Perioperative mortality and 1-year neurodevelopmental outcome after cardiac surgery prior to 6 weeks of age, requiring perioperative extracorporeal membrane oxygenation in the first year of life.

Objectives: Complex congenital heart disease (CHD), neonatal cardiac surgery, and perioperative extracorporeal membrane oxygenation (ECMO) are risk factors for increased perioperative mortality and morbidity, including impaired neurodevelopmental (ND) outcomes. We investigated perioperative mortality and the independent impact of ECMO on 1-year ND outcomes after cardiac surgery in infants younger than 6 weeks. Methods: Using data from the Swiss Outcome Registry for Children with severe CHD (Swiss ORCHID), we assessed the impact of perioperative ECMO on 1-year mortality and ND outcomes using the Bayley Scales of Infant Development, Third Edition (BSID III) and language composite scores (LCSs), cognitive composite scores (CCSs), and motor composite scores (MCSs) while controlling for known risk factors. Results: The 1-year mortality rate among 240 patients who underwent surgery between 1 January 2020 and 30 May 2024 was 5.8%. Perioperative ECMO was used in 34 patients (14.2%). Mortality among patients with perioperative ECMO (ECMO group) was higher (29.4% in the ECMO group vs. 1.9% in the non-ECMO group, Conclusions: Perioperative ECMO might be associated with higher perioperative mortality and morbidity, including lower BSID III ND scores in infants with CHD. Clinical trial registration: clinicaltrials.gov, NCT05996211.