Background: Mechanical circulatory support (MCS) may be necessary in patients with single ventricle anatomy (SVA) due to intractable low cardiac output, shunt occlusion, and cardiac arrest.

Methods: We evaluated our experience from March 1989 to January 2008 of patients with SVA (n = 530) on MCS. Our institutional cardiac database and the ELSO databases were queried.

Results: Sixty-one (12%) patients required MCS. Three patients were supported with ventricular assist devices other than ECMO. Two patients (3.3%) required ECMO support prior to surgical staging; 39/61 (64%) patients were placed on ECMO support after stage 1 palliation; 10/61 (16%) after bidirectional Glenn; and 10/61 (16%) after Fontan completion. Target flows were directed by venous oximetry and/or near infrared spectroscopy. Thirty-five (57%) were placed on mechanical support emergently for cardiac arrest (ECPR). Twenty-six (34%) were placed on MCS electively or for failure to wean from cardiopulmonary bypass. Seven patients required two ECMO runs; one patient required three ECMO runs. Twenty of 61 patients (33%) are alive at a follow-up of 9.9 to 175 months. Among single ventricle patients undergoing ECPR, 13/35 (35%) survived long-term compared to 7/26 (27%) without an arrest (p = 0.43). One of eight patients (12.5%) requiring multiple ECMO runs survived to discharge after transplantation.

Conclusions: Single ventricle patients can have acceptable survival after MCS in the postoperative period. The need for ECPR in patients receiving MCS does not affect survival. ECMO and other forms of ventricular support should be aggressively offered to single ventricle patients when necessary.