Extracorporeal Membrane Oxygenation in the Interstage Period After Norwood and Related Stage I Palliations…

Systematic reviewJournal of the American Heart Association· Jun 2026

Extracorporeal Membrane Oxygenation in the Interstage Period After Norwood and Related Stage I Palliations in Infants With Single Ventricle: A Systematic Review of Incidence, Risk Factors, and Outcomes.

Dongzhe Li, Stephen J Bottrell, Stephen B Horton … Salvatore Pepe

Congenital Cardiac SurgerySystematic reviewPrognosisQ1IF 5.3

Extracorporeal membrane oxygenation used in 18.1% of infants after Norwood procedure.

Extracorporeal Membrane Oxygenation in the Interstage Period After Norwood and Related Stage I Palliations in Infants With Single Ventricle: A Systematic Review of Incidence, Risk Factors, and Outcomes.

Dongzhe Li … Salvatore Pepe

Journal of the American Heart Association · Jun 2026

Background

Neonates with congenital univentricular conditions require staged palliation culminating in a Fontan circulation to support survival.

Purpose

The aim of this systematic review was to examine the incidence, risk factors, and outcomes of post-Norwood extracorporeal membrane oxygenation use during the interstage period.

Methods

We systematically searched MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov for studies published between January 1990 and March 2026 reporting extracorporeal membrane oxygenation use following Norwood procedures.

n = 4030 patients

18.1%

Results

18.1%

Extracorporeal membrane oxygenation needed after Norwood in nearly 1 in 5 infants

n = 4030 patients

More results

From 1509 identified studies, 15 met inclusion criteria, encompassing 4030 patients.

In-hospital survival among extracorporeal membrane oxygenation-supported patients ranged from 28.6% to 50%, with no clear temporal improvement.

More results

Risk factors for extracorporeal membrane oxygenation initiation included low birth weight (<2.5 kg), prolonged cardiopulmonary bypass time, moderate-to-severe preoperative atrioventricular valve regurgitation, and complex cardiac anatomy (aortic atresia, diminutive ascending aorta).

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Conclusion · 1 of 3

Despite increasing post-Norwood extracorporeal membrane oxygenation use, survival outcomes remain poor.

Conclusion · 2 of 3

Identified risk factors may inform prospective risk stratification strategies, early identification of high-risk patients, and evidence-based decision-making regarding extracorporeal membrane oxygenation initiation, continuation, or withdrawal in this vulnerable population.

Conclusion · 3 of 3

Significant heterogeneity across studies precluded meta-analysis, highlighting the need for standardized reporting in future research.

Extracorporeal Membrane Oxygenation in the Interstage Period After Norwood and Related Stage I Palliations in Infants With Single Ventricle: A Systematic Review of Incidence, Risk Factors, and Outcomes.

Extracorporeal Membrane Oxygenation in the Interstage Period After Norwood and Related Stage I Palliations in Infants With Single Ventricle: A Systematic Review of Incidence, Risk Factors, and Outcomes.

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