Extracorporeal membrane oxygenation in adult congenital heart disease: A case series and literature review

Objective: Extracorporeal membrane oxygenation (ECMO) can be used as rescue intervention for cardiac and/or respiratory failure. High-risk adult patients with adult congenital heart disease (ACHD) may require pre- and post-operative ECMO support. Design, setting and participants: Retrospective data collection within a five-year time period from 2011 to 2016, at a single-centre study at a tertiary university hospital and regional unit for ACHD. Patients with ACHD in cardiogenic shock or failure to be separated from cardio-pulmonary bypass (CPB) were included. Intervention: Venoarterial (VA) ECMO. Results: Three patients had Ebstein anomaly and one patient had a double-outlet right ventricle transposition type and severe atrioventricular valve insufficiency. Three male patients and one female patient were aged ranging from 19 to 52 years. All received VA ECMO, two each with central or peripheral cannulation. The mean duration of ECMO support was 7 days (range, 3–13 days) and bleeding complications were the main complications observed, with a range of 12 to 104 blood products used. One patient required renal replacement therapy for acute kidney injury and also had leg ischaemia. Main outcome measures: Two of four patients (50%) were successfully weaned offECMO and survived to hospital discharge in this high-risk group of patients in severe heart failure. The patients are currently at 3 and 4 years follow-up, with improved mobility and exercise tolerance compared with pre-operatively. Conclusion: ECMO is a promising temporary rescue intervention for patients with ACHD and cardiogenic shock. The extracorporeal cardiac support is a useful bridge to recovery.