J Pediatr Surg. 2019 May 6. pii: S0022-3468(19)30326-4. doi: 10.1016/j.jpedsurg.2019.04.025. [Epub ahead of print]
Hemorrhage after on-ECMO repair of CDH is equivalent for muscle flap and prosthetic patch.
Nolan H1, Aydin E2, Frischer JS3, Peiro JL4, Rymeski B5, Lim FY6.
https://www.ncbi.nlm.nih.gov/pubmed/31103273
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Abstract
BACKGROUND/PURPOSE:
Prosthetic patch (patch) and muscle flap (flap) techniques are utilized for severe congenital diaphragmatic hernia (CDH) repair; however, when performed on extracorporeal membrane oxygenation (ECMO), the risk of hemorrhage increases. We sought to compare bleeding complications between repair types.
METHODS:
We retrospectively reviewed 2010-2016 on-ECMO CDH repairs.
RESULTS:
Twenty-nine patients met criteria: 13 patch (44.8%) and 16 flap (55.2%). Eight patch (61.5%) and 13 flap (81.2%) patients had left-sided defects (p = 0.223). All defects were Type C or D (Type C: patch 53.8%, flap 56.2%, p = 0.596). There was no difference in gestational age at delivery (patch 37.5 ± 0.9 weeks, flap 37.2 ± 1.3 weeks, p = 0.390) or age at repair (patch 7.46 ± 6.6 days, flap 6.00 ± 4.3 days, p = 0.476). Seven patch (53.8%) and 9 flap (56.2%) patients survived to discharge (p = 0.596). Estimated intraoperative blood loss was equivalent (patch 35.3 ± 53.9 mL, flap 24.2 ± 18.4 mL, p = 0.443). One patch patient (7.6%) and two (12.5%) flap patients required reoperation in the first 48 h for bleeding (p = 0.580). 48-h postoperative transfusions were the same for those that required reoperation (patch 282.0 mL/kg, flap 208.5 ± 21.9 mL/kg, p = 0.054) and those that did not (patch 120.7 ± 111.7 mL/kg, flap 118.4 ± 89.9 mL/kg, p = 0.561).
CONCLUSIONS:
On-ECMO bleeding complications are equivalent for both flap and patch CDH repair.
LEVEL OF EVIDENCE:
Type III (retrospective comparative study).
Copyright © 2019 Elsevier Inc. All rights reserved.
KEYWORDS:
Congenital diaphragmatic hernia (CDH); Extracorporeal life support; Extracorporeal membrane oxygenation (ECMO); Hemorrhage; Muscle flap; Prosthetic patchPMID: 31103273 DOI: 10.1016/j.jpedsurg.2019.04.02
