Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2014
Reoperations for pediatric and congenital heart disease: an analysis of the Society of Thoracic Surgeons (STS) congenital heart surgery database.
In this descriptive analysis, data in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database pertaining to patients who underwent reoperative cardiac surgery were analyzed. Practice patterns and outcomes are described. Reoperative cardiac surgery for congenital heart disease is common, with one third of index operations in the database occurring subsequent to prior cardiothoracic operation(s) performed on cardiopulmonary bypass. This analysis suggests that a history of previous cardiac surgery does not independently confer a significant incremental risk of operative mortality, but that patients with greater number of previous operations appear to be at higher risk.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2013
ReviewNeonatal cardiac care, a perspective.
Every year in the United States approximately 40,000 infants are born with congenital heart disease. Several of these infants require corrective or palliative surgery in the neonatal period. ⋯ There are several reasons for the increased surgical mortality risk in neonates. This review outlines these risks, with particular emphasis on the relative immaturity of the organ systems in the term and preterm neonate.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2013
Review Comparative StudyLow birth weight and very low birth weight neonates with congenital heart disease: timing of surgery, reasons for delaying or not delaying surgery.
Conventional management of low birth weight and very low birth weight neonates was composed of deferring corrective surgery by aggressive medical management or palliative surgery which does not require cardiopulmonary bypass. However, while waiting for weight gain, these neonates are at risk for various comorbidities. ⋯ However, there still exist some circumstances, which are considered to be unfavorable for corrective surgery due to medical, physiologic, surgeon's technical and institutional-systemic factors. We reviewed the recent literature and examined the reasons for delaying or not delaying surgery.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2013
ReviewThe Norwood procedure: in favor of the RV-PA conduit.
Evolution of the Norwood procedure has culminated in there currently being three treatment strategies available for initial management: the 'classical' Norwood (utilizing a Blalock-Taussig shunt), the Norwood with right-ventricle to pulmonary artery (RV-PA) conduit, and the 'hybrid' Norwood procedure utilizing bilateral pulmonary artery banding and ductal stenting. Each variant has its potential advantages and disadvantages, and this paper looks to examine the evidence in favor of each strategy, with emphasis on the supportive data for the RV-PA conduit. The 'classical' procedure has the benefit of the greatest accumulated surgical experience and avoids any incision into the ventricle. ⋯ The RV-PA conduit has the advantage of maintaining diastolic pressure with a more stable postoperative course, but at the cost of a ventriculotomy that may have detrimental long-term sequelae. The 'hybrid' procedure has the advantage of avoiding cardiopulmonary bypass, but does not always secure coronary blood flow and has a high inter-stage morbidity and reintervention rate. The evidence shows that each technique may have its place in future management, and that treatment algorithms could emerge that direct the choice of procedure for specific patient groups.
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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu · Jan 2012
Aortic valve insufficiency: leaflet reconstruction techniques.
The introduction of effective and durable leaflet repair techniques have enabled repair of the regurgitant aortic valve. Aortic valve repair is favored to avoid the placement of a prosthesis that the patient will likely outgrow. Furthermore, repair has the potential to reduce the incidence of prosthesis-related complications, including endocarditis, thromboembolism, anticoagulant-related hemorrhage, and reoperation. ⋯ The key to successful leaflet repair for aortic insufficiency is a thorough understanding of the mechanism of dysfunction. We have developed a systematic approach to the assessment and repair of aortic insufficiency because of leaflet disease. The combination of leaflet repair and functional aortic annulus annuloplasty can restore the proper geometry of the aortic valve complex and allow for successful repair of aortic insufficiency caused by both restriction and prolapse.