Predictors and Outcome of Extracorporeal Life Support After Pediatric Heart Transplantation.
BACKGROUND
Extracorporeal life support (ECLS) has proven success after conventional cardiac surgery. Its use after pediatric heart transplantation is less well documented. We reviewed ECLS after pediatric heart transplantation, to understand better predisposing factors, morbidity, and mortality.


METHODS
The notes of all patients at Great Ormond Street Hospital undergoing orthotopic heart transplantation from 1999 to 2009 were reviewed (202 transplants; patients aged 0.06 to 17.91 years). Patients were grouped by diagnosis: restrictive cardiomyopathy (n = 17), nonrestrictive cardiomyopathy (n = 134), and anatomic heart disease (n = 51).


RESULTS
Twenty-eight patients (13.9%) required ECLS after transplantation. Those requiring ECLS had longer ischemic times (4.2 versus 3.7 hours, p = 0.02). More restrictive cardiomyopathy patients (35.3%) required ECLS-higher than dilated cardiomyopathy (10.4%) or anatomic heart disease (15.7%; χ(2) 7.99; p = 0.018). Factors associated with posttransplant ECLS were restrictive cardiomyopathy, longer ischemic time, and extracorporeal membrane oxygenation before transplant. Graft survival was higher in the non-ECLS group, with 1-year survival of 98.2% versus 57.7%; however, medium-term survival was comparable, with 5-year survival for those surviving to hospital discharge being 84.7% versus 100%.


CONCLUSIONS
The requirement for ECLS was higher than expected for conventional cardiac surgery. Although just over one half of patients requiring ECLS survived to discharge, they had excellent medium-term survival, with all still alive. Although ECLS is an expensive, invasive therapy, with significant morbidity and mortality, without it, those patients would have perished. Its judicious use, therefore, can be recommended.
Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom.
Jacob
J
Simmonds
Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom.
Troy
T
Dominguez
Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom.
Joanna
J
Longman
Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom.
Nitin
N
Shastri
Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom.
Maura
M
O'Callaghan
Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom.
Aparna
A
Hoskote
Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom.
Matthew
M
Fenton
Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom.
Michael
M
Burch
Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom.
Victor
V
Tsang
Cardiac Unit, Great Ormond Street Hospital, London, United Kingdom. Electronic address: katherine.brown@gosh.nhs.uk.
Kate
K
Brown
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006331:Heart Diseases / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology