Abstract P-567: PRE-OPERATIVE CARDIOGENIC SHOCK IS STRONGLY ASSOCIATED WITH ECMO UTILIZATION AND MORTALITY FOLLOWING REPAIR OF ANOMALOUS ORIGIN OF THE CORONARY ARTERY FROM THE PULMONARY ARTERY

Abstract

Aims & Objectives: Extracorporeal Membrane Oxygenation (ECMO) may be required post-operatively for myocardial dysfunction following repair of Anomalous Coronary Artery from the Pulmonary Artery (ACAPA). We investigated factors associated with ECMO use following ACAPA repair using de-identified data from Society of Thoracic Surgeons database. Methods Retrospective analysis of all ACAPA patients who underwent repair from 2007–2016. Institutional Review Board approval was waived. Demographics, peri-operative variables, complications and outcomes were compared between the ECMO and non-ECMO groups. We used multivariable logistic regression to determine risk factors for post-operative ECMO use. Results Of 703 ACAPA patients, 60 (8.5%) required post-operative ECMO. The ECMO group was significantly younger (median age 0.2 vs. 0.4 years, p<0.001) and weighed less (median weight 4.40 vs. 6.15kg, p<0.001). Multivariable logistic regression showed that the ECMO group was more likely to present in shock (OR 2.98, CI 1.38, 6.42, p=0.005), have longer cardiopulmonary bypass times (OR 1.09 for every 10 min increase; CI 1.05, 1.15, p<0.0001), and have an open sternum following repair (OR 1.92, CI 1.03, 3.60, p=0.04). The ECMO group had more adverse events, including unplanned cardiac re-operations (15% vs. 2%, p<0.0001), mortality (25% vs. 0.8%, p<0.0001), and longer total hospital stay (median 22 vs. 13 days, p<0.0001). Among patients with pre-operative shock, the ECMO group had higher mortality (53% vs. 0%, p<0.0001), bleeding [40% vs. 3.2%, p=0.003) and multi-organ dysfunction (20% vs. 3%, p=0.03)]. Conclusions Pre-operative cardiogenic shock is strongly associated with need for post-operative ECMO after ACAPA repair. Patients requiring ECMO have significantly higher adverse events and mortality.