194: Low Surgical Complication Rate with Early Repair of Congenital Diaphragmatic Hernia on Extracorporeal Life Support Using a Standardized Protocol and Bivalirudin for Anticoagulation

BACKGROUND: Neonates with severe congenital diaphragmatic hernia (CDH) often require extracorporeal life support (ECLS) for survival. Early repair of CDH on ECLS (within 24-48 hours of cannulation) has been shown to decrease mortality, but perioperative complications remain a concern. We developed a standardized protocol for early CDH repair on ECLS using bivalirudin as the anticoagulant. We hypothesized that bleeding complications would be low, with associated improvements in survival. METHODS: A retrospective analysis was conducted on neonates with CDH who underwent early repair on ECLS using bivalirudin between 2021 and 2023. A standardized protocol was implemented that included peri-operative ECLS management and standardized operative technique. We collected data on demographics, operative details, ECLS parameters, hemorrhagic/thrombotic complications and survival. Results: 12 CDH patients received ECLS using bivalirudin and underwent early repair between 2021- 2023. 8.3% (n=1) developed a clinically significant ICH post operatively (within first 48 hours), none had bleeding complications related to the surgery requiring return to OR. Intra-op 33.3% (n=4) of patients had bivalirudin held for some portion of the case. In this high-risk cohort, 75% (n=9) of the infants survived to decannulation, 75% (n=9) survived to 6 months of age and 59% (n=7*) survived to discharge. The average length of days on ECLS was 22.5 (range 5-39). Conclusion: Early repair of CDH on ECLS utilizing a standardized operative protocol and bivalirudin for anticoagulation resulted in low surgical and hemorrhagic complication rates. Further studies are warranted to validate these findings and refine the management of CDH patients on ECLS.