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Background: We developed a novel mechanical rapid cardiopulmonary support system (CPS) in 1996 to eliminate what we believed were shortcomings of conventional extracorporeal membrane oxygenation (ECMO) circuits when used in patients with congenital heart disease. We reviewed the use of this system over a nine year period to determine if we had been successful in improving results compared with ECMO and if outcomes have changed over this time. Methods: All children supported with CPS (110 procedures) were reviewed. Noncardiac CPS cases (7) were excluded. The study population was divided into two time periods (1995 to 2000 and 2001 to 2004), which correlate with significant differences in intraoperative, postoperative, and CPS management. Patients were further analyzed by age (≤ 30 days or > 30 days), repair complexity (risk adjusted classification for congenital heart surgery [RACHS]-1 category 6 or categories 1 to 5), and length of support. Results: Overall thirty day survival of cardiac CPS patients was 55% (57 of 103). Overall survival increased from 45% (23 of 51) during the first period to 65% (34 of 52) during the second period [p ≤ 0.005]. Survival rates in neonates improved from 41% (11 of 27) to 56% (15 of 27) and RACHS-1 category 6 survival improved from 38% (5 of 13) to 69% (9 of 13), but neither change reached statistical significance. Intracranial hemorrhage occurred in 6.4% of all CPS patients. Conclusions: Cardiopulmonary support is an effective alternative to ECMO for pediatric cardiac support. Further, our experience suggests that patient survival may be improved by CPS compared with reported results for ECMO in cardiac patients. [Copyright &y& Elsevier]

Background: The efficacy of antegrade cerebral perfusion (ACP) during complex neonatal single ventricle palliation requiring arch reconstruction is uncertain. We adapted the use of ACP in early 2001 in a programmatic effort to minimize the use of deep hypothermic circulatory arrest (DHCA). Methods: We retrospectively analyzed data of 126 consecutive patients operated on between 1995 and 2004, including stage-one palliation of hypoplastic left heart syndrome, stage-one palliation for nonhypoplastic left heart syndrome, and Damus-Kaye-Stansel procedures. Patients were divided into two groups: those repaired with prolonged DHCA only (n = 67) and those with ACP (n = 59) and usually a shorter period of DHCA. Risk was further stratified into high risk (weight ≤ 2.5 kg or other cardiac lesion) and usual risk for each group. Results: Survival at 30 days in the usual-risk groups was 72.0% DHCA and 93.2% ACP (p ≤ 0.025), and in the high-risk groups it was 61.5% DHCA and 80% ACP (not significant). One-year survival in the usual-risk groups was 57.4% DHCA and 84.1% ACP (p ≤ 0.01), and in the high-risk groups it was 38.5% DHCA and 46.7% ACP (not significant). Overall survival to date is 52.2% DHCA and 71.2% ACP (p ≤ 0.5). Conclusions: There is a statistically significant survival advantage for usual-risk patients with the use of ACP. Although there is a trend to improved survival in the high-risk groups, it does not reach statistical significance and long-term outcomes in these patients remains disappointing. We continue to use ACP and believe it contributes to an overall survival advantage in our institution. [Copyright &y& Elsevier]