PREOPERATIVE ECMO IN CONGENITAL CYANOTIC HEART-DISEASE USING THE ARECSYSTEM

Background. In cyanotic congenital heart disease, oxygen delivery is i mpaired either by reduced pulmonary perfusion or by limited entry of o xygenated blood into the systemic circulation. Additional impairment o f oxygen delivery (eg, in pulmonary hypertension) leads to hypoxic cer ebral damage. Preoperative extracorporeal membrane oxygenation enables oxygenation in otherwise untreatable cases. Methods. In 3 neonates su ffering from cyanotic congenital heart disease (1 with tricuspid atres ia and 2 with transposition of the great arteries) with arterial desat uration despite application of prostaglandins, balloon atrioseptostomy , and eventually inhaled nitric oxide during intermittent positive-pre ssure ventilation with an inspired oxygen fraction of 1, oxygenation c ould only be established by means of preoperative extracorporeal membr ane oxygenation We used a venovenous single-lumen cannula tidal-flow e xtracorporeal membrane oxygenation system described by Chevalier and a ssociates that has previously been used far extracorporeal lung suppor t. In this system, called AREC (assistence respiratoire extra-corporel le), alternating clamps and a nonocclusive roller pump were used. Resu lts. All 3 survived. Conclusions. We conclude that the AREC system ena bles sufficient preoperative oxygenation in patients with cyanotic con genital heart disease and hypoxia in spite of all conventional therape utic means. This provides a stable preoperative condition for elective palliation or correction. (C) 1997 by The Society of Thoracic Surgeon s.