Extracorporeal membrane oxygenation for circulatory support after repair of congenital heart defects.
Extracorporeal membrane oxygenation was used for cardiovascular support in 13 infants and children with complex congenital heart disease and 1 premature neonate treated in preparation for pericardial patch tracheoplasty for long-segment tracheal stenosis. Nine patients were weaned from extracorporeal membrane oxygenation. There were five (36%) early deaths and four (29%) late deaths. Cannulation sites included right carotid/jugular vessels, femoral artery and vein, and right atrium and aorta. In 4 patients, the neck vessels were repaired at decannulation. Five survivors had normal growth and neurodevelopmental evaluations at follow-up. Extracorporeal membrane oxygenation can be successfully used as biventricular support in patients with intractable low cardiac output syndrome after repair of congenital heart disease. Best results are obtained in patients who have several hours of stability after operation before initiation of support. Hemorrhagic complications are reduced and long-term neurodevelopmental outcomes appear promising with right neck vessel cannulation and repair. No bleeding complications were observed in patients cannulated through the neck vessels.
Weinhaus
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L
Division of Pediatric Cardiology, St. Louis Children's Hospital, Washington University Medical Center, Missouri 63110.
Canter
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C
Noetzel
M
M
McAlister
W
W
Spray
T L
TL
D002339:Carotid Arteries / Q000473:pathology; D002560:Cerebrovascular Circulation; D002648:Child; D002657:Child Development / Q000502:physiology; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007432:Intraoperative Period; D008297:Male; D011182:Postoperative Care / Q000379:methods; D012086:Reoperation; D014463:Ultrasonography; D014654:Vascular Patency