Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2004
Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome.
This article reviews our experience using a prosthetic conduit between the right ventricle (RV) and the pulmonary artery (PA), in lieu of the more traditional aortopulmonary shunt, for infants undergoing surgical palliation of hypoplastic left heart syndrome. Thirty-three consecutive infants underwent Norwood procedure between February 1998 and November 2003, using an RV-PA conduit. ⋯ Nine patients have undergone completion Fontan. This technique provides reproducible results, simplifies postoperative management, and improves outcome, especially for "low volume" programs.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2004
ReviewHeart transplantation for the failing Fontan circulation.
The failing Fontan circulation presents difficult treatment challenges. When Fontan revision and or intervention for treatable arrhythmias are not feasible, heart transplantation is the only therapeutic option. ⋯ The pretransplant evaluation, transplant operation, and postoperative management are more problematic for these patients compared with most patients undergoing transplantation. Consequently, failing Fontan patients constitute one of the highest risk heart transplant subsets.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2004
Risk adjustment for congenital heart surgery: the RACHS-1 method.
The new health care environment has increased the need for accurate information about outcomes after pediatric cardiac surgery to facilitate quality improvement efforts both locally and globally. The Risk Adjustment for Congenital Heart Surgery (RACHS-1) method was created to allow a refined understanding of differences in mortality among patients undergoing congenital heart surgery, as would typically be encountered within a pediatric population. ⋯ It can also be used to evaluate the performance of a single institution in comparison to other benchmark data, provided that complete model parameters are known. Underlying assumptions about RACHS-1 risk categories, inclusion and exclusion criteria, and appropriate and inappropriate uses are discussed.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2004
Routine use of mechanical ventricular assist following the Norwood procedure.
Conventional postoperative management after the Norwood procedure in patients with hypoplastic left heart syndrome suffers from three main shortfalls. First, the early postoperative care is often labor-intensive and ironically (despite sometimes heroic efforts), when babies die, health care providers often feel like failures, and in the worst scenarios, surgeons or other physicians create cultures of blame. Second, hospital survival is inconsistent in most centers, especially the ones with small surgical volume and limited experience. ⋯ Neurodevelopmental testing before the Glenn procedure was normal for all patients tested. Routine postoperative use of mechanical ventricular assist device can support the increased cardiac output demands of infants following Norwood procedure and results in a stable postoperative convalescence. This strategy can simplify postoperative management, lead to excellent hospital survival, and possibly augment cerebral oxygen delivery resulting in improved neurologic outcomes for these patients.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2004
Home monitoring of infants after stage one palliation for hypoplastic left heart syndrome.
Despite improved early results with the Norwood procedure (stage one palliation), patients remain with at-risk anatomy and interstage mortality continues to be a limitation of staged single ventricle palliation. Retrospective analyses have implicated residual or recurrent anatomic lesions as well as intercurrent illness as causes of interstage mortality. ⋯ Frequent monitoring of these physiologic variables between stage one and two palliation identified life-threatening anatomic lesions and illness and permitted timely intervention that ultimately improved survival. All 36 survivors of the stage one palliation discharged from the hospital and entered into the home monitoring program survived the interstage period.