Extracorporeal life support after staged palliation of a functional single ventricle: Subsequent morbidity and survival

Hoskote, Aparna; Bohn, Desmond; Gruenwald, Colleen; Edgell, David; Cai, Sally; Adatia, Ian; Arsdell, Glen Van

doi:10.1016/j.jtcvs.2005.11.035

Cited by 76 publications

(77 citation statements)

References 25 publications

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“…8) Morris, et al 9) also reported that development of renal or hepatic dysfunction while patients were on PCPS was a factor associated with an increased probability of mortality in postoperative patients requiring PCPS. Hoskote, et al 10) found that multiple organ system failure was a significant risk factor for poor outcome among the nonsurvivors receiving PCPS after surgery in functional single ventricle patients. Many studies have shown that renal failure is an independent predisposing factor for increased mortality.…”

Section: Discussionmentioning

confidence: 99%

Factors for Successful Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Low Cardiac Output Syndrome After Cardiovascular Surgery

et al. 2007

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SUMMARYThe objective of this study was to analyze the early predictive factors for successful weaning from a percutaneous cardiopulmonary support system (PCPS) in patients with low cardiac output syndrome after cardiovascular surgery.A total of 938 patients underwent cardiovascular surgery with cardiopulmonary bypass (CPB) from January 1991 to September 2006 at Gunma University Hospital. Of these 938 patients, 13 (1.4%) required PCPS to maintain hemodynamics within 48 hours after surgery. The mean age of the 13 patients was 66 years (range, 45 to 86 years). Nine patients underwent open-heart surgery, 3 repair of a thoracic aortic aneurysm, and 1 a pericardiectomy. The patients were divided into 2 groups; group A (n = 4) who were removed from PCPS and group B (n = 9) who were not removed from PCPS. The conditions during the operation and after PCPS support were compared between the 2 groups.The mean age was higher, and operation time, CPB time, and aortic cross-clamping time were significantly (P < 0.05) longer in patients with PCPS than in those without PCPS. The mean PCPS time in all 13 patients was 190 ± 122 hours. The mean age was higher, and CPB time and the aortic cross-clamping time were longer in group B than in group A (NS). The mean duration of PCPS support was significantly (P < 0.05) shorter in group A than in group B (117 ± 42 hours versus 235 ± 136 hours). PCPS flow in group A could be reduced from 48 hours after PCPS induction. However, PCPC flow in group B could not be reduced, and there were significant (P < 0.05) differences in PCPS flow at 72 and 96 hours after starting PCPS. Significant (P < 0.05) differences in the absolute values of the APACHE II score, serum lactate levels, administered epinephrine dose, and levels of total bilirubin (T-Bil), serum creatinine (sCr), and lactate dehydrogenase (LDH) were found between the 2 groups within 96 hours after PCPS induction. In addition, there were significant (P < 0.05) differences in the rate of change compared with the baseline control value obtained prior to PCPS use in PCPS flow, APACHE II score, and levels of T-Bil, sCr, and LDH within 96 hours after PCPS induction. Significant differences in the rate of change of sCr and LDH were found, especially from the early phase after PCPS use, compared with other parameters.From the

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Section: Discussionmentioning

confidence: 99%

Factors for Successful Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Low Cardiac Output Syndrome After Cardiovascular Surgery

et al. 2007

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“…Extracorporeal cardiopulmonary resuscitation (ECPR) is the rapid deployment of ECMO to provide immediate cardiovascular support for patients, who have cardiac arrest refractory to conventional CPR strategies [3,9]. Survival after ECPR in pediatric post-cardiotomy patients varies and results are steadily improving in the last decade [9][10][11][12][13][14][15][16]. With appropriate patient selection and institutional effectiveness to deploy ECMO in a timely fashion, rescue ECMO may influence outcome [9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes

Polimenakos¹,

Wojtyla²,

Smith³

et al. 2011

European Journal of Cardio-Thoracic Surgery

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ECMO support in neonates with FSV requiring ECPR can result in favorable outcome in more than half of patients at hospital discharge. Aggressive strategy toward timely application of ECPR is justified. Expeditious ECPR deployment after proper patients' selection, refinement of CPR quality and use of adjunctive neuroprotective interventions, such as induced hypothermia, might further improve outcomes.

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“…Indeed, the survival for these patients in the reports referenced above is not good. Others, however, have reported over 40% survival with MCS utilization after stage I of palliation (17). Substantially different results may be in part due to device selection, surgical technique or postoperative care, however, patient selection is by far the most likely factor.…”

Section: First Stagementioning

confidence: 99%

An overview of mechanical circulatory support in single-ventricle patients

et al. 2018

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The population of people with a single-ventricle is continually increasing due to improvements across the spectrum of medical care. Unfortunately, a proportion of these patients will develop heart failure.Often, for these patients, mechanical circulatory support (MCS) represents the only available treatment option. While single-ventricle patients currently represent a small proportion of the total number of patients who receive MCS, as the single-ventricle patient population increases, this number will increase as well.Outcomes for these complex single-ventricle patients who require MCS has begun to be evaluated. When considering the entire population, survival to hospital discharge is 30-50%, though this must be considered with the significant heterogeneity of the single-ventricle patient population. Patients with a single-ventricle have unique anatomy, mechanisms of failure, indications for MCS and the type of support utilized. This has made the interpretation and the generalizability of the limited available data difficult. It is likely that some subsets will have a significantly worse prognosis and others a better one. Unfortunately, with these limited data, indications of a favorable or poor outcome have not yet been elucidated. Though currently, a database has been constructed to address this issue. While the outcomes for these complex patients is unclear, at least in some situations, they are poor. However, significant advances may provide improvements going forward, including new devices, computer simulations and 3D printed models. The most important factor, however, will be the increased experience gained by the heart failure team to improve patient selection, timing, device and configuration selection and operative approach.

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Extracorporeal life support after staged palliation of a functional single ventricle: Subsequent morbidity and survival

Cited by 76 publications

References 25 publications

Factors for Successful Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Low Cardiac Output Syndrome After Cardiovascular Surgery

Factors for Successful Weaning From a Percutaneous Cardiopulmonary Support System (PCPS) in Patients With Low Cardiac Output Syndrome After Cardiovascular Surgery

Post-cardiotomy extracorporeal cardiopulmonary resuscitation in neonates with complex single ventricle: analysis of outcomes

An overview of mechanical circulatory support in single-ventricle patients

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