Liu Minglu,Yang Yinyu,Zhang Wei,et al.ECMO in patients with residual lesions after cardiac surgery[J].Journal of Clinical Pediatric Surgery,,20():518-524.[doi:10.12260/lcxewkzz.2021.06.004]
ECMO in patients with residual lesions after cardiac surgery
- Keywords:
- Heart Defects; Congenital/SU; Heart Defects; Congenital/CO; Pathological Conditions; Anatomical; Extracorporeal Membrane Oxygenation; Treatment Outcome
- CLC:
- R541.1;R493.28;R459.6;R726.1
- Abstract:
- Objective To explore the clinical outcomes of extracorporeal membrane oxygenation (ECMO) in children with residual lesions after congenital heart surgery.Methods Clinical data and prognosis were analyzed for postoperative residual anatomic malformations in 132 children with congenital heart disease (CHD) supported by ECMO from January 1,2017 to June 30,2020.The effects of residual anatomical deformities and follow-up treatment on the outcomes were examined.Based upon the presence or absence of residual anatomic malformation, they were assigned into residual group (n=26) and non-residual group (n=106). Then according to the necessity of surgical intervantion, the former group was further divided into intervention sub-group (n=6) and non-intervention sub-group (n=20). Results Among them,26 patients (19.69%) had residual anatomical deformities of valve problems (n=13),residual obstruction (n=12) and residual shunt (n=5).Children with residual anatomical malformation,ECMO support time (5.26±2.77) days was significantly longer than (3.96±2.77) days for those without residual anatomical malformation.And the difference was statistically significant (t=2.241,P=0.027);children with residual anatomy ablation had a mortality rate of 80.77% and it was higher than 45.28% for those without residual anatomy and the difference was statistically significant (χ2=10.539,P=0.001).Twenty-six children with residual anatomy underwent surgical interventions.And the survival rate of intervention group was 50% and it was significantly higher than 10% of non-intervention group (χ2=4.754,P=0.029).The major causes of mortality were low cardiac output syndrome,respiratory complications,multiple organ failure and arrhythmia.All survivors were those undergoing biventricular repair.Conclusion There is a certain probability of residual anatomic malformations in postoperative CHD children requiring ECMO.It is necessary to actively evaluate the existence of residual anatomic malformations.Early detection of residual anatomic malformations and surgical intervention help to improve the clinical prognosis.
References:
1 于新迪,杨寅愉,沈佳,等.体外膜肺氧合在新生儿复杂先天性心脏病术后救治中的效果分析[J].中国体外循环杂志,2018,16(1):7-11.DOI:10.13498/j.cnki.chin.j.ecc.2018.01.03. Yu XD,Yang YY,Shen J,et al.Effect of extracorporeal membrane oxygenation in neonates with complex congenital heart disease after cardiac surgery[J].Chin J ECC,2018,16(1):7-11.DOI:10.13498/j.cnki.chin.j.ecc.2018.01.03.
2 Guo Z,Yang Y,Zhang W,et al.Extracorporeal cardiopulmonary resuscitation in children after open heart surgery[J].Artif Organs,2019,43(7):633-640.DOI:10.1111/aor.13408.
3 Alsoufi B,Awan A,Manlhiot C,et al.Results of rapid-response extracorporeal cardiopulmonary resuscitation in children with refractory cardiac arrest following cardiac surgery[J].Eur J Cardiothorac Surg,2014,45(2):268-275.DOI:10.1093/ejcts/ezt319.
4 Agarwal HS,Hardison DC,Saville BR,et al.Residual lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation support[J].J Thorac Cardiovasc Surg,2014,147(1):434-441.DOI:10.1016/j.jtcvs.2013.03.021.
5 Lin JC.Extracorporeal membrane oxygenation for severe pediatric respiratory failure[J].Respir Care,2017,62(6):732-750.DOI:10.4187/respcare.05338.
6 Mosier JM,Kelsey M,Raz Y,et al.Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department:History,current applications and future directions[J].Crit Care,2015,19:431.DOI:10.1186/s13054-015-1155-7.
7 Lopez-Magallon AJ,Saenz L,Lara Gutierrez J,et al.Telemedicine in pediatric critical care:A retrospective study in an international extracorporeal membrane oxygenation program[J].Telemed J E Health,2018,24(7):489-496.DOI:10.1089/tmj.2017.0223.
8 Maratta C,Potera RM,van Leeuwen G,et al.Extracorporeal life support organization (elso):2020 pediatric respiratory elso guideline[J].Asaio J,2020,66(9):975-979.DOI:10.1097/MAT.0000000000001223.
9 Lorusso R,Whitman G,Milojevic M,et al.2020 eacts/elso/sts/aats expert consensus on post-cardiotomy extracorporeal life support in adult patients[J].Ann Thorac Surg,2021,111(1):327-369.DOI:10.1016/j.athoracsur.2020.07.009.
10 Howard TS,Kalish BT,Wigmore D,et al.Association of extracorporeal membrane oxygenation support adequacy and residual lesions with outcomes in neonates supported after cardiac surgery[J].Pediatr Crit Care Med,2016,17(11):1045-1054.DOI:10.1097/pcc.0000000000000943.
11 Góreczny S,McLennan D,Morgan GJ.Accessing extracorporeal membrane oxygenation circuits to perform emergent interventional cardiac catheterisation[J].Cardiol Young,2019,29(10):1290-1293.DOI:10.1017/s1047951 119001446.
12 Kuraim GA,Garros D,Ryerson L,et al.Predictors and outcomes of early post-operative veno-arterial extracorporeal membrane oxygenation following infant cardiac surgery[J].J Intensive Care,2018,6:56.DOI:10.1186/s40560-018-0326-4.
13 Douflé G,Roscoe A,Billia F,et al.Echocardiography for adult patients supported with extracorporeal membrane oxygenation[J].Crit Care,2015,19:326.DOI:10.1186/s13054-015-1042-2.
14 Feltes TF,Bacha E,Beekman RH 3rd,et al.Indications for cardiac catheterization and intervention in pediatric cardiac disease:A scientific statement from the american heart association[J].Circulation,2011,123(22):2607-2652.DOI:10.1161/CIR.0b013e31821b1f10.
15 Mandalenakis Z,Giang KW,Eriksson P,et al.Survival in children with congenital heart disease:Have we reached a peak at 97%?[J].J Am Heart Assoc,2020,9(22):e017704.DOI:10.1161/JAHA.120.017704.
16 于新迪,杜欣为,王伟,等.小儿先天性心脏病体外循环术后死亡原因的分析与探讨[J].临床小儿外科杂志,2018,17(12):911-916.DOI:10.3969/j.issn.1671-6353.2018.12.008. Yu XD,Du XW,Wang W,et al.Mortality analyses for children with congenital heart disease after cardiopulmonary bypass[J].J Clin Ped Sur,2018,17(12):911-916.DOI:10.3969/j.issn.1671-6353.2018.12.008.
17 刘宇航,文平,刘启龙,等.75例低龄低体重先心病急诊、亚急诊心内直视手术疗效分析[J].临床小儿外科杂志,2019,18(9):779-783.DOI:10.3969/j.issn.1671-6353.2019.09.015. Liu YH,Wen P,Liu QL,et al.Emergency and sub-emergency operations for congenital heart disease in 75 infants with a low age and a low body weight[J].J Clin Ped Sur,2019,18(9):779-783.DOI:10.3969/j.issn.1671-6353.2019.09.015.
18 Moga MA,Manlhiot C,Marwali EM,et al.Hyperglycemia after pediatric cardiac surgery:Impact of age and residual lesions[J].Crit Care Med,2011,39(2):266-272.DOI:10.1097/CCM.0b013e3181fee88e.
19 Wolf MJ,Kanter KR,Kirshbom PM,et al.Extracorporeal cardiopulmonary resuscitation for pediatric cardiac patients[J].Ann Thorac Surg,2012,94(3):874-880.DOI:10.1016/j.athoracsur.2012.04.040
20 Alsoufi B,Awan A,Manlhiot C,et al.Does single ventricle physiology affect survival of children requiring extracorporeal membrane oxygenation support following cardiac surgery?[J].World J Pediatr Congenit Heart Surg,2014,5(1):7-15.DOI:10.1177/2150135113507292.
Memo
收稿日期:2021-02-26;。
基金项目:国家自然科学基金（编号：82070430）
通讯作者:王伟,Email:wangwei@scmc.com.cn