Open Access

ARTICLE

Post-Norwood Extracorporeal Membrane Oxygenation—The Complex Interplay of Cardiopulmonary Bypass and Myocardial Ischemic Time

Ryan G. McQueen¹, Paulina M. Gutkin², George M. Hoffman³, Ronald K. Woods^4,*

1 Medical College of Wisconsin, Herma Heart Institute at Children’s Hospital of Wisconsin, Milwaukee, WI 53226, USA
2 Department of Surgery, Stanford University, Stanford, CA 94305, USA
3 Pediatric Anesthesiology, Medical College of Wisconsin, Herma Heart Institute at Children’s Hospital of Wisconsin, Milwaukee, WI 53226, USA
4 Heart Institute, Johns Hopkins All Children’s, St. Petersburg, FL 33701, USA

* Corresponding Author: Ronald K. Woods. Email:

Congenital Heart Disease 2025, 20(6), 683-692. https://doi.org/10.32604/chd.2025.075838

Received 10 November 2025; Accepted 24 December 2025; Issue published 10 February 2026

Abstract

Objective: The objective of this study was to understand intraoperative risk factors for post-Norwood extracorporeal membrane oxygenation (ECMO) in patients with hypoplastic left heart syndrome (HLHS). Methods: We conducted a retrospective, single-institution review of all patients with HLHS who underwent a Norwood procedure (nadir cardiopulmonary bypass temperature ≤ 22°C) over a 12-year period with quantitative and qualitative analysis. Results: Of 102 Norwood patients, 14 (13.7%) required ECMO. ECMO patients had longer median cardiopulmonary bypass (CPB) times (276 vs. 172 min, p < 0.001) and myocardial ischemic times (98.5 vs 83 min, p = 0.021). Longer CPB time was associated with ECMO (OR 1.04, p = 0.001); the converse was true for myocardial ischemic time (OR 0.94, p = 0.029). For patients with long CPB times (>205 min), 41.9% (13/31) required ECMO. A narrative review for patients with long CPB times revealed suboptimal surgical management in 76.9% (10/13) of ECMO cases, with incorrect problem assessment leading to unnecessary revisions being most common. Conclusion: The qualitative analysis of prolonged CPB time and ECMO highlighted critical surgical decision-making, including consideration for extension of ischemic vs non-ischemic approaches to optimize surgical repair.

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