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Cardiac Catheterization During Extracorporeal Membrane Oxygenation After Congenital Cardiac Surgery: A Multi-Center Retrospective Study

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Abstract

Cardiac catheterization can affect clinical outcomes in patients on extracorporeal membrane oxygenation (ECMO) after congenital heart surgery; however, its effect in this group of patients remains unclear. This study aimed to evaluate the safety and outcome of cardiac catheterization in patients undergoing ECMO after congenital cardiac surgery and determine predictors that influence successful weaning. This retrospective cohort study included pediatric patients who underwent cardiac catheterization while on ECMO after congenital heart surgery in two cardiac centers between November 2012 and February 2020. Predictors of successful weaning from ECMO were studied using univariate and multivariate logistic regression analyses. Of 123 patients on ECMO support after congenital cardiac surgery, 60 patients underwent 60 cardiac catheterizations (31 diagnostic and 29 interventional). Thirty-four (56.7%) and 22 patients (36.7%) underwent successful decannulation from ECMO support and survived after hospital discharge, respectively. Patients who underwent earlier catheterization (within 24 h of ECMO initiation) had more successful weaning from ECMO and survival compared to others. Patients who underwent an interventional procedure (interventional catheterization or redo cardiac surgery after cardiac catheterization) had better survival than those who underwent only diagnostic catheterization (P = 0.038). Shorter durations of ECMO was the most important predictor of successful weaning from ECMO. Early cardiac catheterization greatly impacts successful weaning from ECMO and survival. Patients with correctable lesions amenable either by catheterization or redo surgery are more likely to survive. Shorter durations of ECMO could have a significant influence on successful weaning from ECMO and survival.

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Availability of Data and Material

All data were available at King Abdulaziz University Hospital and King Faisal Specialist Hospital and Research Center. Health care providers and researchers can access these data confidentially.

Code Availability

Statistical Package for Social Science software (SPSS) for Microsoft Windows, version 26 (IBM Corp., Armonk, N.Y., USA).

Abbreviations

ALCAPA:

Aberrant left coronary artery from pulmonary artery

AO:

Aorta

AUC:

Area under the curve

BTS:

Blalock Taussig shunt

CHD:

Congenital heart diseases

CI:

Confidence interval

CPB:

Cardiopulmonary bypass

DORV:

Double outlet right ventricle

ECMO:

Extracorporeal membrane oxygenation

ECPR:

Extracorporeal cardiopulmonary resuscitation

ICU:

Intensive care unit

LV:

Left ventricle

LVOT:

Left ventricle outflow tract

MBTS:

Modified Blalock Taussig shunt

OR:

Odds ration

PAB:

Pulmonary artery banding

PCPC:

Partial cavopulmonary connection

RACHS-1:

Risk adjustment for congenital heart surgery

ROC:

Receiver operating characteristic

RPA:

Right pulmonary artery

RVOT:

Right ventricle outflow tract

TCPC:

Total cavopulmonary connection

TGA:

Transposition of great arteries,

VSD:

Ventricular septal defect

References

  1. Kato A, Lo Rito M, Lee KJ et al (2017) Impacts of early cardiac catheterization for children with congenital heart disease supported by extracorporeal membrane oxygenation. Catheter Cardiovasc Interv 89:898–905. https://doi.org/10.1002/ccd.26632

    Article  PubMed  Google Scholar 

  2. Booth KL, Roth SJ, Perry SB et al (2002) Cardiac catheterization of patients supported by extracorporeal membrane oxygenation. J Am Coll Cardiol 40:1681–1686. https://doi.org/10.1016/S0735-1097(02)02343-4

    Article  PubMed  Google Scholar 

  3. Abraham BP, Gilliam E, Kim DW et al (2016) Early catheterization after initiation of extracorporeal membrane oxygenation support in children is associated with improved survival. Catheter Cardiovasc Interv 88:592–599. https://doi.org/10.1002/ccd.26526

    Article  PubMed  Google Scholar 

  4. Dohain AM, Abdelmohsen G, Elassal AA et al (2019) Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery. Cardiol Young 29:1501–1509. https://doi.org/10.1017/S1047951119002634

    Article  PubMed  Google Scholar 

  5. Boscamp NS, Turner ME, Crystal M et al (2017) Cardiac catheterization in pediatric patients supported by extracorporeal membrane oxygenation: a 15-year experience. Pediatr Cardiol 38:332–337. https://doi.org/10.1007/s00246-016-1518-0

    Article  PubMed  Google Scholar 

  6. Bahaidarah S, Al-Ata J, Abdelmohsen G et al (2020) Cardiac catheterization addressing early post-operative complications in congenital heart surgery—a single-center experience. Egypt Hear J 72:83. https://doi.org/10.1186/S43044-020-00117-6

    Article  Google Scholar 

  7. Agarwal HS, Hardison DC, Saville BR et al (2014) Residual lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation support. J Thorac Cardiovasc Surg 147:434–441. https://doi.org/10.1016/j.jtcvs.2013.03.021

    Article  PubMed  Google Scholar 

  8. Kuraim GA, Garros D, Ryerson L et al (2018) Predictors and outcomes of early post-operative veno-arterial extracorporeal membrane oxygenation following infant cardiac surgery. J Intensive Care 6:1–12. https://doi.org/10.1186/s40560-018-0326-4

    Article  Google Scholar 

  9. Roeleveld PP, Mendonca M (2019) Neonatal cardiac ECMO in 2019 and beyond. Front Pediatr 7:1–13. https://doi.org/10.3389/fped.2019.00327

    Article  Google Scholar 

  10. Güzeltaş A, Kaşar T, Tanıdır IC et al (2017) Cardiac catheterization procedures in pediatric patients undergoing extracorporeal membrane oxygenation cardiac catheterization, ECMO. Anatol J Cardiol 18:425–430. https://doi.org/10.14744/AnatolJCardiol.2017.7927

    Article  PubMed  PubMed Central  Google Scholar 

  11. DesJardins SE, Crowley DC, Beekman RH, Lloyd TR (1999) Utility of cardiac catheterization in pediatric cardiac patients on ECMO. Catheter Cardiovasc Interv 46:62–67. https://doi.org/10.1002/(SICI)1522-726X(199901)46:1%3c62::AID-CCD17%3e3.0.CO;2-9

    Article  CAS  PubMed  Google Scholar 

  12. Ettedgui JA, Fricker FJ, Park SC et al (1996) Cardiac catheterization in children on extracorporeal membrane oxygenation. Cardiol Young 6:59–61

    Article  Google Scholar 

  13. Bautista-Rodriguez C, Sanchez-de-Toledo J, Da Cruz EM (2018) The role of echocardiography in neonates and pediatric patients on extracorporeal membrane oxygenation. Front Pediatr 6:1–13. https://doi.org/10.3389/fped.2018.00297

    Article  Google Scholar 

  14. Platts DG, Sedgwick JF, Burstow DJ et al (2012) The role of echocardiography in the management of patients supported by extracorporeal membrane oxygenation. J Am Soc Echocardiogr 25:131–141. https://doi.org/10.1016/j.echo.2011.11.009

    Article  PubMed  Google Scholar 

  15. Howard TS, Kalish BT, Wigmore D et al (2016) Association of extracorporeal membrane oxygenation support adequacy and residual lesions with outcomes in neonates supported after cardiac surgery∗. Pediatr Crit Care Med 17:1045–1054. https://doi.org/10.1097/PCC.0000000000000943

    Article  PubMed  Google Scholar 

  16. Burke CR, Chan T, Rubio AE, McMullan DM (2017) Early cardiac catheterization leads to shortened pediatric extracorporeal membrane oxygenation run duration. J Interv Cardiol 30:170–176. https://doi.org/10.1111/joic.12368

    Article  PubMed  Google Scholar 

  17. Mascio CE, Austin EH, Jacobs JP et al (2014) Perioperative mechanical circulatory support in children: an analysis of the society of thoracic surgeons congenital heart surgery database. J Thorac Cardiovasc Surg 147:658–665. https://doi.org/10.1016/j.jtcvs.2013.09.075

    Article  PubMed  Google Scholar 

  18. Salvin JW, Laussen PC, Thiagarajan RR (2008) Extracorporeal membrane oxygenation for postcardiotomy mechanical cardiovascular support in children with congenital heart disease. Paediatr Anaesth 18:1157–1162. https://doi.org/10.1111/j.1460-9592.2008.02795.x

    Article  PubMed  Google Scholar 

  19. Sasaki T, Asou T, Takeda Y et al (2014) Extracorporeal life support after cardiac surgery in children: outcomes from a single institution. Artif Organs 38:34–40. https://doi.org/10.1111/aor.12191

    Article  PubMed  Google Scholar 

  20. Maslach-Hubbard A (2013) Extracorporeal membrane oxygenation for pediatric respiratory failure: history, development and current status. World J Crit Care Med 2:29. https://doi.org/10.5492/wjccm.v2.i4.29

    Article  PubMed  PubMed Central  Google Scholar 

  21. Shuhaiber J, Thiagarajan RR, Laussen PC et al (2011) Survival of children requiring repeat extracorporeal membrane oxygenation after congenital heart surgery. Ann Thorac Surg 91:1949–1955. https://doi.org/10.1016/j.athoracsur.2011.01.078

    Article  PubMed  Google Scholar 

  22. Morris MC, Ittenbach RF, Godinez RI et al (2004) Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation. Crit Care Med 32:1061–1069. https://doi.org/10.1097/01.CCM.0000119425.04364.CF

    Article  PubMed  Google Scholar 

  23. Merrill ED, Schoeneberg L, Sandesara P et al (2014) Outcomes after prolonged extracorporeal membrane oxygenation support in children with cardiac disease—extracorporeal life support organization registry study. J Thorac Cardiovasc Surg 148:582–588. https://doi.org/10.1016/j.jtcvs.2013.09.038

    Article  PubMed  Google Scholar 

  24. Kumar TKS, Zurakowski D, Dalton H et al (2010) Extracorporeal membrane oxygenation in postcardiotomy patients: factors influencing outcome. J Thorac Cardiovasc Surg 140:330-336.e2. https://doi.org/10.1016/j.jtcvs.2010.02.034

    Article  PubMed  Google Scholar 

  25. Ford MA, Gauvreau K, McMullan DM et al (2016) Factors associated with mortality in neonates requiring extracorporeal membrane oxygenation for cardiac indications: analysis of the extracorporeal life support organization registry data. Pediatr Crit Care Med 17:860–870. https://doi.org/10.1097/PCC.0000000000000842

    Article  PubMed  Google Scholar 

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Acknowledgements

We want to thank Mahmoud Akl and Mosaab Bakkar the cardiopulmonary perfusionists for their cooperation during data collection.

Funding

This work was supported by the Deanship of Scientific Research (DSR), King Abdulaziz University, Jeddah [Grant number D-094–140-1441]. The authors, therefore, gratefully acknowledge DSR technical and financial support.

Author information

Authors and Affiliations

  1. Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia

    Gaser Abdelmohsen, Jameel Al-Ata, Naif Alkhushi, Saud Bahaidarah, Mohamed Abdelsalam, Abdulhadi Alghamdi, Ahmed Fawzy, Ahmed Elakaby, Ahmed Azhar, Zaher Zaher, Khadijah Maghrabi, Mohamed Mashali & Ahmed Dohain

  2. Paediatric Cardiology Division, Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt

    Gaser Abdelmohsen, Samia Bekheet, Mohamed Mashali & Ahmed Dohain

  3. Paediatric Cardiology Division, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia

    Jameel Al-Ata, Naif Alkhushi, Haysam Baho, Samia Bekheet & Wejdan Ba-Atiyah

  4. Cardiology Department, Benha University, Benha, Egypt

    Mohamed Abdelsalam

  5. Paediatric Department, Al -Azhar University, Cairo, Egypt

    Ahmed Elakaby

  6. Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia

    Osman Al-Radi & Ahmed Elassal

  7. Cardiac Surgery Division, Department of Surgery, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia

    Osman Al-Radi, Ahmed Jamjoom & Mohammad Shihata

  8. Cardiothoracic Surgery Department, Zagazig University, Zagazig, Egypt

    Ahmed Elassal

Authors
  1. Gaser Abdelmohsen
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  2. Jameel Al-Ata
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  3. Naif Alkhushi
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  4. Saud Bahaidarah
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  5. Haysam Baho
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  6. Mohamed Abdelsalam
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  7. Samia Bekheet
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  8. Wejdan Ba-Atiyah
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  9. Abdulhadi Alghamdi
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  10. Ahmed Fawzy
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  11. Ahmed Elakaby
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  12. Osman Al-Radi
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  13. Ahmed Jamjoom
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  14. Ahmed Elassal
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  15. Mohammad Shihata
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  16. Ahmed Azhar
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  17. Zaher Zaher
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  18. Khadijah Maghrabi
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  19. Mohamed Mashali
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  20. Ahmed Dohain
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Contributions

GA: Statistical analysis, Concept and design, JA: Concept and design, NA: Drafting article, SB: Drafting article, HB: Critical revision, MA: Data curation, SB: Data collection, WB: Data collection, AA: Data collection, AF: Data collection, AE: Data collection, OA: Critical revision, AJ: Critical revision, Concept and design, AE: Data collection, MS: Drafting article, AA: Revision of the manuscript. ZZ: Revision of manuscript, KM: data collection during revision, MM: Data curation, AD: Final revision of the manuscript. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Gaser Abdelmohsen.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics Approval

The study was approved by the ethical committee of King Abdulaziz University Hospital (committee’s reference number: 539–20) and King Faisal Specialist Hospital and Research Center (committee’s reference number: IRB 2020–97).

Consent to Participate

Written consents from the patients′ legal guardians were taken retrospectively on admission for potential participation in future research and publication.

Consent for Publication

Available at king Abdulaziz university hospital and King Faisal Specialist Hospital and Research Center.

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Abdelmohsen, G., Al-Ata, J., Alkhushi, N. et al. Cardiac Catheterization During Extracorporeal Membrane Oxygenation After Congenital Cardiac Surgery: A Multi-Center Retrospective Study. Pediatr Cardiol 43, 92–103 (2022). https://doi.org/10.1007/s00246-021-02696-w

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  • DOI: https://doi.org/10.1007/s00246-021-02696-w

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