Objective: 

To describe those neonates with dextro-transposition of the great arteries (d-TGA) who undergo preoperative support with extracorporeal membrane oxygenation (ECMO) and to compare outcomes in those undergoing the arterial switch operation (ASO) on-ECMO vs. those who undergo ASO after weaning from ECMO.

Design: 

Retrospective analysis of the Extracorporeal Life Support Organization (ELSO) Registry data, 2000–2022.

Patients: 

Neonates aged up to 21 days with d-TGA supported by ECMO before ASO.

Interventions: 

None.

Measurements and Main Results: 

We identified 100 neonates with a median (interquartile range [IQR]) age at ECMO initiation of 4 days (IQR 1–9) and median weight of 3.4 kg (IQR 3–3.7). Mortality, as opposed to survival, was associated with the following: older age at ECMO initiation (7 d [IQR 2–12] vs. 2 d [IQR 1–6], p = 0.01), lower birthweight (3.2 kg [IQR 2.8–3.7] vs. 3.5 kg [IQR 3.1–3.7], p = 0.04), longer aortic clamp time (129 min [IQR 94–191] vs. 98 min [IQR 72–121], p = 0.02), longer cardiopulmonary bypass time (326 min [IQR 217–415] vs. 174 min [IQR 137–241], p < 0.001), and longer duration of ECMO support (7 d [IQR 4–11] vs. 4 d [IQR 2–5], p < 0.001). Also, mortality, compared with survival, was associated with occurrence of any complication and the need for renal replacement therapy (both p < 0.001). Overall, 64 of 91 (70%) neonates supported with preoperative ECMO underwent ASO on ECMO. In comparison with those undergoing ASO after ECMO, these patients had more complications (53/64 [83%] vs. 16/27, p = 0.02) and had higher mortality than those weaned from ECMO preoperatively (24/64 [38%] vs. 4/27, p = 0.03).

Conclusions: 

In the ELSO 2000–2022 cohort of neonates with d-TGA, supported with preoperative ECMO, overall mortality was 33%. Continued postoperative ECMO support was associated with worse mortality. Therefore, we wonder whether successful weaning from ECMO before ASO may be associated with improved outcomes.