TY  - EJOU
AU  - McQueen, Ryan G. 
AU  - Gutkin, Paulina M. 
AU  - Hoffman, George M. 
AU  - Woods, Ronald K. 

TI  - Post-Norwood Extracorporeal Membrane Oxygenation—The Complex Interplay of Cardiopulmonary Bypass and Myocardial Ischemic Time
T2  - Structural and Congenital Heart Disease

PY  - 2025
VL  - 20
IS  - 6
SN  - 3071-1738

AB  - <b>Objective:</b> 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). <b>Methods</b>: 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. <b>Results</b>: Of 102 Norwood patients, 14 (13.7%) required ECMO. ECMO patients had longer median cardiopulmonary bypass (CPB) times (276 vs. 172 min, <i>p</i> &lt; 0.001) and myocardial ischemic times (98.5 vs 83 min, <i>p</i> = 0.021). Longer CPB time was associated with ECMO (OR 1.04, <i>p</i> = 0.001); the converse was true for myocardial ischemic time (OR 0.94, <i>p</i> = 0.029). For patients with long CPB times (&gt;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. <b>Conclusion</b>: 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.
KW  - ECMO; cardiopulmonary bypass; Norwood procedure

DO  - 10.32604/chd.2025.075838