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IS PRE-OPERATIVE ECMO IN TREATMENT OF PULMONARY HYPERTENSION (PHT) IN PATIENTS WITH TRANSPOSITION OF THE GREAT ARTERIES (TGA) AN OPTION
  1. E D Wildschut1,
  2. M Van-Gevers Osch2,
  3. F A du Plessis2,
  4. R J Houmes1,
  5. S J Gischler1,
  6. A J Bogers3,
  7. D Tibboel1
  1. 1Department of Pediatrics, Pediatric Intensive Care, ErasmusMC – Sophia Children’s Hospital, Rotterdam, The Netherlands
  2. 2Department of Pediatrics, Pediatric Cardiology, ErasmusMC – Sophia Children’s Hospital, Rotterdam, The Netherlands
  3. 3Department of Cardio-Thoracic Surgery, ErasmusMC Thorax Centre, Rotterdam, The Netherlands

Abstract

Objective TGA with pulmonary hypertension (PHT) is associated with a high risk of mortality in the preoperative period. Few papers report successful treatment with ECMO in the pre-operative period. The goal of this study is to evaluate the incidence of TGA patients with PHT in the need for ECMO support in our centre.

Methods We reviewed all neonatal TGA patients with and without ventricular septum defect (VSD) in our hospital in the last 5 years (2002–2007). Need for ECMO support was defined as uncontrollable PHT not responsive to conventional treatment. Conventional treatment consisted of mechanical ventilation with 100% O2, inotropic support, inhaled nitric oxide (iNO) and sildenafil.

Results 50 TGA patients were included (9 with VSD). Twelve patients had PHT receiving conventional treatment (24,4%). Early mortality in this group was 25% (3 out of 12), 25% (3 out of 12) were canulated for ECMO, all surviving to surgery. All 3 patients were successfully weaned from ECMO postoperatively. Mortality in the conventional treatment group consisted of 1 necrotic enterocolitis, 1 progressive deterioration before ECMO could be initiated and 1 patient died postoperatively due myocardial ischemia.

Conclusions TGA with PHT is associated with a high mortality. 25% of our patients with TGA and PHT received ECMO support in the pre-operative phase. All patients survived to surgery. ECMO seems a viable option in the pre operative setting in patients with TGA and PHT not responding to conventional therapy.

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