Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery

Dohain, Ahmed M.; Abdelmohsen, Gaser; Elassal, Ahmed Abdelrahman; Elmahrouk, Ahmed F.; Al‐Radi, Osman O.

doi:10.1017/s1047951119002634

Cited by 21 publications

(31 citation statements)

References 19 publications

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“…In other series, ECMO was a risk factor for operative mortality [21]. In this study, two patients had ECMO, and both of them died [22,23]. Naimo and colleagues [24] found that 32% of DiGeorge syndrome had operative mortality; similarly, in our study, 25% of DiGeorge syndrome had operative mortality.…”

Section: Discussionsupporting

confidence: 72%

Surgical repair for persistent truncus arteriosus in neonates and older children

Alamri

Dohain

Arafat

et al. 2020

J Cardiothorac Surg

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Objectives: Persistent truncus arteriosus represents less than 3% of all congenital heart defects. We aim to analyze mid-term outcomes after primary Truncus arteriosus repair at different ages and to identify the risk factors contributing to mortality and the need for intervention after surgical repair. Methods: This retrospective cohort study included 36 children, underwent repair of Truncus arteriosus in the period from January 2011 to December 2018 in two institutions. We recorded the clinical and echocardiographic data for the patients preoperatively, early postoperative, 6 months postoperative, then every year until their last documented follow-up appointment. Results: Thirty-six patients had truncus arteriosus repair during the study period. Thirty-one patients had open sternum post-repair, and two patients required extracorporeal membrane oxygenation. Bleeding occurred in 15 patients (41.67%), and operative mortality occurred in 5 patients (14.7%). Patients with truncus arteriosus type 2 (p = 0.008) and 3 (p = 0.001) and who were ventilated preoperatively (p < 0.001) had a longer hospital stay. Surgical re-intervention was required in 8 patients (22.86%), and 11 patients (30.56%) had catheter-based reintervention. Freedom from reintervention was 86% at 1 year, 75% at 2 years and 65% at 3 years. Survival at 1 year was 81% and at 3 years was 76%. High postoperative inotropic score predicted mortality (p = 0.013). Conclusion: Repair of the truncus arteriosus can be performed safely with low morbidity and mortality, both in neonates, infants, and older children. Re-intervention is common, preferably through a transcatheter approach.

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Section: Discussionsupporting

confidence: 72%

Surgical repair for persistent truncus arteriosus in neonates and older children

Alamri

Dohain

Arafat

et al. 2020

J Cardiothorac Surg

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“…Several reports studied the safety of catheter intervention for patients on ECMO support [7,[17][18][19]. When compared to our study, the results are less promising in our cohort.…”

Section: Cardiac Catheterization For the Patient On Ecmo Supportcontrasting

confidence: 63%

Cardiac catheterization addressing early post-operative complications in congenital heart surgery—a single-center experience

et al. 2020

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Background Cardiac catheterization after congenital heart surgery may play an important role in the diagnosis and management of patients with a complicated or unusual post-operative course. The main objective of this study was to evaluate the safety, efficacy, and outcome of cardiac catheterization performed in the early post-operative period following congenital heart surgery. All patients who underwent cardiac catheterization after congenital heart surgery during the same admission of cardiac surgery from November 2015 to May 2018 were included in the study. Results Thirty procedures were performed for 27 patients (20 interventional and 10 diagnostic). The median age of the patients was 15 months (15 days to 20 years), median weight was 8.2 kg (3.4 to 53 kg), and median time from surgery was 3 days (0–32 days). Eleven procedures were performed for 11 patients on extracorporeal membrane oxygenation (ECMO) support. The main indications for catheterization included the inability to wean from ECMO (10 procedures) and cyanosis (10 procedures). Interventional procedures included angioplasty using stents (10 procedures, success rate of 90%), angioplasty using only balloons (2 procedures, success rate of 50%), and occlusion for residual shunts (8 procedures, success rate of 100%). No mortality was recorded during any procedure. Vasoactive–inotropic score had significantly decreased 48 h after catheterization when compared to pre-catheterization scores (p = 0.0001). Moreover, 72% of patients connected to ECMO support were successfully weaned from ECMO after catheterization. Procedural complications were recorded in 3 interventional procedures. Survival to hospital discharge was 55.5% and overall survival was 52%. Patients on ECMO support had a higher mortality than other patients. Conclusion Cardiac catheterization can be performed safely in the early post-operative period, and it could improve the outcome of the patient (depending on the complexity of the cardiac lesions involved).

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“…Our ECMO protocol and data has been published previously 9 Two patients had ECMO for All three patients survived to hospital discharge. 10 Three patients had postoperative complete heart block, two of them required permanent pacemaker. 11 The postoperative complications are listed in Table 3.…”

Section: Patients Characteristics and Index Operationmentioning

confidence: 97%

Outcomes of biventricular repair for shone's complex

et al. 2020

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Background: Shone's complex is a rare lesion affecting the mitral valve (MV) and left ventricular outflow tract (LVOT). The objective of this study is to report the outcomes after Shone's complex repair, the growth of mitral and aortic valve and LVOT, and long-term survival. Methods: This retrospective study included all patients diagnosed with Shone's complex, who underwent biventricular repair. Data including patients' characteristics, type of the MV lesion and the associated lesions were collected. Patients were followed up regularly with echocardiography, and the changes in mitral and aortic valve z-score and LVOT z-score were recorded. Results: Thirty-seven patients were included in the study, the median age was 3.4 months, and 11 patients (30.6%) had pulmonary hypertension. The main procedure performed during the first surgical intervention was coarctation repair in 26 patients (70%). Twelve patients had MV repair, and five had MV replacement. Operative mortality occurred in 1 patient (2.7%), median follow up was 52 (25-75th percentile: 22-84) months. Survival at 1, 5, and 10 years was 94.4%, 90%, and 76.9%, respectively. Reoperation was required in 13 patients, mainly for LVOT repair (n = 8). Reoperation was significantly associated with associated aortic valve lesion (p = .044). The growth of the MV z-score was 0.35 per year; p < .001, aortic valve z-score 0.086 per year; p = 0.422, and the LVOT z-score was 0.53 per year; p = .01. Conclusion: Biventricular repair of Shone's complex has good outcomes. Reoperation is frequently encountered, especially with low aortic valve z-score. The MV and LVOT have significant growth following Shone's complex repair.

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Factors affecting the outcome of extracorporeal membrane oxygenation following paediatric cardiac surgery

Cited by 21 publications

References 19 publications

Surgical repair for persistent truncus arteriosus in neonates and older children

Surgical repair for persistent truncus arteriosus in neonates and older children

Cardiac catheterization addressing early post-operative complications in congenital heart surgery—a single-center experience

Outcomes of biventricular repair for shone's complex

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