Is there a role for extracorporeal life support after stage I Norwood?

Objectives: Controversy still surrounds the use of extracorporeal life supp ort (ECLS) in patients with single ventricle physiology. An analysis of the experience with a,group of neonates who underwent stage I Norwood palliati on and received ECLS is reported. Methods: A retrospective review of hospit al records, operative notes and perfusion data was performed in a group of 12 consecutive patients undergoing ECLS in the perioperative period after s tage I. An analysis to identify risk factors for poor outcome was performed . Results: The mean age and weight were 3.3 days (1-14) and 2.6 kg (1.4-3.8 ), respectively. There were 3/12 patients under 2.5 kg and four patients we re under 35 weeks of gestation. The most common diagnosis (7/12) was hypopl astic left heart syndrome with aortic atresia. Associated extracardiac anom alies were present in four patients. Three patients had an additional cardi ac defect and two of these required an additional surgical procedure beside s the stage I Norwood. The mean circulatory arrest was 56 min (46-63). ECLS was initiated preoperatively in one, intraoperatively in nine, and postope ratively in two patients. The indication for support was: arrhythmia (one), low output (six), cardiac arrest (three). unbalanced circulation (one), an d hypoxemia (two). The mean duration of support was 68 h (24-192). Eight pa tients were weaned off support, and six were discharged home in good condit ion. Morbidity included sepsis in five, renal failure in five, neurologic s equelae in three, and bleeding in two, prematurity, renal dysfunction and t he initiation of ECLS outside the operating room were significantly associa ted with poor outcome. Residual hemodynamic effect, low birth weight and ne urologic event showed a tendency towards poor outcome, but did not reach st atistical significance. Conclusions: Although the use of ECLS in patients w ith single ventricle physiology still carries a significant risk, prompt in itiation of support can improve the outcome in a group of patients with imp aired cardiopulmonary function after stage I palliation. (C) 2001 Elsevier Science B.V. All rights reserved.