Effects of patient blood management in pediatric heart surgery.

OBJECTIVE: Multidisciplinary patient blood management practices reduce costs of blood products and transfusion-related complications in hospitals. Hospital costs are high in pediatric cardiac surgery patients because high hematocrit levels are usually needed; the need for blood products is high due to complex and long surgical procedures; the length of stay in the intensive care unit (ICU) is long, and the use of treatment modalities such as dialysis and ECMO is common in this patient population. METHODS: In this retrospective study, we investigated the effects of the use of the multidisciplinary patient blood management protocols on the use of blood products and associated costs by comparing the outcomes of the protocol implemented in the year 2019 to the blood product use and costs of the previous year. In our clinic, 414 patients were operated on in 2019; 230 of them were males and 184 of them were females. RESULTS: Transfusions carried out in adherence to such protocols have reduced mortality rates along with a decline in hospital costs. CONCLUSIONS: We, too, achieved a 10% reduction in blood product costs per patient after the implementation of the multidisciplinary patient blood management protocol.

OBJETIVO: Las prácticas multidisciplinarias de manejo de la sangre del paciente reducen los costos de los productos sanguíneos y las complicaciones relacionadas con las transfusiones en los hospitales. Los costos hospitalarios son altos en pacientes pediátricos de cirugía cardíaca porque generalmente se necesitan niveles altos de hematocrito; la necesidad de hemoderivados es alta debido a los procedimientos quirúrgicos largos y complejos; la estancia en la unidad de cuidados intensivos (UCI) es larga y el uso de modalidades de tratamiento como la diálisis y la ECMO es común en esta población de pacientes. MÉTODOS: En este estudio retrospectivo; Investigamos los efectos del uso de los protocolos multidisciplinarios de manejo sanguíneo del paciente sobre el uso de hemoderivados y los costos asociados comparando los resultados del protocolo implementado en el año 2019 con el uso de hemoderivados y los costos del año anterior. En nuestra clínica se operaron 414 pacientes en 2019; 230 de ellos eran varones y 184 mujeres. RESULTADOS: Las transfusiones realizadas en cumplimiento de dichos protocolos han reducido las tasas de mortalidad junto con una disminución de los costos hospitalarios. CONCLUSIONES: Nosotros también logramos una reducción del 10% en los costos de los productos sanguíneos por paciente después de la implementación del protocolo multidisciplinario de manejo de sangre del paciente.

Effects of Dexamethasone Exposure on Neural Crest Cells and Primary and Secondary Neurulation in Chick Embryos.

AIM: To evaluate the effects of dexamethasone (Dex) treatment on neural crest cells and primary and secondary neurulation in chick embryos. MATERIAL AND METHODS: Sixty fertilized eggs with an average weight of 65 ± 2 g were incubated in 60%?70% humidity at 37.2°C ± 0.1°C. After 26 hours of incubation, the control group (n=12) received 0.1 mg/kg physiologic saline (S), group 1 (n=12) received 0.1 mg/kg Dex, group 2 (n=12) received 1 mg/kg Dex, and group 3 (n=12) received 5 mg/kg Dex into each embryonic disc. The eggs were incubated until Hamburger?Hamilton stage (HH) 15, HH18, and HH20. Then, the embryos were dissected and evaluated both macroscopically and microscopically. RESULTS: The mortality rate in the control group, group 1, and groups 2 and 3 was 27%, 48%, and 100%, respectively. The neural tube thicknesses in group 1 significantly increased in HH 15 and HH20 (p < 0.05). The mitosis number in group 1 significantly decreased in each stage (p < 0.05). Wnt-1 expression was significantly lower in group 1 in HH15 (p < 0.05) and HH18 (p < 0.05), but there was no significant difference in HH20 (p > 0.05). Fibroblast growth factor (FGF) expression was significantly lower in group 1 in HH15 (p < 0.05). The expression of N-cadherin was significantly higher in group 1 in HH20 (p < 0.05). Fibronectin expression decreased in group 1 in HH18 (p < 0.01). CONCLUSION: Although the Dex treatment did not result in neural tube closure defect, the mortality rates and neural tube thicknesses increased, whereas mitotic activation and Wnt-1 and FGF signal pathways reduced in some stages.

A gray zone in the literature: indications, options, and outcomes for surgical repair of pulmonary artery aneurysms.

Pulmonary artery aneurysms are rare. They are characterised by an aneurysmatic dilatation of the pulmonary vascular bed, including the main pulmonary artery or the accompanying pulmonary artery branches. Increases in pulmonary flow and pulmonary artery pressure increase the risk of rupture: when these conditions are detected, surgical intervention is necessary.This study is a retrospective analysis of 33 patients treated in our paediatric cardiac surgery clinic from 2012 to 2020. Aneurysms and pseudoaneurysms in patients who were patched for right ventricular outflow tract reconstruction and corrected with a conduit were excluded from the study. Seventeen (51.5%) of the patients included in the study were female and 16 (48.5%) were male. The patients were aged between 23 and 61 years (mean 30.66 ± 12.72 years). Graft interpositions were performed in 10 patients (30.3%) and pulmonary artery plications were performed in 23 patients (69.7%) to repair aneurysms. There was no significant difference in mortality between the two groups (p > 0.05).Pulmonary artery aneurysm interventions are safe, life-saving treatments that prevent fatal complications such as ruptures, but at present there is no clear guidance regarding surgical timing or treatment strategies. Pulmonary artery interventions should be performed in symptomatic patients with dilations ≥5 cm or asymptomatic patients with dilations ≥8 cm; pulmonary artery pressure, right ventricular systolic pressure, and pulmonary artery aneurysm diameter must be considered when planning surgeries, their timing, and making decisions regarding indications. Experienced surgical teams can achieve satisfactory results using one of the following surgical techniques: reduction pulmonary arterioplasty, plication, or graft replacement.

Neurological complications after pediatric cardiac surgery.

Background: The number of pediatric patients who survive open-heart surgery has increased in recent years and the complications seen in this patient group continue to decrease with each technological advance, including new surgical and neuroprotective techniques and the improvement in surgeons' experience with this patient population. However, neurological complications, which are the most feared and difficult to manage, require long-term follow-up, and increase hospital costs remain a leading cause of mortality and morbidity in this cohort. Results: We evaluated the neurological physical examination, cranial computed tomography (CT), and magnetic resonance (MRI) records of 162 pediatric patients with neurological symptoms lasting more than 24 h after undergoing heart surgery in our clinic between June 2012 and May 2020. The patients' ages ranged from 0 to 205 months, with a mean of 60.59 ± 46.44 months.Of the 3849 pediatric cardiac surgery patients we screened, 162 had neurological complications in the early period (the first 10 days after surgery). The incidence was calculated as 4.2%; 69 patients (42.6%) experienced seizures, 17 (10.5%) experienced confusion, 39 (24.1%) had stupor, and 37 (22.8%) had hemiparesis. Of the patients who developed neurological complications, 54 (33.3%) died. Patients with neurological complications were divided into 3 groups: strokes (n = 90), intracranial bleeding (n = 37), and no radiological results (n = 35). Thirty-four patients (37.8%) in the stroke group died, as did 15 (40%) in the bleeding group, and 5 (14.3%) in the no radiological results group. Conclusions: Studies on neurological complications after pediatric heart surgery in the literature are currently insufficient. We think that this study will contribute to a more detailed discussion of the issue. Responses to neurological events and treatment in the pediatric group may differ compared to the adult age group. Primary prevention methods should be the main approach in combating neurological complications; their formation mechanisms should be carefully monitored and preventive treatment strategies should be developed.