Results of international assistance for a paediatric heart surgery programme in a single Ukrainian centre.

BACKGROUND: Surgery for CHD has been slow to develop in parts of the former Soviet Union. The impact of an 8-year surgical assistance programme between an emerging centre and a multi-disciplinary international team that comprised healthcare professionals from developed cardiac programmes is analysed and presented.Material and methodsThe international paediatric assistance programme included five main components - intermittent clinical visits to the site annually, medical education, biomedical engineering support, nurse empowerment, and team-based practice development. Data were analysed from visiting teams and local databases before and since commencement of assistance in 2007 (era A: 2000-2007; era B: 2008-2015). The following variables were compared between periods: annual case volume, operative mortality, case complexity based on Risk Adjustment for Congenital Heart Surgery (RACHS-1), and RACHS-adjusted standardised mortality ratio. RESULTS: A total of 154 RACHS-classifiable operations were performed during era A, with a mean annual case volume by local surgeons of 19.3 at 95% confidence interval 14.3-24.2, with an operative mortality of 4.6% and a standardised mortality ratio of 2.1. In era B, surgical volume increased to a mean of 103.1 annual cases (95% confidence interval 69.1-137.2, p<0.0001). There was a non-significant (p=0.84) increase in operative mortality (5.7%), but a decrease in standardised mortality ratio (1.2) owing to an increase in case complexity. In era B, the proportion of local surgeon-led surgeries during visits from the international team increased from 0% (0/27) in 2008 to 98% (58/59) in the final year of analysis. CONCLUSIONS: The model of assistance described in this report led to improved adjusted mortality, increased case volume, complexity, and independent operating skills.

Novel use of extracellular matrix graft for creation of pulmonary valved conduit.

We report the use of a commercially available graft material to create a trileaflet pulmonary valved conduit, which was implanted in a 12-year-old girl with mixed aortic valve disease as part of a Ross procedure. The patient presented with severe aortic insufficiency and left ventricular dilatation following balloon valvuloplasty. The patient lives in Ecuador, where most commonly used replacements for the pulmonary valve are either unavailable or unaffordable. Our technique involves the use of porcine small intestinal submucosal extracellular matrix (SIS-ECM), commercially available as CorMatrix ECM (CorMatrix Cardiovascular, Inc, Tallahassee, Florida) to create a trileaflet-valved conduit.

Anomalous left coronary artery from the pulmonary artery: intermediate results of coronary elongation.

A two coronary system is preferred for correcting anomalous left coronary artery from the pulmonary artery (ALCAPA); however, translocation is not always possible. In countries where neonatal arterial switch operations have not been perfected coronary transfer can be difficult. The purpose of this report is to describe the intermediate results using the coronary elongation and translocation technique in developing countries. Records of patients undergoing operation by the International Children's Heart Foundation team were reviewed (April 1993-October 2008) for those undergoing ALCAPA repair. All patients received a 2-D echocardiographic-color Doppler examination prior to discharge and at follow-up. A total of 13 patients were identified, age ranged from 9 days to 41 years. All but one patient were operated upon at one of our affiliate hospitals in Croatia, Belarus, China and Colombia. All patients presented with moderate to severe mitral regurgitation and cardiac failure. Follow-up ranged from six months to 9.5 years postoperatively. Color Doppler showed a patent left coronary artery; echocardiography estimated a normal left ventricular ejection fraction and improved mitral regurgitation in all patients. The technique provides an alternative approach to translocation for ALCAPA in countries where routine neonatal coronary transfer techniques may not be perfected. Intermediate results are comparable to translocation.

Use of the Quest Myocardial Protection System (MPS) for modified ultrafiltration during pediatric cardiac surgery.

Modified ultrafiltration generally is considered a standard of care for treating children undergoing cardiopulmonary bypass for congenital heat surgery. Different methods, incorporating a variety of devices and technologies, have been described. The present report describes a technique of modified ultrafiltration using arterial-venous flow with the Quest Myocardial Protection System (MPS).