Using cryopreserved allogeneic pericardium to repair congenital heart defects in children.

Patches prepared from autologous, allogeneic, or xenogeneic tissues are widely used in the repair of congenital heart defects in children. Since 2002, cryopreserved allogeneic pericardial patches have been prepared in our institution as an alternative to commercially available patches. This study retrospectively reviewed donor and patient data concerning cryopreservation time and the clinical use of the pericardium in 382 children who were operated on at a single center between 2004 and 2021. There were 177 donors: 98 males and 79 females. The median donor age was 13 years (range: 1 month to 53 years) and the median cryopreservation time was 72 days (range: 3-685). There were 382 pediatric patients: 224 males and 158 females. The median patient age was 1 month (range: 3 days to 17.8 years). The patches were used for primary surgeries in 228 patients and for reoperations in 154. The patches were implanted into the right heart or venous circulation in 209 patients, the left heart or arterial circulation in 246 patients, and both sides of the circulatory system in 73. Extracardiac patch implantation was performed in 339 patients, intracardiac in 79 patients, and both intracardiac and extracardiac in 36 patients. Our study presents a single-center experience in the use of cryopreserved allogeneic pericardium. The pericardium can be used on the systemic and pulmonary sides of the circulatory system, in either extracardiac or intracardiac positions. However, there is no uniform strategy for selecting the "patch of choice" for correcting congenital heart defects in children, especially since there are few studies comparing several types of patches.

Late right pulmonary artery stenosis after arterial switch operation in mirror image dextrocardia and situs inversus totalis.

The operation of D-transposition of the great arteries is performed extremely rarely in patients with mirror image dextrocardia and situs inversus totalis. Therefore, it is not surprising that such unusual anatomy case presents problems with primary operation. We present a case of late right pulmonary artery stenosis after neonatal surgical anatomic correction of mirror image dextrocardia and situs inversus totalis.

Cost-effectiveness of mini-circuit cardiopulmonary bypass in newborns and infants undergoing open heart surgery.

BACKGROUND AND AIM: Miniaturisation of the extracorporeal circuit is a current trend in modern paediatric cardiac surgery. Many investigators stress that reduction of priming volume and artificial surface area of extracorporeal circulation could lead to clinical and economic benefits. The aim of this paper was to evaluate the costs of mini-circuit use in infants undergoing open heart surgery. METHODS: We assessed post-operative course and cost of treatment in 60 infants undergoing open heart surgery. This group was prospectively randomised and divided into 2 equal subgroups: with miniaturised (group M) and conventional cardio pulmonary bypass circuits (group C). The study groups were clinically comparable. Surgical complications, duration of hospitalisation and cost of postoperative treatment were assessed in both groups. RESULTS: Miniaturisation of the extracorporeal circuit led to a significant reduction of priming volume and artificial surface area (by 46.6% and 68.8% respectively, p=0.0000001). Post-operative cardio-respiratory insufficiency (2 vs. 8, p=0.038), and infection (3 vs. 9, p=0.049) occurred less often in children from group M. Hospital stay was significantly shorter in group M. Total cost of treatment was significantly lower in children from group M (median: 4361.4 vs. 6660.5 euro, p=0.037). CONCLUSIONS: Miniaturisation of the extracorporeal circulation significantly improve post-operative outcome in infants undergoing open heart surgery. The mini-circuit significantly reduces cost of treatment in small children undergoing open heart surgery.

Evolving approach to aortic valve replacement in children and adolescents--a preliminary report.

BACKGROUND: Surgical treatment methods are still controversial in children with congenital or acquired aortic valve dysfunction. AIM: To evaluate treatment results in children after mechanical or biological valve implantation. METHODS: We analysed a group of 55 children after mechanical valve implantation (group A) and a group of 8 children after Freestyle biological valve implantation (group B). We evaluated in both groups: patient's age, type of valve dysfunctions, severity of heart failure symptoms, and quality of life. The parameters of physiological left ventricular (LV) remodelling were examined on the basis of echocardiographical signs of LV contractibility (%SF) and anatomical changes: LV diastolic diameter (LVDd), LV posterior wall thickness (LVPW), thickness of intra-ventricle septum (IVS) and pressure gradient between LV and aorta (LV-Ao). RESULTS: There were no hospital deaths in either group. There were two late deaths in children from group A. Thromboembolic (2), nonspecific bleeding complications (2), and infections (2) occurred in group A. There were two re-operations in children after mechanical valve implantation. The early postoperative period was good in groups A and B. Furthermore, late postoperative period was good in group B. Physiological LV remodelling occurred in children in groups A and B. Quality of life was good in both groups. CONCLUSIONS: Good clinical results, simplicity, repeatability and safety of surgical technique mean that mechanical valve implantation in the aortic position is still an attractive option for treatment in children and adults. However, absence of bleeding, thromboembolic and infection complications and improvement of durability mean that the Freestyle biological new generation valve could be a good option for future in children and adolescents who need aortic valve replacement.