Outcomes of Adults with Congenital Heart Disease Supported with Extracorporeal Life Support After Cardiac Surgery. Issue 10 (November 2020)

• Record Type: Journal Article
• Authors: Dolgner, Stephen J.; Keeshan, Britton C.; Burke, Christopher R.; McMullan, David Michael; Chan, Titus
• Is Part Of: ASAIO journal. Volume 66:Issue 10(2020)
• Publication Date: 2020-11
• Subjects: adult congenital heart disease -- cardiac surgery -- extracorporeal life support -- extracorporeal membrane oxygenation -- outcomes research; Artificial organs -- Periodicals; 617
• DOI: 10.1097/MAT.0000000000001141
• Languages: English
• ISSNs: 1058-2916

Abstract

Abstract : Patients with adult congenital heart disease (ACHD) who undergo cardiac surgery may require extracorporeal life support (ECLS) for cardiopulmonary support, but outcomes after ECLS support have not been well described. This study aimed to identify risk factors for ECLS mortality in this population. We identified 368 ACHD patients who received ECLS after cardiac surgery between 1994 and 2016 in the Extracorporeal Life Support Organization (ELSO) database, a multicenter international registry of ECLS centers. Risk factors for mortality were assessed using multivariate logistic regression. Overall mortality was 61%. In a multivariate model using precannulation characteristics, Fontan physiology (odds ratio [OR]: 5.7; 95% CI: 1.6–20.0), weight over 100 kg (OR: 2.6; 95% CI: 1.3–5.4), female gender (OR: 1.6; 95% CI: 1.001–2.6), delayed ECLS cannulation (OR: 2.0; 95% CI: 1.2–3.2), and neuromuscular blockade (OR: 1.9; 95% CI: 1.1–3.3) were associated with increased mortality. Adding postcannulation characteristics to the model, renal complications (OR: 3.0; 95% CI: 1.7–5.2), neurologic complications (OR, 4.7; 95% CI: 1.5–15.2), and pulmonary hemorrhage (OR: 6.4; 95% CI: 1.3–33.2) were associated with increased mortality, whereas Fontan physiology was no longer associated, suggesting the association of Fontan physiology with mortality may be mediated by complications. Fontan physiology was also a risk factor for neurologic complications (OR: 8.2; 95% CI: 3.3–20.9). Given the rapid increase in ECLS use, understanding risk factors for ACHD patients receiving ECLS after cardiac surgery will aid clinicians in decision-making and preoperative planning. Abstract : Supplemental Digital Content is available in the text.