Eleven years experience with the use of contegra

The implantation of the Bovine Jugular Vein [Contegra] in the repair of many congenital heart defects [CHD] had gained a worldwide acceptance. We report our experience in using it over eleven years. During the period from February 2000- December 2011, we implanted the Contegra in 268 patients with different congenital heart defects at the position ventricle-Pulmonary artery [RV/LV-PA]. There were 178 males and 90 females in an age ranging between 2 months- 33 years mean of 5.6 yrs. Echocardiography was performed postoperatively at 3days, 3months, 6months then every year looking for pressure gradient [PG] across the valve, regurgitation and calcification. The primary endpoints of operative mortality and morbidity and secondary endpoints of follow-up haemodynamic performance including severe stenosis, regurgitation and need for reintervention are presented. The follow up of patients were 100% in 1 yr, 98% in 2 yrs; 82% in 3yrs and 57% in 4 yrs, 40% in 5 yrs, 35% in 6 yrs, 20% continued to show up from year 7 to year 11. The performance of the conduit was as follow: Unchanged pressure gradient [PG] or < 15 mmHg over 2 yrs in 98%, PG 15 - 25 mmHg over 3yrs in 25%, PG 25 -35mmHg over 4yrs in 18%, PG 35-45mmHg over 5yrs in 14%, and by the end of 11 yrs 10% of pts had PG >55 mmHg, and were scheduled for redo surgery. The rest of the patients were having minor changes in the pressure gradients over variable periods of follow up. The younger the child at the time of implantation, the higher the chance to develop pressure gradient over the conduit over years. There were no conduit related adverse events, there were 32 deaths; 12 early deaths [4.5%], late 20 deaths, not related to conduit implantation. Operative morbidity was 11.2%.There were mild regurgitation at the valve in 32 cases [12%]; moderate regurgitation in 9 cases [3.4%] and severe regurgitation in 6 cases [2.2%] at variable periods of follow up, calcifications were detected by X-ray and sonography in 37 cases [13.8%] Reintervention by redo surgical procedure in 33 cases [12.3%] The Contegra conduit is s a reliable extra-cardiac conduit for primary and redo- RVOT reconstruction over eleven years of follow up

Early extubation in pediatric patients after cardiothoracic surgery

Early extubation after cardiac operations is an important aspect of fast-track cardiac anesthesia. In order to reduce or eliminate the adverse effects of prolonged ventilation, the concept of early extubation in pediatric patients has been examined at our institution. To allow rapid emergence from anesthesia post cardiac surgery, low-dose opioids, supplemented with continuous propofol infusion and low concentration of inhaled agent was used. Intercostal nerve block was used in thoracotomy operations. Contraindications to early extubation were: cardiopulmonary bypass [CPB] > 2.5 hours, hemodynamic instability, uncontrolled bleeding, severe pulmonary hypertension and congestive heart failure. Eighty-two consecutive patients were reviewed. The age range was 6 months - 14 years with mean of 3.3 years. Closed cardiac procedures were performed in 15 [18.3%] patients, and operations with Cardio-pulmonary bypass in 67 [81.7%] patients. No patient required re-intubation during the first 24 hours after operation. One patient was re-intubated 48 hours after extubation for sputum retention. There was no mortality, and the incidence of perioperative morbidity was low. Early extubation after pediatric cardiothoracic operations can be achieved safely, and is possible in the majority of such patients