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Pediatric heart transplantation is the standard treatment for children complicated with refractory heart failure which is difficult to be treated by conventional surgery or drugs. At present, an increasing quantity of pediatric heart transplantation is being performed worldwide, whereas relevant experience is still lacking in China. In recent 10 years, significant progress has been achieved in pediatric heart transplantation. On one hand, the number of pediatric heart transplantation has been increased year by year. On the other hand, ABO-incompatible heart transplantation, application of ventricular assist device in children, and recipient-donor weight mismatch transplantation have been widely employed to resolve the shortage of donor heart in pediatric heart transplantation. However, relevant experience of pediatric heart transplantation is lacking in China, especially in understanding the indications of pediatric heart transplantation and the application of specific strategies for pediatric heart transplantation, etc. In this article, the development history, advances in therapeutic strategy and clinical prognosis of pediatric heart transplantation were reviewed.
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@#The coronavirus disease 2019 (COVID-19) epidemic has a tremendous impact on the countries around the world since the outbreak in December 2019. From December 2022, with the loosening of domestic epidemic control policies, the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rose significantly and reached to its epidemic peak in the majority of the cities in China, which further overwhelmed our medical care system. The cardiac surgery departments in China lack the experience in conducting work under the COVID-19 pandemic. In this paper, we summarize the main topics that might be faced during the pandemic by reviewing the previous related literatures, which included: the cardiac surgery volume trends, the impact of SARS-CoV-2 infection on the prognosis of cardiac surgery, the timing of cardiac surgery and the surgical strategy should be modified, and possible recommendations for the manager or governors during the pandemic, so as to outline a path forward for cardiac surgery for the near future.
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Objective:To explore the risk factors and follow-up outcomes of pediatric heart transplantation(HT).Methods:Between January 2018 and June 2022, perioperative data are retrospectively reviewed for 41 pediatric HT recipients aged <18 years and donor-recipient weight data for infants aged under 3 years at Guangdong Provincial People's Hospital.Perioperative survivors are followed up until August 31, 2022 through out patient visits and telephone calls.Postoperative survivals are examined by Kaplan-Meier method and possible risk factors for perioperative survival identify with Logistic regression.Results:There are 22 boys and 19 girls with a median age of 120(58~138)months.After preoperative adjuvant therapy of extracorporeal membrane oxygenation(ECMO), 8 cases had a successful transition to HT and 2 children underwent ABO incompatible(ABOi)HT.Six children aged under 3 years had a donor-recipient weight ratio of 2.95.Among 17 children, there are one or more complications, including continuous renal replacement therapy(CRRT, 9 cases, 21.95%), tracheotomy (3 cases, 7.32%), delayed chest closure or redo of sternotomy(6 cases, 14.63%)and acute graft dysfunction(4 cases, 9.76%). Five children died during perioperative period.The possible risk factors for perioperative mortality include preoperative ECMO assistance[ HR: 32.00, 95% CI: (2.83~361.79), P<0.05], preoperative CRRT[ HR: 11.33, 95% CI: (1.15~111.69), P<0.05] and total bilirubin [ HR: 1.02, 95% CI: (1.002~1.040), P<0.05]. During follow-ups, one child died from Epstein-Barr virus (EBV)associated post-transplant lymphoproliferative disease; another case of EBV-associated hepatic leiomyoma underwent transcatheter arterial embolization.With an overall survival rate of 85.37%, the cumulative survival rate is 96.97% for children without preoperative ECMO assistance( P<0.05). Postoperative mortality rate spiked markedly in children with preoperative ECMO assistance ( P=0.0013). However, follow-up results of perioperatively survivors indicate that preoperative usage of ECMO will not affect follow-up survival( P=0.53). In ABOi group or infants aged under 3 years, no mortality occurres postoperatively or during follow-ups. Conclusions:In infant aged under 3 years, the strategies of ABOi HT and large-weight donor HT are both safe and effective and it has no effect upon perioperative and follow-up survivals.Preoperative ECMO assistance, total bilirubin and preoperative use of CRRT are risk factors for perioperative survival.
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Objective:To investigate the clinical characteristics, surgical methods and prognosis of patients with acute type A aortic dissection combining coronary artery involvement.Methods:415 patients diagnosed with acute type A aortic dissection from October 2016 to September 2019 were included in the study.Among them, 358 were males and 57 were females; aged(51.2±10.7) years old.According to the results of intraoperative coronary probes, 342 patients in the group were without coronary involvement, and the other 73 were with coronary involvement.Data on the coronary involvement classification, site, and treatment methods of the coronary involvement group were collected by consulting the ward medical record system.Meanwhile, preoperative baseline data, surgical data and prognostic results were retrospectively collected between the two groups. The data of the two groups were compared by chi- square test, t-test and Mann- Whitney U test. Results:Coronary involvement group: Among 73 (17.6%, 73/415) patients with coronary involvement, 8 (11.0%) in the left coronary, 48 in the right (65.8%), and 17 (23.3%)cases with involvement of both left and right coronary arteries. Classification of coronary artery(90) involvement: Neri A in 47(52.2%, 47/90), 33 with Neri B (36.7%, 33/90), and 10 with type Neri C (11.1%, 10/90). Type Neri B/C coronary artery involvement was mostly treated with artificial vascular coronary artery replacement or coronary artery bypass grafting. Comparison between the two groups show, patients in the coronary involvement group had higher preoperative levels of CK-MB, D-dimer and more severe aortic valve regurgitation compared to the coronary non-involvement group. The comparison of surgical data suggests that the coronary involvement group had a higher proportion of aortic root treatment, longer operation time, cardiopulmonary bypass time and aortic clamping time. A higher percentage of intimal tear located in the ascending aorta or aortic root was found in the coronary involvement group. The mortality rate in the coronary involvement group was significantly higher than that of the non-involvement group (12% versus 4%), and it was more likely to combine heart failure (5% versus 1%) and renal failure (26% versus 13%).Conclusion:Compared with pure type A dissection, patients with coronary artery involvement are more common in patients whose primary intimal tear were found at the proximal aorta, and are more prone to severe aortic valve regurgitation. Coronary artery treatment procedures include direct suture and fixation, coronary artery replacement, and coronary artery bypass grafting. Among them, Neri A coronary involvement can mostly be fixed with direct suture and stabilization, while the Neri B / C type mostly requires artificial vascular replacement of the affected coronary artery or coronary artery bypass. Patients with coronary artery involvement have a higher proportion of deaths and confer relatively higher risk of post-operative renal/cardiac failure.
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Objective: To summarize the peri-operative management experience of pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Methods: A total of 56 CTEPH patients received PEA in our hospital from 2015-01 to 2016-11 were retrospectively analyzed. Our study was focused on the medication in respiratory and circulatory system during ICU stay, peri-operative application of vasoactive drug and target drug to pulmonary hypertension (HP), usage of ventilators, mechanical assisted devices and other management experiences. Results: No peri-operative death occurred. There were 2/56 (3.6%) patients with lung reperfusion, 2 (3.6%) with PH crisis. Compared with pre-operation, the post-operative pulmonary artery hemodynamics parameters were improved as right heart catheter measured pulmonary artery systolic pressure (PASP) decreased from (85.05±22.40) mmHg to (36.83 ±17.21) mmHg and pulmonary vascular resistance decreased from (773.84±342.95) dyn·s·cm-5 to (293.59±214.95) dyn·s·cm-5. Post-operative oxygen saturation was maintained at (95-100) % in all patients. Echocardiography found that PASP from pre-operation (85.03±25.78) mmHg decreased to (39.44±19.24) mmHg at follow-up period, P<0.01.Conclusion: A comprehensive peri-operative management of PEA was helpful to improve pulmonary hemodynamics in CTEPH patients; meanwhile, effective prevention and treatment of severe complication could obviously reduce peri-operative mortality.