Short-Term Outcomes, Functional Status, and Risk Factors for Requiring Extracorporeal Life Support After Norwood Operation: A Single-Center Retrospective Study.
Journal
ASAIO journal (American Society for Artificial Internal Organs : 1992)
ISSN: 1538-943X
Titre abrégé: ASAIO J
Pays: United States
ID NLM: 9204109
Informations de publication
Date de publication:
01 Apr 2024
01 Apr 2024
Historique:
medline:
1
4
2024
pubmed:
1
4
2024
entrez:
1
4
2024
Statut:
ppublish
Résumé
Patients requiring extracorporeal life support (ECLS) post-Norwood operation constitute an extremely high-risk group. We retrospectively described short-term outcomes, functional status, and assessed risk factors for requiring ECLS post-Norwood operation between January 2010 and December 2020 in a high-volume center. During the study period, 269 patients underwent a Norwood procedure of which 65 (24%) required ECLS. Of the 65 patients, 27 (41.5%) survived to hospital discharge. Mean functional status scale (FSS) score at discharge increased from 6.0 on admission to 8.48 (p < 0.0001). This change was primary in feeding (p < 0.0001) and respiratory domains (p = 0.017). Seven survivors (26%) developed new morbidity, and two (7%) developed unfavorable functional outcomes. In the regression analysis, we showed that patients with moderate-severe univentricular dysfunction on pre-Norwood transthoracic echocardiogram (odds ratio [OR] = 6.97), modified Blalock Taussig Thomas (m-BTT) shunt as source of pulmonary blood flow (OR = 2.65), moderate-severe atrioventricular valve regurgitation on transesophageal echocardiogram (OR = 8.50), longer cardiopulmonary bypass time (OR = 1.16), longer circulatory arrest time (OR = 1.20), and delayed sternal closure (OR = 3.86), had higher odds of requiring ECLS (p < 0.05). Careful identification of these risk factors is imperative to improve the care of this high-risk cohort and improve overall outcomes.
Identifiants
pubmed: 38557688
doi: 10.1097/MAT.0000000000002109
pii: 00002480-202404000-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
328-335Informations de copyright
Copyright © ASAIO 2024.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
Références
Debrunner MG, Porayette P, Breinholt JP 3rd, Turrentine MW, Cordes TM: Midterm survival of infants requiring postoperative extracorporeal membrane oxygenation after Norwood palliation. Pediatr Cardiol. 34: 570–575, 2013.
Friedland-Little JM, Hirsch-Romano JC, Yu S, et al.: Risk factors for requiring extracorporeal membrane oxygenation support after a Norwood operation. J Thorac Cardiovasc Surg. 148: 266–272, 2014.
Bove EL: Current status of staged reconstruction for hypoplastic left heart syndrome. Pediatr Cardiol. 19: 308–315, 1998.
Mahle WT, Spray TL, Wernovsky G, Gaynor JW, Clark BJ 3rd: Survival after reconstructive surgery for hypoplastic left heart syndrome: A 15-year experience from a single institution. Circulation. 102(19 Suppl 3): III–136, 2000.
Sherwin ED, Gauvreau K, Scheurer MA, et al.: Extracorporeal membrane oxygenation after stage 1 palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg. 144: 1337–1343, 2012.
Allan CK, Thiagarajan RR, del Nido PJ, Roth SJ, Almodovar MC, Laussen PC: Indication for initiation of mechanical circulatory support impacts survival of infants with shunted single-ventricle circulation supported with extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg. 133: 660–667, 2007.
Ravishankar C, Dominguez TE, Kreutzer J, et al.: Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome. Pediatr Crit Care Med. 7: 319–323, 2006.
ELSO. Registry of the Extracorporeal Life Support Organization. Ann Arbor ME, Registry Report. 2022.
Thiagarajan RR, Laussen PC, Rycus PT, Bartlett RH, Bratton SL: Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation. 116: 1693–1700, 2007.
Friedland-Little JM, Uzark K, Yu S, Lowery R, Aiyagari R, Hirsch-Romano JC: Functional status and quality of life in survivors of extracorporeal membrane oxygenation after the Norwood operation. Ann Thorac Surg. 103: 1950–1955, 2017.
Pollack MM, Holubkov R, Glass P, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: Functional status scale: New pediatric outcome measure. Pediatrics. 124: e18–e28, 2009.
Berg RA, Nadkarni VM, Clark AE, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: Incidence and outcomes of cardiopulmonary resuscitation in PICUs. Crit Care Med. 44: 798–808, 2016.
Beshish AG, Baginski MR, Johnson TJ, Deatrick BK, Barbaro RP, Owens GE: Functional status change among children with extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in a pediatric cardiac ICU: A single institution report. Pediatr Crit Care Med. 19: 665–671, 2018.
Beshish AG, Rodriguez Z, Hani Farhat M, et al.: Functional status change among infants, children, and adolescents following extracorporeal life support: A multicenter report. ASAIO J. 69: 114–121, 2022.
Han B, Yang JK, Ling AY, et al.: Early functional status after surgery for congenital heart disease: A single-center retrospective study. Pediatr Crit Care Med. 23: 109–117, 2021.
Pollack MM, Holubkov R, Funai T, et al.: Relationship between the functional status scale and the pediatric overall performance category and pediatric cerebral performance category scales. JAMA Pediatr. 168: 671–676, 2014.
Han B, Yang JK, Ling AY, et al.: Early functional status after surgery for congenital heart disease: A single-center retrospective study. Pediatr Crit Care Med. 23: 109–117, 2022.
Berger JT, Holubkov R, Reeder R, et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network: Morbidity and mortality prediction in pediatric heart surgery: Physiological profiles and surgical complexity. J Thorac Cardiovasc Surg. 154: 620–628.e6, 2017.
Rai V, Mroczek T, Szypulski A, et al.: Outcome of Norwood operation for hypoplastic left heart syndrome. Indian J Thorac Cardiovasc Surg. 34: 337–344, 2018.
Norwood WI, Lang P, Hansen DD: Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med. 308: 23–26, 1983.
Carvajal HG, Canter MW, Abarbanell AM, Eghtesady P: Does ascending aorta size affect Norwood outcomes in hypoplastic left heart with aortic atresia? Ann Thorac Surg. 110: 1651–1658, 2020.
Chen Q, Tulloh R, Caputo M, Stoica S, Kia M, Parry AJ: Does the persistence of pulsatile antegrade pulmonary blood flow following bidirectional Glenn procedure affect long term outcome? Eur J Cardiothorac Surg. 47: 154–158; discussion 1582015, 2019.