¿Es necesario disponer de ECMO para reparar cardiopatías congénitas de complejidad elevada? Nuestra experiencia en los últimos 6 años

Abstract

Introduction and objectivesThe use of ECMO postcardiotomy can help optimize surgical outcomes in addressing highly complex congenital heart diseases. The objective is to analyze the morbidity rate associated with the procedure and the risk factors for mortality when an ECMO Postcardiomatomy is used with patients. MethodsRetrospective review of patients who required the use of ECMO after surgical repair of congenital heart diseases between March 2010 and March 2015. Results30 patients required ECMO after reconstructive surgery. The most frequent diagnoses were: Transposition of great arteries, Fallot and post-transplant. Median age was 5 months (7 days-20 years), with an average weight of 10kg (2-92). In 22 patients (73%), extracorporeal circulation could not be removed and the ECMO was implanted in the operating room. In 8 patients (26%), the ECMO was implanted in the intensive care unit, of these 6 due to low cardiac output and 2 due to bad oxygenation.In patients with biventricular physiology the survival rate was 60% and 40% for those with univentricular physiology. In 20 patients (67%) the ECMO could be removed, of which 16 survived afterwards. The overall survival rate of the series was 53%. Mortality risk factors: renal failure, ECMO for more than 5 days, lactate >5 (pre-ECMO), pH<7,35 (pre-ECMO) and sepsis. Re-operation due to bleeding was not related to mortality.The mean follow-up was 23 months, without a patient death during this period. ConclusionsCurrently, ECMO is essential during the post-surgery of patients operated on due to congenital heart disease.