach to complex congenital heart disease*. Pediatr Crit Care Med 12:46–51

    Article  PubMed  Google Scholar 

  22. Wilhelm CM, Paulus D, Cua CL et al (2015) Arrhythmias following comprehensive stage II surgical palliation in single ventricle patients. Pediatr Cardiol 37:552–557

    Article  PubMed  Google Scholar 

  23. Chetan D, Kotani Y, Jacques F et al (2013) Surgical palliation strategy does not affect interstage ventricular dysfunction or atrioventricular valve regurgitation in children with hypoplastic left heart syndrome and variants. Circulation 128:S205–S212

    Article  PubMed  Google Scholar 

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Acknowledgments

The NPCQIC is supported by participation fees from centers, a gift from the Children’s Heart Association of Cincinnati and from the pediatric Center for Education and Research on Therapeutics, supported by Cooperative Agreement No. U19HS021114 from the Agency for Healthcare Research and Quality.

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Authors and Affiliations

  1. The Heart Center, Nationwide Children’s Hospital, 700 Chlidren’s Drive, Columbus, OH, 43205, USA

    Richard P. Fernandez, Robin Allen, Jamie Stewart, Holly Miller-Tate, Yongjie Miao, Lisa Nicholson & Clifford L. Cua

  2. University of Minnesota Masonic Children’s Hospital, Minneapolis, MN, USA

    Brian F. Joy

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  1. Richard P. Fernandez
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  2. Brian F. Joy
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  3. Robin Allen
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  4. Jamie Stewart
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  5. Holly Miller-Tate
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  6. Yongjie Miao
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  7. Lisa Nicholson
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  8. Clifford L. Cua
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Correspondence to Richard P. Fernandez.

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The authors declare no potential conflicts of interest with respect to the research, authorship, and publication of this article.

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Fernandez, R.P., Joy, B.F., Allen, R. et al. Interstage Survival for Patients with Hypoplastic Left Heart Syndrome After ECMO. Pediatr Cardiol 38, 50–55 (2017). https://doi.org/10.1007/s00246-016-1483-7

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  • DOI: https://doi.org/10.1007/s00246-016-1483-7

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