ABSTRACT
Background and Aim: Before 2020, no pediatric cardiac surgery pro-gram was available at our institution, despite being a university hospital providing tertiary care for 6 million inhabitants. Our goal is to describe the preparation and the first year of expe-rience of our pediatric cardiac surgery program, which will even-tually cater for 300 patients annually. Method(s): The project was supported by European funds (INTERREG program). Medical and nursing staff training was performed via a transborder collaboration. Significant investments were necessary to reach the required standards for the facilities (operating rooms, pediatric intensive care beds) and equipment (cardiopulmonary bypass and ECMO machines, ultrasound sys-tems etc.). A multidisciplinary team was built over 3 years. The pediatric ECMO program was started a year prior to the surgical program. In parallel, a program dedicated to the study and care of neurological impact of congenital heart diseases and interventions was set up. Importantly, a progressive upscale was devised: only children with a weight gt;5 kg requiring non-complex surgeries were operated on during the first year. Result(s): The first year of experience was marked by challenges caused by the successive COVID-19 waves, such as restricted access to the operating room and a subsequent slow-down in the progression of the schedule. Fifty-nine patients constituted the cohort of the first year (October 2020-October 2021). In addition to low-risk procedures (left-to-right shunts closures etc.), cases included 6 tetralogy of Fallot repairs, 1 Ross procedure and 2 bilateral cavopulmonary connections. There were no early or late deaths. Median age was 6.3 years old (1.8-9.8) and median weight was 18.5 kg (10.0-32.0). Fourteen patients (23.7%) were operated on with a weight lt;10 kg. Bypass cases represented 72.9% (43 patients) of all cases. Median cardiopulmonary bypass and cross-clamping times were 88 (52-153) and 51 (26-98) minutes respectively. Median intensive care and hospital stays were 3 (2.0-6.7) and 6 days (5-11) respectively. Conclusion(s): Despite COVID-19-related difficulties, our pediatric cardiac surgery program achieved excellent outcomes in selected patients. Institutional support, meticulous planning, team cohesion and perseverance are keys for successful initiation of a program requiring such high technicality.
ABSTRACT
Introduction The goal of this study is to describe the preparation and the first year of experience of the pediatric cardiac surgery program at our institution, where such a program was not available before 2020. Methods The project was initiated by the university hospital, in collaboration with the Regional Health Agency. Transborder staff training and significant investments were supported by the Interreg program. A multidisciplinary team was built, which started the pediatric ECMO program in the pediatric intensive care unit prior to the surgical program and set up a parallel program dedicated to the neurodevelopmental follow-up of operated infants. Importantly, a progressive upscale was devised: only children with a weight>5kg requiring low or moderate-complexity surgeries were operated on during the first year. Results From October 2020 to December 2021, 77 children were operated on, including 64 in the new pediatric cardiac surgery program. Repeated waves of COVID-19 made the start of the program difficult by restricting access to the operating room. The age of the 64 patients of the new program was 6.2 years old (1.7–9.5). Cardiopulmonary bypass cases represented 47 (74.6%) of all cases. In addition to low-complexity surgeries, procedures such as tetralogy of Fallot repair (n=6) and bilateral cavopulmonary connection (n=4) were performed. There were no early or late deaths postcardiotomy. Intensive care and hospital stays were 3 (2–7) and 6 (5–11) days, respectively. Conclusion Our pediatric cardiac surgery program achieved very satisfactory outcomes in selected patients, despite difficulties related to the current pandemic. Institutional support, meticulous planning and excellent team cohesion were keys for successful initiation of our program.
ABSTRACT
Introduction Diagnosis delay leads to an increased risk of coronary artery aneurysms in Kawasaki disease. In multisystem inflammatory syndrome in children (MIS-C), diagnosis delay could worsen heart failure. Objective This study aims to test the hypothesis that a long time to diagnosis is associated with heart failure severity in MIS-C. Methods A retrospective single-center observational study was conducted between May 2020 and April 2022. Children with a MIS-C diagnosis meeting WHO criteria were included. A long time to diagnosis was defined as 6 days or more. Outcomes were assessed on severity of heart failure, including peak NT-proBNP, minimal left ventricular ejection fraction (LVEF) and need for inotropes (dobutamine, milrinone, adrenaline). Results Thirty-two children were included in the study. One child was excluded due to previous vaccination against COVID-19. The median age [1st–3rd interquartile range] was 8 [5–10] years old. The median time to diagnosis was 5.3 [4.0–6.3] days. Children with a long time to diagnosis (n=13), compared with those with a short time to diagnosis (n=18), had a higher peak NT-proBNP (22304 [13859–47889] ng/L versus 5555 [2384–10227] ng/L, respectively, P<0.001), lower LVEF (40 [30–50] % versus 45 [45-55,5] %, respectively, P=0.02), and were more often treated with inotropes (8 children (57%) versus 0 child (0%) respectively, P<0.001). Conclusion Diagnosis delay is associated with heart failure severity in MIS-C. Early diagnosis and treatment are crucial to avoid the use of inotropes and limit morbidity.