Factors influencing the intermediate outcome in patients with single-ventricle physiology after Fontan operation.

OBJECTIVE: This study was conducted to analyze the factors affecting the intermediate outcome following the Fontan procedure in the current era. METHODS: Between January 1992 and December 2008, 189 patients underwent Fontan procedure at a median age of 3.4 years (0.4-37 years). Single left ventricle was present in 77 (40%) patients, right ventricle in 70 (37%), in 7 (3.7%) patients, the ventricular morphology was indetermined and in 35 (18.5%) a dominant systemic ventricle with smaller second ventricle was present. The Fontan procedure was performed using an atriopulmonary connection (n=5, 5.6%), lateral atrial tunnel (n=99, 52%) or extracardiac conduit (n=85, 45%). 97.4% of patients recieved fenestration. RESULTS: The hospital survival was 95% and five patients required a takedown of Fontan circulation. The survival at 1.5 and 10 years was 94%, 93% and 92%, respectively. Multivariate analysis identified that the outcome was influenced by the diagnosis of a complete common AV canal (p = 0.015), duration of ventilation (p < 0.0001) and duration of pleural effusions (p = 0.003). Failure-free survival at 1.5 and 10 years was 95%, 92% and 89%, respectively. The overall freedom from reoperation was 73%. Risk factors for reoperation were preoperative pulmonary artery pressure and duration of ventilation. CONCLUSIONS: The Fontan procedure is associated with excellent operative and intermediate survival. Common atrioventricular canal, duration of pleural effusions and ventilation have an adverse influence on the intermediate outcome. Reintervention is associated with pulmonary artery pressure and duration of ventilation (Tab. 7, Fig. 3, Ref. 16).

Long-term results of surgical treatment of total anomalous pulmonary venous drainage in children.

AIM OF STUDY: Retrospective analysis of surgical correction of TAPVD performed between January 1992 and March 2008. METHODS: Review of patients' medical records. Patients' preoperative, operative as well as postoperative data were collated and analyzed using JMP statistical program version 5. RESULTS: A total of 51 patients with total anomalous pulmonary venous drainage underwent surgery at our center during a period of over seventeen years. Actuarial survival was 90.2%. Early postoperative death was recorded in 4 patients (7.8%) as against one late postoperative death. The only statistically significant risk factor for death was the time of surgical repair. Patients undergoing the repair before 1997 were more likely to die than those operated on after this period, p=0.006. Patients' survival following the surgical correction prior to the year 1997 was 63.63% as opposed to 97.5% for the period between 1997 and 2008. Freedom from surgical re-intervention over the period of follow-up was 92%. The obstructive type of TAPVD was associated with longer ICU stay and higher postoperative complications, p=0.003. CONCLUSION: We have recorded a significant improvement in patients' survival following surgery for total anomalous pulmonary venous drainage in the last decade. This can be attributed to a number of new measures both surgical and medical employed in the treatment of our patients (Tab. 3, Fig. 7, Ref. 17). Full Text (Free, PDF) www.bmj.sk.

Surgical closure of patent ductus arteriosus in pre-term babies.

OBJECTIVES: To present by illustration the surgical options in neonatal PDA closure with emphasis on clip application. METHODS: Photo/video-documentation of surgical closure of PDA in a neonate by clip application coupled with free-hand drawings showing PDA closure by ligation and division. Review of 38 neonates undergoing surgical PDA closure in our institution between 1998 and 2006. RESULTS: Overall survival following surgery was 100%. There was one case of residual PDA and three postoperative complications - 2 cases of pneumothorax and one chylothorax. CONCLUSION: The outcome of surgical closure of PDA in neonates is very good with zero mortality in our series and only few postoperative complications.

Surgical treatment of aortic coarctation.

Coarctation of the aorta accounts for about 8% of all congenital heart diseases. Since the first successful case of surgical treatment in 1944 by Crafoord and Nylin1 in Sweden, several surgical techniques have been employed in the treatment of this anomaly. Here, we review by illustration the various surgical options in coarctation of the aorta with emphasis on our preferred technique - the extended resection and end-to-end anastomosis. Why the extended resection technique? Our experience - and that of other institutions - has shown that this is a better option in childhood as it is associated with a lesser degree of recoarctation and subsequent need for re-intervention.2.