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Ann Thorac Surg 2009;88:1306-1311. doi:10.1016/j.athoracsur.2009.06.074
© 2009 The Society of Thoracic Surgeons
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Victor Bautista-Hernandez
Francis Fynn-Thompson
Daniel E. Nento
Sitaram M. Emani
Peter C. Laussen
Frank A. Pigula
Emile A. Bacha
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Original Articles: Pediatric Cardiac

Preoperative Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Surgery in Children With Congenital Heart Disease

Victor Bautista-Hernandez, MDa,c, Ravi R. Thiagarajan, MBBS, MPHb,d, Francis Fynn-Thompson, MDa,c, Satish K. Rajagopal, MDb,d, Daniel E. Nento, MDa,c, Vamsi Yarlagadda, MDb,d, Sarah A. Teele, MDb,d, Catherine K. Allan, MDb,d, Sitaram M. Emani, MDa,c, Peter C. Laussen, MBBSb,d, Frank A. Pigula, MDa,c, Emile A. Bacha, MDa,c,*

a Department of Cardiac Surgery, Children's Hospital Boston, Boston, Massachusetts
b Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts
c Department of Surgery, Harvard Medical School, Boston, Massachusetts
d Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

Accepted for publication June 22, 2009.

* Address correspondence to Dr Bacha, Department of Cardiac Surgery, Children's Hospital Boston, Bader 273, 300 Longwood Ave, Boston, MA 02115 (Email: emile.bacha{at}cardio.chboston.org).

Background: The efficacy of extracorporeal membrane oxygenation (ECMO) in bridging children with unrepaired heart defects to a definitive or palliative surgical procedure has been rarely reported. The goal of this study is to report our institutional experience with ECMO used to provide preoperative stabilization after acute cardiac or respiratory failure in patients with congenital heart disease before cardiac surgery.

Methods: A retrospective review of the ECMO database at Children's Hospital Boston was undertaken. Children with unrepaired congenital heart disease supported with ECMO for acute cardiac or respiratory failure as bridge to a definitive or palliative cardiac surgical procedure were identified. Data collection included patient demographics, indication for ECMO, details regarding ECMO course and complications, and survival to hospital discharge.

Results: Twenty-six patients (18 male, 8 female) with congenital heart disease were bridged to surgical palliation or anatomic repair with ECMO. Median age and weight at ECMO cannulation were, respectively, 0.12 months (range, 0 to 193) and 4 kg (range, 1.8 to 67 kg). Sixteen patients (62%) survived to hospital discharge. Variables associated with mortality included inability to decannulate from ECMO after surgery (p = 0.02) and longer total duration of ECMO (p = 0.02). No difference in outcomes was found between patients with single and biventricular anatomy.

Conclusions: Extracorporeal membrane oxygenation, used as a bridge to surgery, represents a useful modality to rescue patients with failing circulation and unrepaired complex heart defects.






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