Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Mar 2018
ReviewGiessen Procedure as Comprehensive Stage II Palliation With Aortic Arch Reconstruction After Hybrid Bilateral Pulmonary Artery Banding and Ductal Stenting for Hypoplastic Left Heart Syndrome.
This article reviews our experience using hybrid stage I palliation in the neonatal period and subsequently with comprehensive stage II palliation for hypoplastic left heart syndrome. Between June 1998 and April 2017, 154 patients with the diagnosis of hypoplastic left heart syndrome and variants underwent a hybrid stage I palliation (bilateral pulmonary artery banding and ductal stenting). ⋯ One hundred twenty-one patients underwent a comprehensive stage II operation with an operative mortality of 6.6%. The hybrid procedure provides reproducible results with reduced in-hospital, interstage, and long-term mortality and lower rates of aortic arch reinterventions.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2017
ReviewThe Society of Thoracic Surgeons Congenital Heart Surgery Database Public Reporting Initiative.
Three basic principles provide the rationale for the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (CHSD) public reporting initiative: (1) Variation in congenital and pediatric cardiac surgical outcomes exist. (2) Patients and their families have the right to know the outcomes of the treatments that they will receive. (3). It is our professional responsibility to share this information with them in a format they can understand. The STS CHSD public reporting initiative facilitates the voluntary transparent public reporting of congenital and pediatric cardiac surgical outcomes using the STS CHSD Mortality Risk Model. ⋯ The STS CHSD Mortality Risk Model is the best available model to date for measuring outcomes after pediatric cardiac surgery. As of March 2016, 60% of participants in STS CHSD have agreed to publicly report their outcomes through the STS Public Reporting Online website (http://www.sts.org/quality-research-patient-safety/sts-public-reporting-online). Although several opportunities exist to improve our risk models, the current STS CHSD public reporting initiative provides the tools to report publicly, and with meaning and accuracy, the outcomes of congenital and pediatric cardiac surgery.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2017
ReviewCongenital Heart Surgery Subspecialty Certification: How Is It Working? The American Board of Thoracic Surgery Perspective.
Congenital heart surgery is among the most challenging fields in all of medicine. The unique skills and knowledge base required prompted the American Board of Thoracic Surgery (ABTS) to establish the Subspecialty Certificate in Congenital Heart Surgery (CHS). Standards for operative experience and fellowship training programs were established by the ABTS and the Accreditation Council for Graduate Medical Education. ⋯ Today, the overwhelming majority of congenital heart surgeons in the United States hold a Subspecialty Certificate in CHS. Recent survey data suggests those individuals who have completed Accreditation Council for Graduate Medical Education fellowship training in CHS were satisfied with the operative experience they received during training and the vast majority are practicing CHS. While surgical training and education will always be a work in progress, in the 7 years since its inception, the ABTS Subspecialty Certificate in CHS has achieved the goal of quality control and standardization of CHS training.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2015
ReviewChecklists and safety in pediatric cardiac surgery.
In rebuilding Tulane's pediatric heart center after Hurricane Katrina, the use of checklists proved to be essential, not only in rebuilding inventory and systems, but the culture of continued debriefing around their use was seminal in establishing a culture of safety and trust between caregivers; safety that ultimately benefitted our patients.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2015
ReviewRoot translocation in congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonary stenosis, and other lesions.
The pulmonary root translocation (PRT) procedure has been used to correct ventriculoarterial discordance or malposition of great arteries since 1994. It was part of the surgical repair of 62 consecutive patients presenting with congenitally corrected transposition of the great arteries (CCTGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS), or other complex congenital heart disease with malposition of the great arteries, VSD, and PS. PRT was performed as follows: removal of the pulmonary artery (PA) with the pulmonary valve from its abnormal position, closure of the consequent hole with an autologous pericardial patch, resection of some conal septum, creation of an intraventricular tunnel connecting the left ventricle to the aorta, and construction of a new right ventricular outflow tract using the translocated PA. ⋯ The Senning procedure was used with some modification to complete the anatomical repair in CCTGA patients. Overall in-hospital and long-term mortality were 4.8% and 3.4%, respectively. PRT appears to be a good surgical alternative for patients presenting with CCTGA with VSD and PS, and other lesions involving malposition of the great arteries, VSD, and PS.