From
StayCurrentMD
CDH-ECMO - VV vs. VA - Repair on ECMO: Update Course 2015
Chapter 1 of 4 · Surgical Management
VV vs VA ECMO
VV versus VA ECMO: Institutional Approaches and Cannulation Techniques
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Controversies in Congenital Diaphragmatic Hernia: Update Course 2018
41 min · Published Aug 2018
Video
Challenges in Diaphragmatic Hernia Repair: Update Course 2016
44 min · Published Oct 2018
Video
CDH - MIS vs. Open: Update Course 2015
5 min · Published Nov 2015
Podcast
Case-Based Journal Review: Congenital Diaphragmatic Hernia 2023
19 min · Published Oct 2023
Podcast
Congenital Diaphragmatic Hernia with Dr. Charlie Stolar
82 min · Published Jan 2017
Video
Improving Outcomes for Congenital Diaphragmatic Hernia (CDH): Protocol Changes at Cincinnati Children's
5 min · Published Jun 2026
Video
Pediatric Surgical Oncology Research Collaborative (PSORC): Studying Rare Pediatric Tumors
56 s · Published May 2026
Video
Update Course Rewind 2025: Hirschsprung + ARM: Rare but Real
1 min · Published May 2026
Video
Pooling Patients to Study Rare Pediatric Tumors: An Introduction to PSORC
56 s · Published May 2026
Video
The fetal frontier: A review of current and emerging fetal therapies for genetic diseases
44 s · Published May 2026
Video
Indocyanine green assists with sentinel lymph node mapping in pediatric and adolescent patients
1 min · Published May 2026
Video
Tricuspid valve surgery in transposition of the great arteries with a systemic right ventricle
46 s · Published May 2026
What the experts said
VV ECMO with cephalad cannula has been performed at the speaker's institution since the late 1990s with good results.
Conversion from VV to VA ECMO is exceedingly rare, occurring approximately 3 times in the last 10 years at the speaker's institution.
For composite patch repair, SIS is used on the underlay on the abdominal side and Gore-Tex on the thoracic side.
The Gore-Tex provides the security in composite patch repair, not the SIS underlay.
Muscle flap repair using transversus abdominis causes some abdominal wall weakness but not a true hernia.
Muscle flap repair has not been found to cause a significant amount of scoliosis more than any other repair method.
Most CDH patients have issues with scoliosis when sutures are taken around the ribs and bite into the intercostal tissue, causing skeletal defects.
The risk of skeletal deformity is higher with patches compared to muscle flaps.
During thoracoscopic CDH repair, very low insufflation pressures are used, with the highest being about 5 mmHg.
Once the viscera is reduced during thoracoscopic repair, insufflation can often be turned off because pulmonary hypoplasia provides adequate domain without gas.
The spleen can act as a cap once reduced, helping maintain the repair during thoracoscopic approach.
Aggressive hemofiltration and other interventions can obviate some of the renal complications associated with VV ECMO.
If an institution has expertise in a particular ECMO mode, they will not achieve as good results with the alternative mode.
For poor-prognosis CDH patients, aggressive repair within the first 24 to 48 hours on ECMO is performed at the speaker's institution.
For CDH patients with acute pulmonary hypertension crisis expected to have a short ECMO run, repair is delayed until after ECMO decannulation when echocardiography demonstrates subsystemic pulmonary hypertension.
For CDH patients on ECMO for 2-3 weeks, repair is performed toward the end of the ECMO run.
The diaphragmatic defect itself is not causing the pulmonary problems in CDH.
Some institutions will stop ECMO without performing repair in patients who cannot be decannulated.
The complication rate with VA ECMO is higher than VV ECMO.
VA ECMO is associated with more neurological complications than VV ECMO.
VV ECMO is associated with more renal complications than VA ECMO.
In the ELSO registry for CDH, VA ECMO had 48% survival and VV ECMO had 43% survival, with no statistically significant difference.
A propensity-matched analysis of the ELSO registry showed a survival advantage for VV ECMO over VA ECMO.
Data from Texas Children's Group shows that early repair on ECMO versus off ECMO does not have statistically significant difference in outcomes, though curves show a tendency favoring repair after the ECMO run.
After ECMO decannulation, most surgeons perform open CDH repair rather than minimally invasive repair.