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

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 reviewof all patients with HLHS who underwent a Norwood procedure(nadir cardiopulmonary bypass temperature≤22℃)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.