Fahrettin UYSAL, Işık Şenkaya SIĞNAK, Ahmet YÜKSEL, İrem İris KAN, Atıf YOLGÖSTEREN, Mustafa GÜNEŞ, Mehmet Hadi ÇAĞLAYAN

Pediyatrik kalp cerrahisi sonrası ekstrakorporeal membran oksijenasyon desteği: Tek merkez deneyimimiz

Amaç: Bu çalışmada, pediyatrik açık kalp cerrahisi sonrası mekanik destek gereken hastalarda beş yıllık ekstrakorporeal membran oksijenasyonu deneyimimiz sunuldu. Çalışma planı: Şubat 2010 - Mart 2015 tarihleri arasında açık kalp cerrahisi yapılan ve postkardiyotomi dolaşım yetmezliği nedeniyle ekstrakorporeal membran oksijenasyonu desteği gereken 29 çocuğun (16 erkek, 13 kız; ort. yaş 21.6 ay; dağılım 5 gün-162 ay) tıbbi kayıtları retrospektif olarak incelendi. Bulgular: En sık tanı, sekiz hastada (%27.5) Fallot tetralojisi idi. En sık ekstrakorporeal membran oksijenasyonu endikasyonu, 12 hastada (%41) kardiyopulmoner baypastan ayrılmada yetersizlik idi. Ortalama ekstrakorporeal membran oksijenasyonu destek süresi 6.9 gündü (dağılım 14 saat-32 gün). En sık görülen ekstrakorporeal membran oksijenasyonu ile ilişkili komplikasyon, 14 hastada (%48.3) böbrek yetmezliği idi. On dört hasta (%48.3) başarıyla ekstrakorporeal membran oksijenasyonu desteğinden ayrılırken, altı hasta (%20.7) herhangi bir nörolojik sekel olmaksızın hastaneden taburcu edildi. Hiç bir anlamlı bir mortalite öngördürücüsü bulunmadı. Kardiyopulmoner baypastan ayrılmada yetersizlik, diğer ekstrakorporeal membran oksijenasyonu endikasyonlarına kıyasla, daha iyi sonuçlar ile neticelendi. Sonuç: Ekstrakorporeal membran oksijenasyonu, pediyatrik açık kalp cerrahisi sonrasında etkili bir kardiyopulmoner desteği sağlar. Dikkatli hasta seçimi ve ekstrakorporeal membran oksijenasyonu için doğru zamanlama ve uygun tedavi optimum sonuçlar için çok önemlidir.

Extracorporeal membrane oxygenation support after pediatric cardiac surgery: our single-center experience

Background: In this study, we present our five-year extracorporeal membrane oxygenation experiences in patients requiring mechanical support after pediatric open heart surgery.Methods: We retrospectively reviewed the medical records of 29 children (16 males, 13 females; mean age 21.6 months; range 5 days to 162 months) who underwent open heart surgery and required extracorporeal membrane oxygenation support due to postcardiotomy circulatory failure between February 2010 and March 2015.Results: The most common diagnosis was tetralogy of Fallot in eight patients (27.5%). The most common extracorporeal membrane oxygenation indication was failure to wean from cardiopulmonary bypass in 12 (41%) patients. The mean duration of extracorporeal membrane oxygenation support was 6.9 days (range 14 hours to 32 days). The most common complication related to extracorporeal membrane oxygenation support was renal insufficiency in 14 patients (48.3%). Fourteen patients (48%) were able to be successfully weaned from extracorporeal membrane oxygenation support, while six patients (20.7%) were discharged without any neurological sequelae. No significant predictor of mortality was found. Failure to wean from cardiopulmonary bypass resulted improved outcomes than other extracorporeal membrane oxygenation indications.Conclusion: Extracorporeal membrane oxygenation provides an effective cardiopulmonary support for cardiopulmonary failure after pediatric open heart surgery. Careful patient selection, and correct timing and appropriate management of extracorporeal membrane oxygenation are crucial for optimal outcomes.

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27. Çelik N, Yılmaz AA, Sarıtaş T, Karadaş U, Türkoğlu H. Does late primary arterial switch operation with extracorporeal membrane oxygenator support change the surgical approach in simple transposition of the great arteries? Turk Gogus Kalp Dama 2016;24:350 -5.
26. Chakravarthy M. ECMO - the way to go. Ann Card Anaesth 2011;14:1-2.
25. Sasson L, Cohen I, Tamir A, Sternfeld AR, Berlowitz Y, Lenczner O, et al. Extracorporeal membrane oxygenation in pediatric patients: our experience in the last ten years. Isr Med Assoc J 2013;15:13- 6.
24. Ghez O, Feier H, Ughetto F, Fraisse A, Kreitmann B, Metras D. Postoperative extracorporeal life support in pediatric cardiac surgery: recent results. ASAIO J 2005;51:513-6.
23. Thourani VH, Kirshbom PM, Kanter KR, Simsic J, Kogon BE, Wagoner S, et al. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in pediatric cardiac support. Ann Thorac Surg 2006;82:138-44.
22. Gupta P, McDonald R, Chipman CW, Stroud M, Gossett JM, Imamura M, et al. 20-year experience of prolonged extracorporeal membrane oxygenation in critically ill children with cardiac or pulmonary failure. Ann Thorac Surg 2012;93:1584-90.
21. Morris MC, Ittenbach RF, Godinez RI, Portnoy JD, Tabbutt S, Hanna BD, et al. Risk factors for mortality in 137 pediatric cardiac intensive care unit patients managed with extracorporeal membrane oxygenation. Crit Care Med 2004;32:1061-9.
20. Belohlávek J, Rohn V, Tosovsky J, Kunstyr J, Semrád M, Horák J, et al. A review of a newly established ECMO program in a university affiliated cardiac center. J Cardiovasc Surg (Torino) 2011;52:445-51.
19. Itoh H, Ichiba S, Ujike Y, Kasahara S, Arai S, Sano S. Extracorporeal membrane oxygenation following pediatric cardiac surgery: development and outcomes from a single-center experience. Perfusion 2012;27:225-9.
18. Bae JO, Frischer JS, Waich M, Addonizio LJ, Lazar EL, Stolar CJ. Extracorporeal membrane oxygenation in pediatric cardiac transplantation. J Pediatr Surg 2005;40:1051-6.
17. Dhillon R, Pearson GA, Firmin RK, Chan KC, Leanage R. Extracorporeal membrane oxygenation and the treatment of critical pulmonary hypertension in congenital heart disease. Eur J Cardiothorac Surg 1995;9:553-6.
16. Fiser WP, Yetman AT, Gunselman RJ, Fasules JW, Baker LL, Chipman CW, et al. Pediatric arteriovenous extracorporeal membrane oxygenation (ECMO) as a bridge to cardiac transplantation. J Heart Lung Transplant 2003;22:770-7.
15. Cingöz F, Tatar H. Extracorporeal membrane oxygenation in pediatric patients. Turk Gogus Kalp Dama 2008;16:50-7.
14. Wilmot I, Morales DL, Price JF, Rossano JW, Kim JJ, Decker JA, et al. Effectiveness of mechanical circulatory support in children with acute fulminant and persistent myocarditis. J Card Fail 2011;17:487-94.
13. Delmo Walter EM, Stiller B, Hetzer R, Alexi-Meskishvili V, Hübler M, Böttcher W, et al. Extracorporeal membrane oxygenation for perioperative cardiac support in children I: experience at the Deutsches Herzzentrum Berlin (1987-2005). ASAIO J 2007;53:246-54.
12. Erek E, Haydin S, Onan B, Onan IS, Yazici P, Kocyigit O, et al. Extracorporeal life support experiences of a new congenital heart center in Turkey. Artif Organs 2013;37:29-34.
11. Kolovos NS, Bratton SL, Moler FW, Bove EL, Ohye RG, Bartlett RH, et al. Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery. Ann Thorac Surg 2003;76:1435 -41.
10. Alsoufi B, Shen I, Karamlou T, Giacomuzzi C, Burch G, Silberbach M, et al. Extracorporeal life support in neonates, infants, and children after repair of congenital heart disease: modern era results in a single institution. Ann Thorac Surg 2005;80:15-21.
9. Baffes TG, Fridman JL, Bicoff JP, Whitehill JL. Extracorporeal circulation for support of palliative cardiac surgery in infants.Ann Thorac Surg 1970;10:354-63.
8. Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002;123:110-8.
7. Hetzer R, Stiller B. Technology insight: Use of ventricular assist devices in children.Nat Clin Pract Cardiovasc Med 2006;3:377-86.
6. Goto T, Suzuki Y, Suzuki Y, Osanai A, Aoki K, Yamazaki A, et al. The impact of extracorporeal membrane oxygenation on survival in pediatric patients with respiratory and heart failure: review of our experience. Artif Organs 2011;35:1002-9.
5. Tajik M, Cardarelli MG. Extracorporeal membrane oxygenation after cardiac arrest in children: what do we know? Eur J Cardiothorac Surg 2008;33:409-17.
4. Loforte A, Walter EMD, Stiller B, Huebler M, Alexi-Meskishvili V, Boettcher W, et al. Extracorporeal membrane oxygenation for intraoperative cardiac support in children with congenital heart disease. Interact Cardiovasc Thorac Surg 2010;10:753-9.
3. Paden ML, Conrad SA, Rycus PT, Thiagarajan RR. Extracorporeal Life Support Organization Registry Report 2012. ASAIO J 2013;59:202-10.
2. Chaturvedi RR, Macrae D, Brown KL, Schindler M, Smith EC, Davis KB, et al. Cardiac ECMO for biventricular hearts after paediatric open heart surgery. Heart 2004;90:545-51.
1. Balasubramanian SK, Tiruvoipati R, Amin M, Aabideen KK, Peek GJ, Sosnowski AW, et al. Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support. J Cardiothorac Surg 2007;2:4.