ABSTRACT
EMB, the gold standard for diagnosis of ACR, poses unique risks in children. Limited cross-sectional data have associated LV MPI with ACR. We hypothesize that a relative change in MPI from baseline without ACR to the time of ACR will better detect ACR than an absolute threshold LV MPI value. We identified 40 children with ACR ≥60 days post-transplant matching them by age and time from transplantation to 40 children without ACR. There was a significant increase in LV MPI at time of ACR vs. baseline (0.59 ± 0.17 vs. 0.41 ± 0.11; p < 0.001). There was no difference in LV MPI between baseline and follow-up (0.41 ± 0.11 vs. 0.42 ± 0.11; p = 0.65). An absolute increase in LV MPI of ≥0.47 had 82.5% sensitivity and 85% specificity for ACR, whereas an increase in LV MPI from baseline of ≥20.4% was 90% sensitive and 100% specific. Serial measurement of LV MPI appears to be a sensitive and specific marker of ACR. LV MPI shows good interobserver agreement and increases at the time of EMB-proven ACR with subsequent resolution to baseline measurements upon EMB-proven resolution of ACR. Future studies in larger, prospective cohorts should be undertaken to validate these findings.
Subject(s)
Graft Rejection/diagnosis , Heart Failure/therapy , Heart Transplantation , Ventricular Dysfunction, Left/pathology , Ventricular Function, Left/physiology , Adolescent , Adult , Biopsy , Child , Child, Preschool , Diastole , Echocardiography , Female , Humans , Infant , Male , Myocardium/pathology , Observer Variation , Prospective Studies , ROC Curve , Reperfusion Injury/pathology , Risk , Sensitivity and Specificity , Time Factors , Treatment Outcome , Young AdultABSTRACT
This study reports the mid-term survival for neonates undergoing extracorporeal membrane oxygenation (ECMO) after Norwood palliation at a single center. Limited data exist on the mid-term survival of patients undergoing ECMO after Norwood palliation. We reviewed our ECMO experience from July 1994 to October 2008 and compared two groups: patients who required ECMO after Norwood palliation and patients who underwent Norwood palliation without ECMO. We analyzed 30-day survival, survival to hospital discharge, and survival to most recent follow-up. One hundred sixty patients underwent Norwood palliation for hypoplastic left heart syndrome (HLHS) and its variants. A total of 32 patients (20%) required postoperative ECMO. Using Kaplan-Meier analysis, the predicted survival rates for Norwood/non-ECMO patients to 30 days, 1 year, and 3 years after the procedure are 87.6% (CI 79.5-91.5%), 62.5% (CI 54.3-71.0%), and 59.9% (CI 50.8-67.8%), respectively. Survival to 30 days, 1 year, and 3 years after Norwood was significantly decreased in Norwood/ ECMO patients, with predicted survival rates of 50.0% (CI 31.9-65.7%), 24.6% (CI 11.4-40.4), and 13.2% (CI 3.9-28.3%), respectively (p < 0.0001). Risk factors for hospital mortality included nonelective or emergency placement onto ECMO, longer duration of ECMO support, and the development of acute renal failure while on ECMO. Of the original Norwood/ECMO hospital survivors, only half of these patients survived a mean of nearly 4 years. ECMO after Norwood palliation is associated with significant mortality. Our data suggest that neonates who require ECMO after Norwood palliation are prone to continued attrition once discharged from the hospital.
