Regionalization in Neonatal Congenital Heart Surgery: The Impact of Distance on Outcome After Discharge

The coronavirus disease 2019 (COVID-19) pandemic currently gripping the globe is impacting the entire health care system with rapidly escalating morbidities and mortality. Although the infectious risk to the pediatric population appears low, the effects on children with congenital heart disease (CHD) remain poorly understood. The closure of congenital heart surgery programs worldwide to address the growing number of infected individuals could have an unintended impact on future health for COVID-19-negative patients with CHD. Pediatric and congenital heart surgeons, given their small numbers and close relationships, are uniquely positioned to collectively assess the impact of the pandemic on surgical practice and care of children with CHD. We present the results of an international survey sent to pediatric and congenital heart surgeons characterizing the early impact of COVID-19 on the care of patients with CHD.

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3D Modeling and Printing in Congenital Heart Surgery: Entering the Stage of Maturation

Frontiers in Pediatrics ◽

10.3389/fped.2021.621672 ◽

2021 ◽

Vol 9 ◽

Author(s):

Shi Joon Yoo ◽

Nabil Hussein ◽

Brandon Peel ◽

John Coles ◽

Glen S. van Arsdell ◽

...

Keyword(s):

3D Printing ◽

Surgical Training ◽

Congenital Heart ◽

Heart Surgery ◽

Surgical Simulation ◽

Heart Diseases ◽

Congenital Heart Surgery ◽

Congenital Heart Diseases ◽

3D Printed ◽

The Impact

3D printing allows the most realistic perception of the surgical anatomy of congenital heart diseases without the requirement of physical devices such as a computer screen or virtual headset. It is useful for surgical decision making and simulation, hands-on surgical training (HOST) and cardiovascular morphology teaching. 3D-printed models allow easy understanding of surgical morphology and preoperative surgical simulation. The most common indications for its clinical use include complex forms of double outlet right ventricle and transposition of the great arteries, anomalous systemic and pulmonary venous connections, and heterotaxy. Its utility in congenital heart surgery is indisputable, although it is hard to “scientifically” prove the impact of its use in surgery because of many confounding factors that contribute to the surgical outcome. 3D-printed models are valuable resources for morphology teaching. Educational models can be produced for almost all different variations of congenital heart diseases, and replicated in any number. HOST using 3D-printed models enables efficient education of surgeons in-training. Implementation of the HOST courses in congenital heart surgical training programs is not an option but an absolute necessity. In conclusion, 3D printing is entering the stage of maturation in its use for congenital heart surgery. It is now time for imagers and surgeons to find how to effectively utilize 3D printing and how to improve the quality of the products for improved patient outcomes and impact of education and training.

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Abstract 14639: An Integrated Heart Center Model Improves Outcomes After Congenital Heart Surgery

Circulation ◽

10.1161/circ.142.suppl_3.14639 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Carlos M Mery ◽

Andrew M Well ◽

Ziv Beckerman ◽

Erin Gottlieb ◽

Byron Holt ◽

...

Keyword(s):

Congenital Heart ◽

Heart Surgery ◽

Patient Characteristics ◽

Congenital Heart Surgery ◽

Readmission Rates ◽

Perioperative Mortality ◽

Multidisciplinary Program ◽

Postoperative Length ◽

Heart Center ◽

The Impact

Introduction: Contemporary experience suggests that congenital heart surgery (CHS) outcomes are optimized with an integrated, focused, and multidisciplinary program. In July 2018, our institution transitioned to an integrated Heart Center (IHC) model with new dedicated surgical, cardiac intensive care, anesthesiology, perfusion, and nursing teams. Multidisciplinary protocols and quality processes were implemented. This transition provides an unusual opportunity to evaluate the impact of an IHC model on outcomes after CHS. Methods: Patients who underwent index CHS 10/16-3/20 were included. The cohort was divided into 2 groups: historical (first 21 mo) and IHC (second 21 mo). Cases were evaluated using STAT category, mortality, and other outcomes as defined by Society of Thoracic Surgeons criteria. Descriptive statistics, univariate analyses, and multivariable regression models were used. Results: The cohort included 627 patients (historical: 230, IHC: 396, 72% increase). Numbers of STAT 4 and 5 cases increased 174% (31 to 85) and 900% (1 to 10), respectively. Neonatal cases increased 100%, infants 138%, and adults 622%. Despite an increase in complexity, perioperative mortality decreased from 3.5% to 0.5% (p=0.007) (Table). Median postoperative length of stay (LOS) increased from 5[4-10] to 7 [4-18] days (p<0.001). 30-day readmission rates increased from 8.6% to 14% (p=0.048). After adjusting for patient characteristics and STAT category, perioperative mortality remained significantly lower (OR 3.4, 95% CI 1.1-5.6, p=0.004), postoperative LOS was longer (RR 6.9, 95% CI 2.6-11.1, p=0.002), and 30-day readmission was not different (p=0.7). Conclusions: Implementation of an IHC model improves perioperative survival after CHS, coupled with an increase in volumes and complexity. CHS care should be delivered as part of a dedicated and multidisciplinary IHC model.

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The improvement of care for paediatric and congenital cardiac disease across the World: a challenge for the World Society for Pediatric and Congenital Heart Surgery

Cardiology in the Young ◽

10.1017/s1047951108002801 ◽

2008 ◽

Vol 18 (S2) ◽

pp. 63-69 ◽

Cited By ~ 51

Author(s):

Christo I. Tchervenkov ◽

Jeffrey Phillip Jacobs ◽

Pierre-Luc Bernier ◽

Giovanni Stellin ◽

Hiromi Kurosawa ◽

...

Keyword(s):

Cardiac Disease ◽

Congenital Heart ◽

Heart Surgery ◽

Surgical Care ◽

Congenital Heart Surgery ◽

World Society ◽

Congenital Cardiac Disease ◽

The World ◽

Developed World ◽

The Impact

AbstractThe diagnosis and treatment for paediatric and congenital cardiac disease has undergone remarkable progress over the last 60 years. Unfortunately, this progress has been largely limited to the developed world. Yet every year approximately 90% of the more than 1,000,000 children who are born with congenital cardiac disease across the world receive either suboptimal care or are totally denied care.While in the developed world the focus has changed from an effort to decrease post-operative mortality to now improving quality of life and decreasing morbidity, which is the focus of this Supplement, the rest of the world still needs to develop basic access to congenital cardiac care. The World Society for Pediatric and Congenital Heart Surgery [http://www.wspchs.org/] was established in 2006. The Vision of the World Society is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The Mission of the World Society is to promote the highest quality comprehensive care to all patients with pediatric and/or congenital heart disease, from the fetus to the adult, regardless of the patient’s economic means, with emphasis on excellence in education, research and community service.We present in this article an overview of the epidemiology of congenital cardiac disease, the current and future challenges to improve care in the developed and developing world, the impact of the globalization of cardiac surgery, and the role that the World Society should play. The World Society for Pediatric and Congenital Heart Surgery is in a unique position to influence and truly improve the global care of children and adults with congenital cardiac disease throughout the world [http://www.wspchs.org/].

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