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Ann Thorac Surg 1997;63:1298-1302
© 1997 The Society of Thoracic Surgeons

Original Article: Cardiovascular

Preoperative ECMO in Congenital Cyanotic Heart Disease Using the AREC System

Gerhard Trittenwein, MD, Gerhard Fürst, MD, Johann Golej, MD, Karola Frenzel, MD, Gudrun Burda, MD, Michael Hermon, MD, Manfred Marx, MD, Gregor Wollenek, MD, Arnold Pollak, MD

Departments of Neonatology and Critical Care and Cardiac and Thoracic Surgery, University Hospital of Vienna, Vienna, Austria

Accepted for publication November 18, 1996.

Background. In cyanotic congenital heart disease, oxygen delivery is impaired either by reduced pulmonary perfusion or by limited entry of oxygenated blood into the systemic circulation. Additional impairment of oxygen delivery (eg, in pulmonary hypertension) leads to hypoxic cerebral damage. Preoperative extracorporeal membrane oxygenation enables oxygenation in otherwise untreatable cases.

Methods. In 3 neonates suffering from cyanotic congenital heart disease (1 with tricuspid atresia and 2 with transposition of the great arteries) with arterial desaturation despite application of prostaglandins, balloon atrioseptostomy, and eventually inhaled nitric oxide during intermittent positive-pressure ventilation with an inspired oxygen fraction of 1, oxygenation could only be established by means of preoperative extracorporeal membrane oxygenation. We used a venovenous single-lumen cannula tidal-flow extracorporeal membrane oxygenation system described by Chevalier and associates that has previously been used for extracorporeal lung support. In this system, called AREC (assistence respiratoire extra-corporelle), alternating clamps and a nonocclusive roller pump were used.

Results. All 3 survived.

Conclusions. We conclude that the AREC system enables sufficient preoperative oxygenation in patients with cyanotic congenital heart disease and hypoxia in spite of all conventional therapeutic means. This provides a stable preoperative condition for elective palliation or correction.




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