title: Intermediate-term results of extracorporeal membrane oxygenation support following congenital heart surgery.
abstract: BACKGROUND
  Although there are considerable data regarding in-hospital results of congenital heart surgery (CHS) patients requiring postoperative extracorporeal membrane oxygenation (ECMO) support, there is limited information on intermediate-term outcomes.
  
  
  METHODS
  A single-institution retrospective review of 25 consecutive postoperative CHS patients who required ECMO and survived to hospital discharge between January 2003 and June 2008. Survival was estimated by the Kaplan-Meier method.
  
  
  RESULTS
  At a median follow-up of 3.3 years (interquartile range: 1.2-5.9 years), there was one death which occurred at six months postsurgery. Kaplan-Meier-estimated survival at three years was 95% (95% confidence interval: 90%-100%). Indications for ECMO included extracorporeal cardiopulmonary resuscitation (48%), systemic hypoxia (4%), postoperative low-cardiac output syndrome (28%), and intraoperative failure to wean off cardiopulmonary bypass (20%). Following ECMO support, 65% of patients had unplanned cardiac reinterventions (three requiring operative interventions, six requiring percutaneous interventions, and four requiring both), and 47% of patients required unplanned hospitalizations. In all, 29% of patients developed neurological deficits and 12% of patients developed chronic respiratory failure. No patients developed renal failure. Overall, systemic ventricular (SV) function normalized in 83% of patients, whereas 17% of patients had persistent mild-to-moderate SV dysfunction.
  
  
  CONCLUSIONS
  Intermediate-term patient survival of ECMO following CHS is encouraging. However, neurological impairment and unplanned cardiac reinterventions remain significant concerns. Further delineation of risk factors to improve patient outcomes is warranted.
authors.affiliation: Division of Cardiovascular Surgery, Children's National Medical Center, Washington, DC, USA.
authors.forename: Syed M
authors.initials: SM
authors.lastname: Peer
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Emerson
authors.forename: John P
authors.initials: JP
authors.lastname: Costello
authors.forename: Michael K
authors.initials: MK
authors.lastname: Shu
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
authors.forename: John T
authors.initials: JT
authors.lastname: Berger
authors.forename: Dilip S
authors.initials: DS
authors.lastname: Nath
mesh_terms: D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: ECMO; cardiac critical care; congenital heart surgery; extracorporeal membrane oxygenation