IntroductionAnimal pericardial patches are widely used in adult and pediatric cardiac surgery. A search is ongoing for a new material with optimal surgical properties that will reduce intraoperative bleeding and the occurrence of restenosis, calcification, and pseudoaneurysms in long-term observation. One product of interest is the CardioCel bovine pericardial patch.AimEvaluation of the short-term results of CardioCel bovine pericardial patch implantation during pediatric cardiac surgery.Material and methodsThe study included 8 patients who underwent surgical correction of congenital cardiac defects between January 2015 and February 2016. Pericardial patches were used to repair supravalvular aortic stenosis and reconstruct the aortic arch and pulmonary arteries. The age of the patients ranged from 10 days to 14 years.ResultsThere were no hospital deaths. The new material exhibited satisfactory durability and elasticity during surgery, facilitating optimal adaptation of the patch to the patient's tissues. No significant bleeding was reported from the suture site. The median duration of follow-up was 58 days. During the follow-up, there were no symptoms of pseudoaneurysm formation, patch thickening, or calcification in the areas where the pericardial patches were implanted. No clinical or laboratory symptoms of infection were observed in locations where the new material was applied.ConclusionsSatisfactory surgical properties of the patch were observed intraoperatively. Positive results using the new pericardial patch were obtained in short-term follow-up.

IntroductionCardioplegia is one of the most important modalities of myocardial protection during heart surgery.AimTo assess the impact of blood cardioplegia on postoperative variables, in comparison with two types of crystalloid cardioplegic solutions during pediatric heart surgery.Material and methodsOne thousand one hundred and twenty-nine patients underwent surgical correction of congenital heart disease with cardioplegia administration between 2006 and 2012. Nonlinear regression models of postoperative low cardiac output syndrome (LCOS) incidence, catecholamine index and total complication count were developed using a genetic algorithm. The Akaike information criterion was applied for selection of the best model. The following explanatory variables were evaluated: cardioplegia type (ST – Saint Thomas, n = 440; FR – Fresenius, n = 432; BL – Calafiore, n = 257), congenital heart diseases (CHD) type, age, sex, genetic disorder presence, body surface area (BSA), cardiopulmonary bypass (CBP) time, aortic cross-clamp time, operation urgency, redo surgery, surgeon.ResultsLow cardiac output syndrome presence and higher than average catecholamine indexes were negatively influenced by use of crystalloid cardioplegia (ST or FR), presence of specific CHDs, redo surgery and prolonged CBP time. Increased complication count was related to: crystalloid cardioplegia, presence of specific CHDs, redo surgery, urgency of operation, operation time and CBP time. Higher BSA had a protective effect against higher catecholamine index and increased complication count. Older age was protective against LCOS.ConclusionsCardioplegic solutions type influences postoperative variables in children after heart surgery by the negative impact of crystalloid cardioplegia. Blood cardioplegia presents potential advantages for patients – its application may reduce the incidence of low cardiac output syndrome and related complications.

Objectives:To perform the preliminary tests of coarctation of aorta repair trainer, evaluate the surgical properties of the simulation and to assess and enhance residents’ skills.Methods:Single patient’s angio-CT anatomy data were converted into magnified 3D-printed model of aortic coarctation with hypoplastic aortic arch, serving for creation of a mould used during wax copies casting. Wax cores were painted with six layers of elastic silicone and melted, yielding phantoms that were consecutively fixed in a mounting with and without a thoracic wall. Simulation included: proximal and distal aortic arch clamping, incision of its lesser curvature, extended end-to-end anastomosis with 7-0 suture. A head-mounted camera video recording enabled anastomosis time and mean one suture bite time evaluation. Leakage assessment was done by a water test.Results:Two residents performed nine simulations each. Last four runs were performed with thoracic wall attached. All phantoms performed well, enabling tissue-like handling and cutting, excellent suture retention, and satisfactory elasticity. Median anastomosis times were 22′33″ and 24′47″ for phantoms without and with thoracic wall (p = not significant (NS)). Median times needed to pass suture through one side of anastomosis and regrasp needle were, respectively, 9″ and 13″ (p < 0.001). Median total number of leakages per phantom equalled 2 for both difficulty levels. There were no significant inter-resident differences in all assessed parameters.Conclusions:This medium-fidelity aortic coarctation repair trainer showed its feasibility in replication of major critical steps of the real operation. Objective surgical efficiency parameters could be obtained from each simulation and compared between trainees and at different adjustable difficulty levels.

Valve replacement seems to be the most straightforward option for patients with mitral valve (MV) pathology. However, this approach is connected with all the intrinsic side effects of mechanical or biological valve implantation, including susceptibility to infection, thrombosis and degeneration. Thus, a reconstructive surgery has been recognized as the best option for the majority of patients including children. Many repair techniques have been developed to address mitral valve insufficiency (MI) in case of congenital, ischemic and infective pathologies. The majority of procedures concern the posterior mitral leaflet (PML) and the posterior annulus as well as commissures.The techniques regarding anterior mitral leaflet (AML) and anterior annulus are less frequently utilized in clinical practice as there is a concern of possible distortion of the aortic valve, narrowing of left ventricle outflow tract and unpredictable long-term MV function. Nevertheless, certain interventions on AML were introduced with acceptable results to treat MV systolic anterior motion, degenerative MV disease or Barlow disease (3, 7).Infective and congenital pathologies in children necessitate a search for an alternative reconstructive approach when all procedures utilizing implants (e.g. artificial chordae, pericardial patches) or an opera- Antosik P., Sologashwilli T., Pawelec-Wojtalik M., Wodziński A., Ładziński P., Bartkowska-Śniatkowska A., Bukowska D., Sobieraj M., Nałęcz T., Cudak E., Wojtalik M.Partial anterior mitral leaflet resection with adjacent ring plication -feasibility pilot study Summary The aim of the study was to assess the feasibility and repeatability of a partial removal of the anterior mitral leaflet medial part (AML-A3) accompanied by corresponding anterior mitral annulus plication as a method of valve repair. Four male land race pigs underwent median sternotomy and consecutive cardio-pulmonary by-pass under general anesthesia with hemodynamic monitoring. The AML was detached from the annulus at ⅓ of its length beginning from the postero-median commissure in the direction to the aortic valve and cut off towards the A2-A3 indentation. Three single 3-0 silk sutures were utilized to plicate the mitral annulus segment corresponding with the detached leaflet. The remaining free edge of the AML lateral part was reattached to the plicated ring and to the postero-median commissure with the running 5-0 polypropylene suture. Preoperative and postoperative epicardial echocardiography was performed. All animals survived the operation and were weaned from the cardiopulmonary bypass. All reconstructed MVs were competent. Mean MV diameter decreased after the plasty and did not cause significant diastolic MV flow velocity increase. LVOT anatomy was not altered as well as LVOT flow velocities remained unchanged. The AoV was competent after the operation and did not change its diameter. Partial AML resection completed by corresponding annulus plication is a feasible and repeatable procedure. It does not negatively influence the func...

Aim. The aim of this study was to analyze the results of surgical treatment of balanced AVSD during 10-year period in a single center. The adequacy of atrioventricular valves reconstruction was scrutinized as well as risk factors for mortality, redo surgery, pulmonary hypertension incidence were assessed.Materials and method. One hundred twenty one patients underwent surgical correction of AVSD between 2004 and 2013. All patients were operated by double patch technique with the apposition zone closure. Patients’ median age was: 109 (86–151) days, body weight: 4.5 (4–5.5) kg. Down syndrome was present in 100 (82.6%) patients. Results. Early mortality equaled 17.3% (21 patients) and late mortality was 1.7% (2 patients). Pulmonary hypertension (42.9%) and heart failure (33.3%) were the main causes. Cardiopulmonary bypass time (p < 0.0001), aortic cross-clamping time (p = 0.003), inotropic index value (p < 0.0001), maximal mean pulmonary artery pressure (p = 0.008) were significantly higher in the group of patients who died. Ten patients (8.3%) required early reoperation and nine (9%) required late reoperation. Early postoperative mitral valve regurgitation of III-rd or higher degree was risk factor for early and late reoperations (p = 0.0002). The probability of freedom from all reoperations at 6 months, 1 and 5 years was respectively: 0.83; 0.80 and 0.71.Conclusions. Pulmonary hypertension and low cardiac output syndrome have significant influence on results of AVSD treatment. The predisposing risk factors are prolonged time of surgical procedure and presence of pneumonia. Mitral valve reconstruction quality has an influence for early and late results.