Preoperative Venovenous Extracorporal Membrane Oxygenation for Transposition of Great Arteries With Severe Pulmonary Hypertension in a Newborn

Yam, Nicholson; Chen, Robin Hay-Son; Rocha, Barnabe Antonio; Lun, Kin‐Shing; Yung, TC; Au, Wing‐Kuk

doi:10.1016/j.athoracsur.2019.08.077

Cited by 3 publications

(2 citation statements)

References 8 publications

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“… 13 Unfortunately, only a few successful reports are available on these patients. 14 Although two preoperative ECMO supports failed in our study, lessons learned still need to be discussed for future success. A thoughtful approach with regard to the mode of support (veno-arterial vs veno-venous), management of extracorporeal support, as well as the timing of the arterial switch operation, may be beneficial for the outcome of patients.…”

Section: Discussionmentioning

confidence: 76%

Lessons learned from ECMO support in pediatric patients with D-transposition of the great arteries: preoperative, intraoperative and postoperative

Yang

et al. 2021

World Jnl Ped Surgery

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BackgroundExtracorporeal membrane oxygenation (ECMO) support on D-transposition of the great arteries (D-TGA) carries formidable challenges.MethodsA retrospective study was performed on pediatric patients with D-TGA supported by ECMO from July 2007 to December 2019. This study summarized the clinical experience of ECMO support in pediatric patients with D-TGA preoperative, intraoperative, and postoperative.ResultsOverall, 16 children with D-TGA received ECMO support during this period. Two (2 of 16) were supported before cardiac surgery, 3 (3 of 16) were supported postoperatively in the intensive care unit, and 11 (11 of 16) failed to wean off cardiopulmonary bypass. Two cases of preoperative ECMO support for patients with D-TGA with an intact ventricular septum and restrictive atrial septum due to severe hypoxemia died. In this study, D-TGA with coronary artery malformation and other complicated deformities died (8 of 14), whereas uncomplicated D-TGA without coronary artery malformation all survived (6 of 14). The wean-off rate of ECMO patients supported in D-TGA was 62.5% (10 of 16), while the 30-day survival rate was 44% (7 of 16).ConclusionAlthough a promising ECMO weaning rate was obtained, 30-day survival of this population was frustrating, mainly attributed to the original anatomy of coronary arteries and the concomitant deformities.

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Section: Discussionmentioning

confidence: 76%

Lessons learned from ECMO support in pediatric patients with D-transposition of the great arteries: preoperative, intraoperative and postoperative

Yang

et al. 2021

World Jnl Ped Surgery

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“…Pulmonary hypertension is uncommon in patients with TGA/IVS). The incidence of TGA/IVS with pulmonary hypertension was 1%–12% [ 88 , 89 ]. Increased pulmonary vascular resistance leads to reduced pulmonary blood flow and atrial blood does not mix effectively.…”

Section: Special Considerations For Complicated Chdmentioning

confidence: 99%

Perioperative extracorporeal membrane oxygenation in pediatric congenital heart disease: Chinese expert consensus

Lin

Wang

et al. 2022

World J Pediatr

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Background Congenital heart disease (CHD) is one of the main supportive diseases of extracorporeal membrane oxygenation in children. The management of extracorporeal membrane oxygenation (ECMO) for pediatric CHD faces more severe challenges due to the complex anatomical structure of the heart, special pathophysiology, perioperative complications and various concomitant malformations. The survival rate of ECMO for CHD was significantly lower than other classifications of diseases according to the Extracorporeal Life Support Organization database. This expert consensus aims to improve the survival rate and reduce the morbidity of this patient population by standardizing the clinical strategy. Methods The editing group of this consensus gathered 11 well-known experts in pediatric cardiac surgery and ECMO field in China to develop clinical recommendations formulated on the basis of existing evidences and expert opinions. Results The primary concern of ECMO management in the perioperative period of CHD are patient selection, cannulation strategy, pump flow/ventilator parameters/vasoactive drug dosage setting, anticoagulation management, residual lesion screening, fluid and wound management and weaning or transition strategy. Prevention and treatment of complications of bleeding, thromboembolism and brain injury are emphatically discussed here. Special conditions of ECMO management related to the cardiovascular anatomy, haemodynamics and the surgical procedures of common complex CHD should be considered. Conclusions The consensus could provide a reference for patient selection, management and risk identification of perioperative ECMO in children with CHD.

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Emergency arterial switch: Rescue therapy for life-threatening hypoxemia in infants with transposition of great arteries with intact intraventricular septum

Hussey

Gentles

Perelini

et al. 2023

The Journal of Thoracic and Cardiovascular Surgery

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Preoperative Venovenous Extracorporal Membrane Oxygenation for Transposition of Great Arteries With Severe Pulmonary Hypertension in a Newborn

Cited by 3 publications

References 8 publications

Lessons learned from ECMO support in pediatric patients with D-transposition of the great arteries: preoperative, intraoperative and postoperative

Lessons learned from ECMO support in pediatric patients with D-transposition of the great arteries: preoperative, intraoperative and postoperative

Perioperative extracorporeal membrane oxygenation in pediatric congenital heart disease: Chinese expert consensus

Emergency arterial switch: Rescue therapy for life-threatening hypoxemia in infants with transposition of great arteries with intact intraventricular septum

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