Current Assessment of Mortality Rates in Congenital Cardiac Surgery

Welke, Karl F.; Shen, Irving; Ungerleider, Ross M.

doi:10.1016/j.athoracsur.2006.03.004

Cited by 93 publications

(68 citation statements)

References 12 publications

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“…With in-hospital mortality reported to be below 3% for categorized operations in a recent study despite an increase in case complexity (1), there is a growing need to address the paradoxical increased incidence of adverse neurological outcomes in the survivors of surgery. Cardiopulmonary bypass (CPB) presents unique challenges in this regard, with the extreme conditions encountered during extracorporeal support coupled with requisite surgical techniques that place severe stress on the patient acting in tandem to cause insult and injury to the brain.…”

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confidence: 99%

Improved Cerebral Oxygen Saturation and Blood Flow Pulsatility With Pulsatile Perfusion During Pediatric Cardiopulmonary Bypass

Guan

Barnes

et al. 2011

Pediatr Res

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Brain monitoring techniques near-infrared spectroscopy (NIRS) and transcranial Doppler (TCD) ultrasound were used in pediatric patients undergoing cardiopulmonary bypass for congenital heart defect (CHD) repair to analyze the effect of pulsatile or nonpulsatile flow on brain protection. Regional cerebral oxygen saturation (rSO 2 ) and cerebrovascular pulsatility index (PI) were measured by NIRS and TCD, respectively, in 111 pediatric patients undergoing bypass for CHD repair randomized to pulsatile (n ϭ 77) or nonpulsatile (n ϭ 34) perfusion. No significant differences in demographic and intraoperative data, including surgical risk stratification, existed between groups. Patients undergoing pulsatile perfusion had numerically lower decreases in rSO 2 from baseline for all time points analyzed compared with the nonpulsatile group, with significant ϳ12% lower decreases at 40 and 60 min after crossclamp. Patients undergoing pulsatile perfusion had numerically lower decreases in PI from baseline for the majority of time points compared with the nonpulsatile group, with significant ϳ30% lower decreases between 5 and 40 min after crossclamp. Pulsatile flow has advantages over nonpulsatile flow as measured by NIRS and TCD, especially at advanced time points, which may improve postoperative neurodevelopmental outcomes. A dvances in intraoperative surgical techniques and postoperative intensive care have substantively improved patient outcomes and decreased mortality rates in pediatric cardiac surgery for the repair of congenital heart defects (CHDs). With in-hospital mortality reported to be below 3% for categorized operations in a recent study despite an increase in case complexity (1), there is a growing need to address the paradoxical increased incidence of adverse neurological outcomes in the survivors of surgery. Cardiopulmonary bypass (CPB) presents unique challenges in this regard, with the extreme conditions encountered during extracorporeal support coupled with requisite surgical techniques that place severe stress on the patient acting in tandem to cause insult and injury to the brain. With increased incidence of postoperative neurologic complications reported in pediatric patients undergoing CPB, including neuromotor disabilities, learning disabilities, and behavioral abnormalities (2,3), there is increasing relevance for intra-and early postoperative brain monitoring techniques, which may predict neurologic outcomes and provide medical professionals actionable information to aid in the minimization of adverse sequelae (4).The debate between pulsatile and nonpulsatile perfusion modes further complicates considerations of best practices during pediatric CPB with the aim of minimizing neurological morbidity (5). Although current findings suggest that pulsatile flow imparts distinct advantages including increased hemodynamic energy leading to better blood flow to major organs such as brain, movement of lymph that prevents edema and sludging in microcapillaries, maintained microcirculatory flow, improve...

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confidence: 99%

Improved Cerebral Oxygen Saturation and Blood Flow Pulsatility With Pulsatile Perfusion During Pediatric Cardiopulmonary Bypass

Guan

Barnes

et al. 2011

Pediatr Res

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“…However, the greatest proportion of children requiring longterm anticoagulation have congenital cardiac disease and with increased life expectancy are contributing significantly to the numbers of children receiving anticoagulation to prevent both venous and arterial events (Welke et al, 2006).…”

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Aspects of anticoagulation in children

Payne

2010

Br J Haematol

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SummaryThe number of children receiving anticoagulation is increasing. Thromboembolic events are associated with significant risk of morbidity and mortality although the optimal management of asymptomatic events remains unclear. Specific challenges in paediatrics include the diagnosis of thrombosis, delivery and monitoring of anticoagulation in a wide range of ages from neonates through to adolescents. The development of the haemostatic system as children age results in changing pathophysiology of thrombosis and response to anticoagulation agents. Although registry and observational studies have provided vital information, specific paediatric, prospective anticoagulation studies have been few and limited in design. The result is that much of current practice is extrapolated from adult studies. Traditional anticoagulants have significant limitations. Both heparin and warfarin are in widespread use but many fundamental questions regarding dose, therapeutic range, efficacy and optimum duration have not been fully answered. Alternative agents, such as direct thrombin inhibitors and the selective anti-factor Xa inhibitor fondaparinux, may have advantages for children. Clinical trials in adults and preliminary data in children are promising but caution should be applied until specific paediatric studies have demonstrated safety and efficacy.

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“…With the advance of surgical notion and experience in parallel to the technology in the last 30 years, the baby who undergoes increasing number of heart operations each year grows, starts school life and even reaches adolescence (15). In patients with complex heart anomalies, a need for improving quality of life in the ones who survive after operation has become prominent (16,17).…”

Section: Discussionmentioning

confidence: 99%

Bebeklik döneminde siyanotik kalp hastalığı nedeniyle açık kalp cerrahisi uygulanmış ergenlerde kendilik algısı ve yaşam niteliği

Yıldız¹,

Zahmacioglu²,

Koca³

et al. 2011

tpa

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Aim:To assess the quality-of-life of the teenage patients who had undergone open heart surgery because of cyanotic heart disease during their infancy together with their parents and to compare their self-perception to that of the physically healthy control group. Material and Method:This study includes 53 patients who had undergone operation for cyanotic congenital heart disease in İstanbul University, Institute of Cardiology between 1989 and 1994. The relatives and the patients were informed with a consent form approved by İstanbul University, Cerrahpaşa Medical Faculty, Clinical Studies, Ethics Commitee (Decree no. D-005, Date: 11-10-2009). Group 1 was the healthy control group (15 patients, median age: 19 years 8 months), Group 2 included patients with single ventricle who had undergone Fontan procedure (20 patients, median age: 19 years 6 months; 10 of them had tricuspid atresia, 5 of them had pulmonary atresia with intact ventricular septum, 3 of them had double inlet left ventricle, 1 of them had double outlet right ventricle, 1 of them had ventricular septal defect and pulmonary atresia), group 3 included patients who had undergone operation for congenital cyanotic heart disease (33 patients, median age: 19 years 2 months; 18 of them had transposition of the great arteries, 10 of them had tetralogy of Fallot, 2 of them had complete atrioventricular canal defect and pulmonary stenosis, 2 of them had double outlet right ventricle, 1 of them had pentalogy of Fallot). In this study, the quality of life and self perception inventories were used. The quality of life inventory was completed by patients, healthy adolescents and their parents seperately. The self perception inventory was completed only by the patients and healthy adolescents. The comparison of age and self perception scores between the groups was carried out with unidirectional analysis of variance (ANOVA) and the multicomparisons with LSD (Least Significant Difference). Since the quality of life variable did not have a normal distribution, the comparions were carried out with Kruskal-Wallis nonparametric ANOVA test and the multicomparisons were carried out with Dunn's test. Results:There was not a significant difference between the groups in terms of age and sex. In the quality of life scale (QOLS), for the replies to related questions, a significant difference was determined between the groups. The replies of group 2 and 3 about quality of life of both the children and the parents were far more negative when compared to those of the control group. When the groups were compared via multiple comparison tests, there was no significant difference between group 2 and 3. The replies of the parents regarding their children's quality of life were statistically more negative than those of their children (p<0,001). Within the self perception scale, there were significant differences in terms of social acceptance, behaviours in relationships and general self perception (p=0.03, p=0.03 and p=0.01; repectively) between group 1 and 3. The most significant dif...

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Current Assessment of Mortality Rates in Congenital Cardiac Surgery

Cited by 93 publications

References 12 publications

Improved Cerebral Oxygen Saturation and Blood Flow Pulsatility With Pulsatile Perfusion During Pediatric Cardiopulmonary Bypass

Improved Cerebral Oxygen Saturation and Blood Flow Pulsatility With Pulsatile Perfusion During Pediatric Cardiopulmonary Bypass

Aspects of anticoagulation in children

Bebeklik döneminde siyanotik kalp hastalığı nedeniyle açık kalp cerrahisi uygulanmış ergenlerde kendilik algısı ve yaşam niteliği

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