JTCS Click here to go to SJM website.
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Pedro J. del Nido
Peter C. Laussen
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Allan, C. K.
Right arrow Articles by Laussen, P. C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Allan, C. K.
Right arrow Articles by Laussen, P. C.
Related Collections
Right arrow Extracorporeal circulation
Right arrow Mechanical Circulatory Assistance

J Thorac Cardiovasc Surg 2007;133:660-667
© 2007 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Indication for initiation of mechanical circulatory support impacts survival of infants with shunted single-ventricle circulation supported with extracorporeal membrane oxygenation

Catherine K. Allan, MDa,*, Ravi R. Thiagarajan, MBBS, MPHa, Pedro J. del Nido, MDb, Stephen J. Roth, MD, MPHc, Melvin C. Almodovar, MDa, Peter C. Laussen, MBBSa

a Department of Cardiology, Children’s Hospital Boston and Harvard Medical School, Boston, Mass
b Department of Cardiac Surgery, Children’s Hospital Boston and Harvard Medical School, Boston, Mass
c Division of Pediatric Cardiology, Lucile Packard Children’s Hospital and Stanford University School of Medicine, Palo Alto, Calif.

Received for publication August 24, 2006; revisions received October 26, 2006; accepted for publication November 1, 2006.

* Address for reprints: Catherine K. Allan, MD, Children’s Hospital Boston, Department of Cardiology, 300 Longwood Avenue, Boston, MA 02115. (Email: catherine.allan{at}cardio.chboston.org).

Objectives: The use of extracorporeal membrane oxygenation to support patients with shunted single-ventricle physiology has been controversial. Variable survivals are reported in a number of small case series. We sought to evaluate outcomes and identify predictors of survival for patients with shunted single-ventricle physiology who require extracorporeal membrane oxygenation support.

Methods: We retrospectively reviewed the medical records of all patients aged less than 1 year with shunted single-ventricle physiology who were supported with extracorporeal membrane oxygenation at Children’s Hospital Boston between 1996 and 2005. Survivors and nonsurvivors were compared with respect to demographics, diagnosis, operative variables, indication for extracorporeal membrane oxygenation, and extracorporeal membrane oxygenation variables.

Results: Forty-four infants with shunted single-ventricle physiology were supported with extracorporeal membrane oxygenation. Diagnoses included hypoplastic left heart syndrome (24), other single-ventricle lesions (12), and pulmonary atresia/intact ventricular septum or a variant (8). Overall survival to discharge was 48%. Indication for extracorporeal membrane oxygenation was the strongest predictor of survival to discharge, with 81% of patients cannulated for hypoxemia but only 29% of those cannulated for hypotension surviving to discharge. Specifically, patients cannulated for shunt obstruction had the highest survival (83%).

Conclusions: Overall survival to discharge for patients with shunted single-ventricle physiology is similar to survival reported in the Extracorporeal Life Support Organization registry for all infants supported with cardiac extracorporeal membrane oxygenation. Thus, shunted single-ventricle physiology should not be considered a contraindication to extracorporeal membrane oxygenation. Patients cannulated for hypoxemia, particularly shunt thrombosis, had markedly improved survival compared with those supported primarily for hypotension/cardiovascular collapse. Survival did not differ depending on anatomic diagnosis.

Abbreviations and Acronyms BT = Blalock–Taussig; CICU = cardiac intensive care unit; CPB = cardiopulmonary bypass; CPR = cardiopulmonary resuscitation; ECMO = extracorporeal membrane oxygenation; ELSO = Extracorporeal Life Support Organization; HLHS = hypoplastic left heart syndrome; IVS = intact ventricular septum; PA = pulmonary atresia; RVDCC = right ventricle-dependent coronary circulation




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
V. Bautista-Hernandez, R. R. Thiagarajan, F. Fynn-Thompson, S. K. Rajagopal, D. E. Nento, V. Yarlagadda, S. A. Teele, C. K. Allan, S. M. Emani, P. C. Laussen, et al.
Preoperative extracorporeal membrane oxygenation as a bridge to cardiac surgery in children with congenital heart disease.
Ann. Thorac. Surg., October 1, 2009; 88(4): 1306 - 1311.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2007 by The American Association for Thoracic Surgery.