Heather Nolan1, Emrah Aydin2, Jason S Frischer3, Jose L Peiro4, Beth Rymeski5, Foong-Yen Lim6. 1. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: Heather.Nolan@cchmc.org. 2. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: dremrahaydin@yahoo.com. 3. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: Jason.Frischer@cchmc.org. 4. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: Jose.Peiro@cchmc.org. 5. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: Beth.Rymeski@cchmc.org. 6. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: Foong.Yen.Lim@cchmc.org.
Abstract
BACKGROUND/ PURPOSE: Prosthetic patch (patch) and muscle flap (flap) techniques are utilized for severe congenital diaphragmatic hernia (CDH) repair; however, when performed on extracorporeal membrane oxygenation (ECMO), the risk of hemorrhage increases. We sought to compare bleeding complications between repair types. METHODS: We retrospectively reviewed 2010-2016 on-ECMO CDH repairs. RESULTS: Twenty-nine patients met criteria: 13 patch (44.8%) and 16 flap (55.2%). Eight patch (61.5%) and 13 flap (81.2%) patients had left-sided defects (p = 0.223). All defects were Type C or D (Type C: patch 53.8%, flap 56.2%, p = 0.596). There was no difference in gestational age at delivery (patch 37.5 ± 0.9 weeks, flap 37.2 ± 1.3 weeks, p = 0.390) or age at repair (patch 7.46 ± 6.6 days, flap 6.00 ± 4.3 days, p = 0.476). Seven patch (53.8%) and 9 flap (56.2%) patients survived to discharge (p = 0.596). Estimated intraoperative blood loss was equivalent (patch 35.3 ± 53.9 mL, flap 24.2 ± 18.4 mL, p = 0.443). One patch patient (7.6%) and two (12.5%) flap patients required reoperation in the first 48 h for bleeding (p = 0.580). 48-h postoperative transfusions were the same for those that required reoperation (patch 282.0 mL/kg, flap 208.5 ± 21.9 mL/kg, p = 0.054) and those that did not (patch 120.7 ± 111.7 mL/kg, flap 118.4 ± 89.9 mL/kg, p = 0.561). CONCLUSIONS: On-ECMO bleeding complications are equivalent for both flap and patch CDH repair. LEVEL OF EVIDENCE: Type III (retrospective comparative study).
BACKGROUND/ PURPOSE: Prosthetic patch (patch) and muscle flap (flap) techniques are utilized for severe congenital diaphragmatic hernia (CDH) repair; however, when performed on extracorporeal membrane oxygenation (ECMO), the risk of hemorrhage increases. We sought to compare bleeding complications between repair types. METHODS: We retrospectively reviewed 2010-2016 on-ECMO CDH repairs. RESULTS: Twenty-nine patients met criteria: 13 patch (44.8%) and 16 flap (55.2%). Eight patch (61.5%) and 13 flap (81.2%) patients had left-sided defects (p = 0.223). All defects were Type C or D (Type C: patch 53.8%, flap 56.2%, p = 0.596). There was no difference in gestational age at delivery (patch 37.5 ± 0.9 weeks, flap 37.2 ± 1.3 weeks, p = 0.390) or age at repair (patch 7.46 ± 6.6 days, flap 6.00 ± 4.3 days, p = 0.476). Seven patch (53.8%) and 9 flap (56.2%) patients survived to discharge (p = 0.596). Estimated intraoperative blood loss was equivalent (patch 35.3 ± 53.9 mL, flap 24.2 ± 18.4 mL, p = 0.443). One patch patient (7.6%) and two (12.5%) flap patients required reoperation in the first 48 h for bleeding (p = 0.580). 48-h postoperative transfusions were the same for those that required reoperation (patch 282.0 mL/kg, flap 208.5 ± 21.9 mL/kg, p = 0.054) and those that did not (patch 120.7 ± 111.7 mL/kg, flap 118.4 ± 89.9 mL/kg, p = 0.561). CONCLUSIONS: On-ECMO bleeding complications are equivalent for both flap and patch CDH repair. LEVEL OF EVIDENCE: Type III (retrospective comparative study).
Authors: Emrah Aydın; Rashika Joshi; Marc Oria; Foong-Yen Lim; Brian Michael Varisco; Jose Luis Peiro Journal: J Vis Exp Date: 2021-02-05 Impact factor: 1.355