Single-centre outcome of extracorporeal membrane oxygenation after the neonatal Norwood procedure

• Published in: European journal of cardio-thoracic surgery Vol. 62; no. 3
• Main Authors: Mayr, Benedikt, Kido, Takashi, Holder, Samantha, Wallner, Marie, Vodiskar, Janez, Strbad, Martina, Ruf, Bettina, Hager, Alfred, Ewert, Peter, Hörer, Jürgen, Lange, Rüdiger, Ono, Masamichi
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 03.08.2022
• Subjects: Norwood; Single ventricle; Extracorporeal membrane oxygenation/Extracorporeal life support
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezac129

Abstract OBJECTIVES Despite improvements in the surgical management of the hypoplastic left heart syndrome and its variant, the Norwood procedure is still associated with substantial mortality and morbidity and extracorporeal membrane oxygenation support is required in some patients. METHODS We reviewed patients with the Norwood procedure between 2007 and 2019. The primary end point of the study was mortality during extracorporeal membrane oxygenation. Secondary end points included morbidity, bidirectional cavopulmonary shunt and Fontan completion. RESULTS Of the 257 patients in whom the Norwood procedure was performed, mechanical support was required in 41 patients (16%). Indications for extracorporeal membrane oxygenation were low cardiac output (n = 16, 39%), hypoxaemia (n = 12, 29%) and inability to wean from cardiopulmonary bypass (n = 9, 22%). The median age at extracorporeal membrane oxygenation was 10.9 days (interquartile range, 7.9–21.2) and veno-arterial support was required in 37 patients (90.2%). Weaning from extracorporeal membrane oxygenation was achieved in 61% (n = 25). Survival to hospital discharge and 1-year survival was 34.6% (standard deviation: 17.1) and 25.7% (standard deviation: 7), respectively. Bidirectional cavopulmonary shunt was performed in 24% (n = 10) and Fontan completion in 7% (n = 3). Preoperative moderate or greater atrioventricular valve regurgitation was independently associated with mechanical support. Implantation of extracorporeal membrane oxygenation in the paediatric catheter laboratory was identified as an independent risk factor for mortality. CONCLUSIONS Moderate or greater atrioventricular valve regurgitation is an independent risk factor for mechanical support after the Norwood procedure. Mechanical support is associated with substantial in-hospital mortality; however, successful Fontan completion was accomplished in some patients. Despite improvements in perioperative care and surgical techniques for the treatment of neonates with single ventricle (SV) abnormalities, hypoplastic left heart syndrome (HLHS) and its variants, who needed the Norwood stage I procedure (S1P), are still associated with the highest mortality risk of any common form of congenital heart disease [1–3].