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J Thorac Cardiovasc Surg 2006;131:1114-1121
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Extracorporeal life support after staged palliation of a functional single ventricle: Subsequent morbidity and survival

^a Department of Critical Care Medicine, The Hospital for Sick Children and University of Toronto, Toronto, Canada
^b Division of Perfusion Services, The Hospital for Sick Children and University of Toronto, Toronto, Canada
^c Division of Cardiovascular Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Canada
^d Division of Cardiology, The Hospital for Sick Children and University of Toronto, Toronto, Canada

Received for publication August 1, 2005; revisions received November 2, 2005; accepted for publication November 28, 2005.

^_* Address for reprints: Ian Adatia, MB, ChB, University of California San Francisco Children's Hospital, 505 Parnassus Ave, Room M-655, San Francisco, CA 94143-0106 (Email: ian.adatia{at}ucsf.edu).

OBJECTIVE: We sought to review the outcome of infants with a functional single ventricle receiving postoperative extracorporeal life support.

METHODS: We reviewed all patients with a functional single ventricle receiving postoperative extracorporeal life support between January 1997 and May 2003.

RESULTS: We supported 25 infants (age range, 2-139 days; median age, 15 days; weight range, 1.9-5.9 kg; median weight, 3.4 kg) with extracorporeal life support. Operative procedures were Norwood stage 1 procedure in 18 patients, modified Blalock-Taussig shunt in 4 patients, bidirectional superior cavopulmonary shunt in 2 patients, and pulmonary vein repair in 1 patient. Indications for extracorporeal life support included cardiac arrest (14/25) and low cardiac output state (11/25). Extracorporeal membrane oxygenation was initiated in 19 patients, with conversion to a ventricular assist device in 7 patients. Ventricular assist device alone was initiated in 6 patients. Survival to decannulation was 76%, with 5 late deaths from multiorgan failure and 56% intensive care unit survival. Survival to hospital discharge was 44%. On univariate analysis, the presence of arrhythmia before extracorporeal life support (P = .005), renal failure (P = .0007), Candida species–induced sepsis (P = .026), and multiorgan failure (P = .0009) were significant risk factors in the nonsurvivors. Median hospital stay was 43.5 days (range, 6-181 days) for the whole group and 93 days (range, 36-181 days) for survivors. Eight patients completed next stage palliation.

CONCLUSIONS: Twenty percent of patients were supported with a ventricular assist device alone, with 50% conversion to a ventricular assist device from extracorporeal membrane oxygenation. Survival to decannulation was encouraging. Multiorgan failure and risk of invasive infection in the post–extracorporeal membrane oxygenation period mitigate against survival to hospital discharge. Use of extracorporeal life support before cardiac arrest might reduce attrition between decannulation and hospital discharge.

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