Hemant S Agarwal1, Daphne C Hardison2, Benjamin R Saville3, Brian S Donahue4, Fred S Lamb5, David P Bichell6, Zena L Harris5. 1. Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn. Electronic address: Hemant.Agarwal@Vanderbilt.edu. 2. ECMO Division, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn. 3. Division of Pediatric Cardiac Anesthesia, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn. 4. Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn; Department of Anesthesia, Vanderbilt University Medical Center, Nashville, Tenn. 5. Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn. 6. Department of Cardio-Thoracic Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn.
Abstract
OBJECTIVE: The objective of this study was to examine the incidence and clinical outcomes of residual lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation (ECMO) support. METHODS: A retrospective observational study was undertaken at a pediatric heart institution. Postoperative pediatric cardiac surgery patients receiving ECMO support within 7 days of surgery during the past 7 years (2005-2011) were studied. A hemodynamically significant cardiac lesion on ECMO support that required intervention to decannulate successfully was defined as a residual lesion. Demographic data, complexity of cardiac defect, surgical data, indications for ECMO, echocardiographic findings, and cardiac catheterization results were studied. Evaluation of residual lesions based on duration of ECMO support, interventions undertaken, and clinical outcomes were also examined. RESULTS: Residual lesions were evaluated in 43 of 119 postoperative patients placed on ECMO support. Lesions were detected in 35 patients (28%), predominantly in branch pulmonary arteries (n = 10), shunts (n = 7), and ventricular outflow tracts (n = 9). Echocardiography detected 7 residual lesions (20%) and cardiac catheterization detected 28 residual lesions (80%). Earlier detection of residual lesions during the first 3 days of ECMO support in 24 patients improved their rate of decannulation significantly (P = .004) and survival to hospital discharge (P = .035), compared with later detection (after 3 days of ECMO support) in 11 patients. CONCLUSIONS: Residual lesions are present in approximately one-quarter of postoperative cardiac surgery patients requiring ECMO support. All postoperative pediatric cardiac surgery patients unable to be weaned off ECMO successfully should be evaluated actively for residual lesions, preferably by cardiac catheterization imaging. Earlier detection of residual lesions and reintervention are associated with improved clinical outcome.
OBJECTIVE: The objective of this study was to examine the incidence and clinical outcomes of residual lesions in postoperative pediatric cardiac surgery patients receiving extracorporeal membrane oxygenation (ECMO) support. METHODS: A retrospective observational study was undertaken at a pediatric heart institution. Postoperative pediatric cardiac surgery patients receiving ECMO support within 7 days of surgery during the past 7 years (2005-2011) were studied. A hemodynamically significant cardiac lesion on ECMO support that required intervention to decannulate successfully was defined as a residual lesion. Demographic data, complexity of cardiac defect, surgical data, indications for ECMO, echocardiographic findings, and cardiac catheterization results were studied. Evaluation of residual lesions based on duration of ECMO support, interventions undertaken, and clinical outcomes were also examined. RESULTS: Residual lesions were evaluated in 43 of 119 postoperative patients placed on ECMO support. Lesions were detected in 35 patients (28%), predominantly in branch pulmonary arteries (n = 10), shunts (n = 7), and ventricular outflow tracts (n = 9). Echocardiography detected 7 residual lesions (20%) and cardiac catheterization detected 28 residual lesions (80%). Earlier detection of residual lesions during the first 3 days of ECMO support in 24 patients improved their rate of decannulation significantly (P = .004) and survival to hospital discharge (P = .035), compared with later detection (after 3 days of ECMO support) in 11 patients. CONCLUSIONS: Residual lesions are present in approximately one-quarter of postoperative cardiac surgery patients requiring ECMO support. All postoperative pediatric cardiac surgery patients unable to be weaned off ECMO successfully should be evaluated actively for residual lesions, preferably by cardiac catheterization imaging. Earlier detection of residual lesions and reintervention are associated with improved clinical outcome.
Authors: Ryan Callahan; Sara M Trucco; Peter D Wearden; Lee B Beerman; Gaurav Arora; Jacqueline Kreutzer Journal: Pediatr Cardiol Date: 2014-11-09 Impact factor: 1.655
Authors: Punkaj Gupta; Michael J Robertson; Mallikarjuna Rettiganti; Paul M Seib; Gil Wernovsky; Barry P Markovitz; Janet Simsic; Joseph D Tobias Journal: Pediatr Cardiol Date: 2016-04-01 Impact factor: 1.655
Authors: Masaki Kajimoto; Colleen M O'Kelly Priddy; Dolena R Ledee; Chun Xu; Nancy Isern; Aaron K Olson; Michael A Portman Journal: Am J Physiol Heart Circ Physiol Date: 2014-02-14 Impact factor: 4.733
Authors: Maziar Khorsandi; Mark Davidson; Omar Bouamra; Andrew McLean; Kenneth MacArthur; Ida Torrance; Gillian Wylie; Ed Peng; Mark Danton Journal: Ann Pediatr Cardiol Date: 2018 Jan-Apr