Interstage Survival for Patients with Hypoplastic Left Heart Syndrome After ECMO

• Published in: Pediatric cardiology 2017-01, Vol.38 (1), p.50-55
• Main Authors: Fernandez, Richard P., Joy, Brian F., Allen, Robin, Stewart, Jamie, Miller-Tate, Holly, Miao, Yongjie, Nicholson, Lisa, Cua, Clifford L.
• Format: Article
• Language: English
• Subjects: Cardiac patients; Cardiac Surgery; Cardiology; Care and treatment; Communications industry; Comparative analysis; Databases, Factual; Extracorporeal Membrane Oxygenation - methods; Female; Humans; Hypoplastic left heart syndrome; Hypoplastic Left Heart Syndrome - mortality; Hypoplastic Left Heart Syndrome - therapy; Infant; Infant, Newborn; Male; Medical care; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Mortality; Norwood Procedures - adverse effects; Norwood Procedures - methods; Original Article; Palliative Care - methods; Patient Discharge; Patient outcomes; Pediatric cardiology; Quality management; Retrospective Studies; Risk Factors; Survival Rate; Telecommunications services industry; Treatment Outcome; United Kingdom; Vascular Surgery
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-016-1483-7

There is a reported 5–20 % incidence of extracorporeal membrane oxygenation (ECMO) following stage I palliation for hypoplastic left heart syndrome (HLHS). This study compares the interstage mortality of HLHS patients supported with ECMO (HLHS-ECMO) to those who were not supported with ECMO (HLHS-nECMO) using the National Pediatric Cardiology Quality Improvement Initiative database. Patients with HLHS who survived to hospital discharge after stage I palliation were analyzed. HLHS-ECMO patients were compared to HLHS-non-ECMO patients with respect to demographics, surgical variables, and interstage survival. A total of 931 patients were identified in the database. Sixty-six (7.1 %) patients were supported with ECMO during their stage I palliation admission. There were no statistically significant differences between the groups with respect to demographics or anatomic subtype. HLHS-ECMO patients were more likely to have a preoperative risk factor identified (62 vs. 48 %, p  = 0.03) or require ECMO prior to stage I palliation (3 vs. 0.5 %, p  = 0.03). HLHS-ECMO patients had a significantly higher incidence of death or transplant versus the HLHS-nECMO group (18 vs. 9 %, p  = 0.03). Despite survival to discharge, patients with HLHS requiring ECMO after their palliation continue to have an increased risk of death/cardiac transplant versus patients that do not require ECMO. ECMO use is likely a marker for a high-risk patient group. These patients may benefit from closer follow-up during the interstage period.