Preoperative ECMO in Transposition of the Great Arteries With Persistent Pulmonary Hypertension

Jaillard, Sophie; Belli, Emrè; Rakza, Thameur; Larrue, Benoît; Magnenant, Eric; Rey, Christian; Storme, Laurent

doi:10.1016/j.athoracsur.2003.12.037

Cited by 26 publications

(24 citation statements)

References 6 publications

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“…Only eight surviving patients managed with iNO and/or ECMO are reported in the literature [3,5,12,13]; similar to our two patients, they recovered normal pulmonary pressure rapidly after the surgical procedure. The fact that PPHN did not relapse after surgery suggests a functional form of PPHN due to pulmonary arterial vasoconstriction, as opposed to a restrictive form of pulmonary hypertension.…”

Section: Discussionsupporting

confidence: 84%

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Persistent pulmonary hypertension of the newborn with transposition of the great arteries: successful treatment with bosentan

et al. 2007

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Persistent pulmonary hypertension of the newborn (PPHN) occurs in 1-4% of neonates with transposition of the great arteries with intact ventricular septum (TGA/IVS). This association is often lethal. To our knowledge, only eight survivors have been described in the literature, two of whom benefited from extracorporeal membrane oxygenation (ECMO). We report two cases of PPHN complicating a TGA/IVS that were refractory to multiple therapies and resolved 48 hours after initiation of bosentan therapy. Bosentan, an oral dual endothelin-1 receptor antagonist, is a new treatment for pulmonary arterial hypertension that was both effective and safe in these two cases of TGA/IVS with PPHN. To our knowledge, it is the first use of bosentan in newborns.

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Section: Discussionsupporting

confidence: 84%

“…This condition is associated with poor survival contrasting with the usually favorable prognosis of TGA. Only eight survivors have been described in the literature, two of whom benefited from ECMO [3,5,12,13].…”

Section: Introductionmentioning

confidence: 97%

Persistent pulmonary hypertension of the newborn with transposition of the great arteries: successful treatment with bosentan

et al. 2007

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“…We did not wean from ECMO before arterial switch operation, preferring to deal with end-organ issues with the assistance of a repaired circulation in series. This management strategy has been described before, although some have recommended discontinuation of ECMO before surgery (8, 19). …”

Section: Resultsmentioning

confidence: 99%

“…Support of failing cardiorespiratory function in patients with unrepaired congenital heart disease (CHD) remains a challenging clinical scenario. Reports of ECMO support as a preoperative bridge to a surgical procedure in children with CHD are lacking and restricted to small series of patients or case reports (8, 9). …”

mentioning

confidence: 99%

Preoperative Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Surgery in Children With Congenital Heart Disease

Bautista-Hernández

Thiagarajan

Fynn‐Thompson

et al. 2009

The Annals of Thoracic Surgery

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Background The efficacy of extracorporeal membrane oxygenation (ECMO) in bridging children with unrepaired heart defects to a definitive or palliative surgical procedure has been rarely reported. The goal of this study is to report our institutional experience with ECMO used to provide preoperative stabilization after acute cardiac or respiratory failure in patients with congenital heart disease before cardiac surgery. Methods A retrospective review of the ECMO database at Children's Hospital Boston was undertaken. Children with unrepaired congenital heart disease supported with ECMO for acute cardiac or respiratory failure as bridge to a definitive or palliative cardiac surgical procedure were identified. Data collection included patient demographics, indication for ECMO, details regarding ECMO course and complications, and survival to hospital discharge. Results Twenty-six patients (18 male, 8 female) with congenital heart disease were bridged to surgical palliation or anatomic repair with ECMO. Median age and weight at ECMO cannulation were, respectively, 0.12 months (range, 0 to 193) and 4 kg (range, 1.8 to 67 kg). Sixteen patients (62%) survived to hospital discharge. Variables associated with mortality included inability to decannulate from ECMO after surgery (p = 0.02) and longer total duration of ECMO (p = 0.02). No difference in outcomes was found between patients with single and biventricular anatomy. Conclusions Extracorporeal membrane oxygenation, used as a bridge to surgery, represents a useful modality to rescue patients with failing circulation and unrepaired complex heart defects.

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“…These neonates would include such patients as those with obstructed totally anomalous pulmonary venous connection, or tetralogy of Fallot with absent pulmonary valve syndrome. Such patients may present in extremis [13][14][15]. It is generally accepted that they benefit from preoperative stabilization with extracorporeal membrane oxygenation (ECMO) [16].…”

Section: Preoperative Stabilizationmentioning

confidence: 99%

Perioperative Mechanical Circulatory Support in Children with Critical Heart Disease

Checchia

2011

Curr Treat Options Cardio Med

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The treatment of cardiovascular failure in the perioperative period with the use of mechanical circulatory support is a well-recognized, well-developed, and commonly utilized treatment modality. Regardless of the exact circumstances of initiation, the use of a support device is a "bridge." Where there has been an acute myocardial insult, short-term assist devices can serve as a "bridge to immediate survival," a "bridge to recovery," or even a "bridge to the next decision." Mechanical circulatory support can serve as a treatment of cardiovascular decompensation caused by myocarditis, acute myocardial insult, low cardiac output following surgery, and congenital heart disease. The utilization of such support carries significant risks such as bleeding, infection, and thrombosis. However, these can be minimized in order to allow for the safe and effective deployment of this therapeutic strategy. One specific therapeutic domain in which these devices provide immediate impact is during cardiac arrest. Although outcomes of cardiac arrest remain poor, use of a mechanical device as an intervention has allowed salvage of otherwise certain mortality. However, it is important to note that the utility of support was most pronounced in patients that were not on either extreme of the survival prediction curve. This can be best summarized by the concept of "not too early, not too late." Therefore, it is the responsibility of the entire care team to find the appropriate patient population in which to "pull the trigger" on mechanical support as a therapy. This decision point is supported by a monitoring strategy that can be utilized to predict deterioration and intervene adequately. Most importantly, an effective monitoring strategy allows the practitioner to judge the effectiveness of treatment and support strategies and make adjustments in a timely manner, potentially with mechanical support in the perioperative period.

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Preoperative ECMO in Transposition of the Great Arteries With Persistent Pulmonary Hypertension

Cited by 26 publications

References 6 publications

Persistent pulmonary hypertension of the newborn with transposition of the great arteries: successful treatment with bosentan

Persistent pulmonary hypertension of the newborn with transposition of the great arteries: successful treatment with bosentan

Preoperative Extracorporeal Membrane Oxygenation as a Bridge to Cardiac Surgery in Children With Congenital Heart Disease

Perioperative Mechanical Circulatory Support in Children with Critical Heart Disease

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