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Ann Thorac Surg 2003;76:848-852
© 2003 The Society of Thoracic Surgeons

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Original article: cardiovascular

After repair, atrioventricular valve regurgitation during cardiac extracorporeal membrane oxygenation predicts survival

^a section of Pediatric Cardiology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA,
^b section of Neonatology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
^c Department of Surgery, Section of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA

Accepted for publication March 20, 2003.

^* Address reprint requests to Dr Johnson, Department of Pediatrics, Section of Pediatric Cardiology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Riley Research 104, 702 Barnhill Dr, Indianapolis, IN, USA 46202-5225
e-mail: tifjohns{at}iupui.edu

BACKGROUND: When echocardiography is used to follow up cardiac patients on extracorporeal membrane oxygenation (ECMO), ejection fraction as a measure of ventricular function has been used to determine likelihood of survival after decannulation. We hypothesized that systemic atrioventricular (AV) valve regurgitation while on ECMO may be a better predictor of survival.

METHODS: From February 1995 to March 2001, 64 patients required ECMO postoperatively. Three were removed from ECMO owing to brain death, so 61 patients formed our study group. Retrospective chart review was performed with systemic AV valve regurgitation and ejection fraction while on ECMO recorded from echocardiography reports. Patients alive 1 month after decannulation were considered survivors.

RESULTS: There were 29 survivors (47.5%). Ejection fraction in survivors (mean 41% ± 0.13%) was not significantly different from that of nonsurvivors (41% ± 0.18%; p 0.839) but severity of systemic AV valve regurgitation was significantly different. Only 2 survivors (6.8%) had at least moderate AV valve regurgitation compared with 17 of the 32 nonsurvivors (53%). Patients with moderate to severe regurgitation while on ECMO were less likely to survive for 1 month after decannulation, with an odds ratio of 16.63 (95% confidence interval 3.08, 89.70; p = 0.001). Also female sex increased the odds of death by a factor of 5.43 (95% confidence interval 1.45, 20.36; p = 0.012).

CONCLUSIONS: Severity of systemic AV valve regurgitation on ECMO is a more reliable predictor than ejection fraction for survival at 1 month after decannulation. Patients with less than moderate AV valve regurgitation have a significantly better chance of survival.

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