Abstract 18391: Birth at 39-40 Weeks Gestation is Associated With Improved Survival in Neonates Supported With Post-Operative Extracorporeal Life Support for Congenital Heart Disease
Introduction: The neonatal population compared to other age groups with congenital heart disease (CHD) is unique because of their developmental immaturity, case complexity and consequent higher rates of extracorporeal life support (ECLS) in the post-operative period. Debate remains around whether those with single ventricle (SV) anatomy have worse outcomes after ECLS compared to biventricle (BV) anatomy.
Methods: From 2005-2014, 110 neonates (representing 9.5% of neonates undergoing cardiac surgery) required ELCS after initial cardiac surgery. Indications were failure to separate from cardiopulmonary bypass in 40 (36%), extracorporeal cardiopulmonary resuscitation (ECPR) in 48 (44%), progressive low cardiac output in 15 (14%) and other reasons in 7 (6%).
Results: Median age was 5 days (IQR 2 - 9 days), 54 (49%) underwent SV repair and median support duration was 94 hours (IQR 53 - 135). Overall survival to intensive care unit (ICU) discharge was 54.5% (95% CI 44.7 - 64.0), with 1-year survival of 43.6% (95% CI 34.2 - 53.4). There was no difference in ICU survival based on underlying anatomy [51.8% (95% CI 37.8 - 65.6) for SV vs 57.1% (95% CI 43.2 - 70.2) for BV anatomy; p=0.55], but era influenced survival [43.5% (95% CI 29 - 59) for 2005-2009 vs 62.5% (95% CI 49 - 74) for 2010-2014; p=0.048]. By multivariable analysis, gestational age was the only independent predictor of ICU mortality (when compared to being born before 37 weeks, the OR (95% CI) for 37-38 weeks was 0.3 (0.12 - 1.19), for 39-40 weeks 0.27 (0.08 - 0.84) and for ≥41 weeks 1.06 (0.07 - 14.7).
Conclusions: Mortality for neonates requiring ECLS following cardiac surgery is high but has improved in the most recent era. Gestational age 39-40 weeks appears to be the optimal time of delivery for neonates with complex congenital heart disease, as this may confer a survival advantage.
Author Disclosures: J. McKenzie: None. T. Scodellaro: None. Y. d’Udekem: None. W. Butt: None. S. Namachivayam: None.
- © 2016 by American Heart Association, Inc.