Predictors Of Veno-arterial Extracorporeal Membrane Oxygenation After Surgical Repair Of Peripheral Pulmonary Stenoses
Lloyd M. Felmly, MD, Richard D. Mainwaring, MD, Elisabeth Martin, MD, Michael R. Ma, MD, Frank L. Hanley, MD.
Stanford University School of Medicine, Palo Alto, CA, USA.
Objectives: Acute lung injury is a known complication of pulmonary artery reconstruction for peripheral pulmonary artery stenosis (PPAS). Severe cases may require extracorporeal membrane oxygenation (ECMO) support. The purpose of this study was to evaluate the characteristics of patients requiring ECMO after pulmonary artery reconstruction.
Methods: This was a retrospective study of 150 patients who underwent surgical repair of PPAS at our institution from 2004 through 2022. Underlying diagnoses included Williams syndrome (n=44), Alagille syndrome (n=43), Elastin arteriopathy (n=21) Tetralogy of Fallot (n=21), and other (n=21). Characteristics of patients who required ECMO were compared to those who did not.
Results: Ten of the 150 patients undergoing pulmonary artery reconstruction (6.7%) required postoperative ECMO support (9 for acute lung injury and one for cardiac insufficiency). Three ECMO patients had Williams syndrome, three had Alagille, and four had Tetralogy of Fallot. Patients requiring ECMO had higher pre-operative right ventricle to aortic peak systolic pressure ratios (mean 1.10 vs 0.95, P < 0.10), greater number of pulmonary artery ostial interventions (median 25 vs 18), and longer duration of cardiopulmonary bypass (mean 609 vs 415 minutes, P < 0.001).
Conclusions: The data demonstrate multiple differences between patients who did and did not require ECMO after surgical repair of PPAS. These results suggest that the pre-operative extent of disease may predispose to development of acute lung injury requiring ECMO support.
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