• Muayad Kadhim, Ellen Spurrier, Deepika Thacker, Christian Pizarro, and William G Mackenzie.
• 1Department of Orthopaedic Surgery, 2Department of Anesthesiology, 3Department of Cardiology, 4Department of Cardiac Surgery Alfred I DuPont Hospital for Children, DE, USA.
• Spine. 2013 Oct 22.

AbstractStudy Design. Retrospective cohort study.Objective. To describe preoperative evaluation, anesthetic and peri-operative management and complications in patients with congenital heart disease (CHD) who underwent surgery to correct a spine deformity.Summary of Background Data. Patients with surgically palliated or repaired CHD may have nearly normal circulation or may have important residual abnormalities that affect the planning and conduct of surgery to correct a spine deformity.Methods. We examined the records of 21 patients with spine deformity who had previous surgical intervention for CHD. Three types of spine surgery and instrumentation were examined, posterior fusion with instrumentation (PSFI), growing rod instrumentation (GR), and vertical expandable prosthetic titanium rib instrumentation (VEPTR).To objectify the degree of preoperative cardiac physiologic derangement, patients were classified into three groups: single ventricle physiology and Fontan circulation (S), two ventricles with no residual abnormal cardiac physiology condition (2N), and two ventricles with residual cardiac physiology problem(2R).Results. Subjects were 8 boys and 13 girls with mean age of 11.1±5.2 years. Sixteen patients underwent surgery to correct scoliosis, one to correct kyphosis, and 4 did not undergo surgery. Total number of surgeries was 23 (16 PSFI, 5 GR and 2 VEPTR). Based on cardiac physiology, two patients were 2N, 11 were 2R and 8 were Group S. Mean estimated blood loss was 1685 ml during PSFI, 515 ml during GR and 150 ml during VEPTR. Mean volume of blood transfusion was 44 ml/kg for PSFI, 19 ml/kg for GR, while no transfusion was administered during VEPTR. Median ICU stay was 2 days ranging from hours to 78 days. Median hospital length of stay was 7 days ranging from 3 to 93 days. There were no deaths.Conclusion. Given meticulous multidisciplinary planning and execution, major spine surgery can be safely and successfully performed in patients with significant residua of CHD.

19 keywords...

hide…