Delayed Sternal Closure after Cardiac Operations for Congenital Heart Disease in Infancy.

Abstract Objectives To determine the prevalence of surgical site infections (SSIs) in neonatal congenital heart disease patients undergoing delayed sternal closure (DSC) and evaluate risk factors for SSI. Methods Hospital records of 483 consecutive neonates who underwent surgical intervention between January 2013 and December 2017 were reviewed, and perioperative variables were recorded. Results We found that the prevalence of SSI was 87.5% when the body weight was less than 1500 g. When the operative age was between seven and 14 days, the probability of no SSI is about 93.9%. When the duration of the aortic cross-clamp was more than 60 min, the prevalence of SSI was 91.2%. The prevalence without SSI was 96.6% when the duration of DSC was less than 24 h. However, when the duration of DSC was more than 120 h, the prevalence of SSI was 88.9% (p = 0.000). Conclusions With the prolongation of aortic clamping duration, the probability of occurrence of SSI increased in neonatal CHD with DSC. The age at operation and body weight are closely related to the occurrence of SSI in neonatal CHD patients with DSC.

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Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective

Seminars in Cardiothoracic and Vascular Anesthesia ◽

10.1177/1089253221998546 ◽

2021 ◽

pp. 108925322199854

Author(s):

Dash F. T. Newington ◽

Fabrizio De Rita ◽

Alan McCheyne ◽

Claire Louise Barker

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Extracorporeal Membrane Oxygenation ◽

Congenital Heart ◽

Anesthetic Management ◽

Inotropic Support ◽

Ventricular Assist Devices ◽

Ventricular Assist ◽

Membrane Oxygenation ◽

Delayed Sternal Closure

Background Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures. Aims To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease. Methods Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019. Results Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%). Conclusions Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.

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German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease: Report 2020—Comprehensive Data from 6 Years of Experience

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1722978 ◽

2021 ◽

Vol 69 (S 03) ◽

pp. e21-e31

Author(s):

Andreas Beckmann ◽

S. Dittrich ◽

C. Arenz ◽

O.N. Krogmann ◽

A. Horke ◽

...

Keyword(s):

Congenital Heart Disease ◽

Quality Assurance ◽

Heart Disease ◽

Surgical Procedures ◽

Congenital Heart ◽

Interventional Procedures ◽

German Society ◽

Medical Quality ◽

German Registry ◽

Cardiac Operations

Abstract Background Based on a quality assurance initiative of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) and the German Society for Pediatric Cardiology and Congenital Heart Defects (DGPK), a voluntary registry was founded for assessment of treatment and outcomes of patients with congenital heart disease in Germany. This evaluation by the German Registry for cardiac operations and interventions in patients with congenital heart disease reports the data and the outcome over a 6-year period in patients undergoing invasive treatment. Methods This real-world database collects clinical characteristics, in-hospital complications, and medium-term outcome of patients who underwent cardiac surgical and interventional procedures within the prospective, all-comers registry. Patients were followed-up for up to 90 days. Results In the period from 2013 to 2018, a total of 35,730 patients, 39,875 cases, respectively 46,700 procedures were included at up to 31 German institutions. The cases could be subcategorized according to the treatment intention into 21,027 (52.7%) isolated operations, 17,259 (43.3%) isolated interventions, and 1,589 (4.0%) with multiple procedures. Of these, 4,708 (11.8%) were performed in neonates, 10,047 (25.2%) in infants, 19,351 (48.5%) in children of 1 to 18 years, and 5,769 (14.5%) in adults. Also, 15,845 (33.9%) cases could be allocated to so-called index procedures which underwent a more detailed evaluation to enable meaningful comparability. The mean unadjusted in-hospital mortality of all cases in our registry ranged from 0.3% in patients with isolated interventions and 2.0% in patients with surgical procedures up to 9.1% in patients undergoing multiple procedures. Conclusion This annually updated registry of both scientific societies represents voluntary public reporting by accumulating actual information for surgical and interventional procedures in patients with congenital heart disease (CHD) in Germany. It describes advancements in cardiac medicine and is a basis for internal and external quality assurance for all participating institutions. In addition, the registry demonstrates that in Germany, both interventional and surgical procedures for treatment of CHD are offered with high medical quality.

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Constrictive pericarditis in patients with coronary, valvular, or congenital heart disease: outcome of pericardiectomy combined with other cardiac operations

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(02)81918-0 ◽

2002 ◽

Vol 39 ◽

pp. 427

Author(s):

David G. Cable ◽

Hartzell V. Schaff ◽

Thomas A. Orszulak ◽

Jae K. Oh ◽

Joseph A. Dearani ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Constrictive Pericarditis ◽

Congenital Heart ◽

Disease Outcome ◽

Cardiac Operations

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MON-082 The Neonatal Screen That Cried Wolff

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.298 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Fabiola D’Ambrosio ◽

Laika M Nur ◽

Stelios Mantis ◽

Carla Z Minutti

Keyword(s):

Congenital Heart Disease ◽

Cardiac Surgery ◽

Heart Disease ◽

Thyroid Function ◽

Congenital Hypothyroidism ◽

Congenital Heart ◽

Thyroid Function Tests ◽

Pediatric Endocrinology ◽

Transient Hypothyroidism ◽

Delayed Sternal Closure

Abstract Introduction: Hypothyroidism is one of the major causes of preventable mental retardation. Neonatal screening aids in the prompt diagnosis of newborns with congenital hypothyroidism. There are other clinical conditions that can alter thyroid function during the newborn period, including exposure of high iodine concentrations. Case Presentation: One day old female born at 37 3/7 weeks of gestational age by C-section with imperforated anus and congenital heart disease was transferred to our children’s hospital within the first day of life for a hybrid cardiac procedure of bilateral pulmonary artery banding and PDA stenting. She had an Illinois Neonatal screen done at 36 hours of life that was normal. Her cardiac surgery was performed at 10 days of life, where she was exposed to iodine products transdermally. At 14 days of age, she had a repeat Illinois Neonatal screen that was positive for congenital hypothyroidism with a TSH of 78 mIu/mL (normal < 20 mIu/mL) and reflex total T4 of 5.4ug/dL (normal is > 8ug/dL). No family history of thyroid disease; mother was healthy during pregnancy and was not on medications that could affect baby’s thyroid function. Subsequent serum laboratory testing confirmed a TSH of 74.3mIu/mL and Free T4 of 0.6ng/dL. Patient was diagnosed with Wolff-Chaikoff effect, which is the phenomenon of transient hypothyroidism caused by exposure to high doses of iodine (iodine containing contrast agents or topical antiseptics). Pediatric Endocrinology was consulted at 2 weeks of life and she was started on 25mcg of levothyroxine PO daily. Levothyroxine dose decreased at 16 month of age to 12.5mcg due to stable thyroid function tests. The patient was last seen at 30 months of age by Pediatric Endocrinology. She is still on the low dose of levothyroxine and her thyroid labs have been within normal limits for an infant. She will likely not require lifelong thyroid supplementation. Conclusion: Risk of hypothyroidism among neonates must be considered seriously after large iodine exposure and monitoring for transient hypothyroidism should be performed. It is thus recommended that attempts should be made to reduce the amount of iodine used during procedures and to carefully monitor thyroid function in all neonates exposed to an excess of iodine. Reference: Markou, K., et al. “Iodine-Induced Hypothyroidism.” Thyroid, vol. 11, no. 5, 2001, pp. 501–510., doi:10.1089/105072501300176462. Linder N, Sela B, German B, et al. Iodine and hypothyroidism in neonates with congenital heart disease. Archives of Disease in Childhood - Fetal and Neonatal Edition 1997;77:F239-F240. Kovacikova, Lubica, et al. “Thyroid Function and Ioduria in Infants after Cardiac Surgery: Comparison of Patients with Primary and Delayed Sternal Closure.” Pediatric Critical Care Medicine, vol. 6, no. 2, 1 Mar. 2005, pp. 154–159., doi:10.1097/01.pcc.0000154960.59452.06.

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Preliminary Results of Cryoablation for Surgical Treatment of Arrhythmias in Adults With Congenital Heart Disease

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.770221 ◽

2021 ◽

Vol 8 ◽

Author(s):

Giulia Poretti ◽

Stiljan Hoxha ◽

Antonio Segreto ◽

Gardellini Jacopo ◽

Camilla Sandrini ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Surgical Treatment ◽

Congenital Heart ◽

Hospital Admissions ◽

Intraoperative Complications ◽

Open Heart ◽

Treatment Of Arrhythmias ◽

Cardiac Operations

Background: Arrhythmias in adult congenital heart disease (ACHD) are responsible for the majority of hospital admissions and 20–25% of late deaths. Since need for further cardiac operations is frequent in ACHD, concomitant arrhythmia surgery represents a strategic treatment modality.Material and Methods: A two-center retrospective study was undertaken on cryoablation of supraventricular arrhythmias in 25 conescutive ACHD patients (16/9, M/F, median age 38.5 years, IQR 38–60) operated between 01/2017 and 12/2020. Nineteen (76%) had undergone one or more previous cardiac operations and 8 (32%) one or more trans-catheter ablations. Indications included Fontan conversion in seven patients, septal defect repair in 6, pulmonary valve replacement in 10 and tricuspid surgery in 2. Open-heart cryoablation included: 4 cavotricuspid isthmus ablations, 19 right-sided Maze for atrial tachycardia/flutter, and 2 Cox-Maze III for atrial fibrillation.Results: There were 2 (8%) hospital deaths, unrelated to cryoablation, due to low cardiac output syndrome. There were no intraoperative complications related to cryoablation. Seven (28%) patients required pace-maker implantation due to post-operative atrioventricular block. All patients were discharged on oral antiarrhythmic and anticoagulantion for 6 months. After a median follow-up of 14 months (IQR 7–27) no late mortality was observed. At follow-up, 16/23 (69%) patients are in stable sinus rhythm, 12 without anti-arrhythmic therapy. Two (8.6%) patients had relapse of arrhythmia. Freedom from arrhythmia was 90.9% and cumulative risk of recurrence was 9.6%.Conclusions: Intraoperative cryoablation is safe and effective procedure. Surgical treatment of arrhythmias should always be considered in ACHD, whenever further open-heart repair is needed.

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