CardioCel® for repair of congenital heart defects: nationwide results of over 1000 implants.

OBJECTIVES: To assess the mid-term performance of CardioCel for the repair of congenital heart defects. METHODS: Data were retrospectively collected from databases and hospital records in 3 congenital cardiac surgery centres in Australia. Kaplan-Meier curves and log-rank tests were used to test for associations between patient age, gender, patch type and site of implantation. Multivariable Cox regression was used to test whether any specific implantation site was associated with reintervention risk, after adjusting for age group, gender and patch type. RESULTS: A total of 1184 CardioCel patches were implanted in 752 patients under the age of 18 years. Median age at implant was 12 months [interquartile range (IQR) 3.6-84]. Median follow-up was 2.1 years (IQR 0.6-4.6). Probability of freedom from CardioCel-related reintervention was 93% [95% confidence interval (CI) 91-95] at 1 year, 91% (95% CI 88-93) at 3 years and 88% (95% CI 85-91) at 5 years, respectively. On multivariable regression analysis, aortic valve repair had a higher incidence of reintervention [hazard ratio (HR) = 7.15, P = 0.008] compared to other sites. The probability of reintervention was higher in neonates (HR = 6.71, P = 0.0007), especially when used for augmentation of the pulmonary arteries (HR = 14.38, P = 0.029), as compared to other age groups. CONCLUSIONS: CardioCel can be used for the repair of a variety of congenital heart defects. In our study, in patients receiving a CardioCel implant, reinterventions were higher when CardioCel was used to augment the pulmonary arteries in neonates and for aortic valve repair as compared to other sites.

Utility of routine chest radiographs after chest drain removal in paediatric cardiac surgical patients-a retrospective analysis of 1076 patients.

OBJECTIVES: Chest drains are routinely placed in children following cardiac surgery. The purpose of this study was to determine the incidence of a clinically relevant pneumothorax and/or pleural effusion after drain removal and to ascertain if a chest radiograph can be safely avoided following chest drain removal. METHODS: This single-centre retrospective cohort study included all patients under 18 years of age who underwent cardiac surgery between January 2015 and December 2019 with the insertion of mediastinal and/or pleural drains. Exclusion criteria were chest drain/s in situ ≥14 days and mortality prior to removal of chest drain/s. A drain removal episode was defined as the removal of ≥1 drains during the same episode of analgesia ± sedation. All chest drains were removed using a standard protocol. Chest radiographs following chest drain removal were reviewed by 2 investigators. RESULTS: In all, 1076 patients were identified (median age: 292 days, median weight: 7.8 kg). There were 1587 drain removal episodes involving 2365 drains [mediastinal (n = 1347), right pleural (n = 598), left pleural (n = 420)]. Chest radiographs were performed after 1301 drain removal episodes [mediastinal (n = 1062); right pleural (n = 597); left pleural (n = 420)]. Chest radiographs were abnormal after 152 (12%) drain removal episodes [pneumothorax (n = 43), pleural effusion (n = 98), hydropneumothorax (n = 11)]. Symptoms/signs were present in 30 (2.3%) patients. Eleven (<1%) required medical management. One required reintubation and 2 required chest drain reinsertion. CONCLUSIONS: The incidence of clinically significant pneumothorax/pleural effusion following chest drain removal after paediatric cardiac surgery is low (<1%). Most patients did not require reinsertion of a chest drain. It is reasonable not to perform routine chest radiographs following chest drain removal in most paediatric cardiac surgical patients.

Subperiosteal Orbital Hematoma From SVC Occlusion During Cardiac Surgery: To See or Not to See.

We present a case in which the superior vena cava (SVC) cannula was inadvertently clamped for a short while during cardiopulmonary bypass, completely occluding SVC drainage. This resulted in a rarely seen complication - bilateral subperiosteal orbital hematomas causing orbital compartment syndrome. Other instances of intentional SVC occlusion include during the creation of a bidirectional cavo-pulmonary shunt and for emergency control of bleeding during thoracic surgery.

Left atrial maze procedure using diathermy and high-frequency ultrasound as an adjunct to mitral valve replacement in mitral valve disease with atrial fibrillation: a comparative study.

PURPOSE: Mitral valve disease is often complicated with atrial fibrillation (AF). Conventional treatment for AF has now been replaced by various energy sources. Our purpose was to evaluate a cost-effective and efficient energy source for performing the Maze procedure. We evaluated and compared diathermy and high-frequency ultrasound as energy source to create maze lines, in terms of outcome. METHODS: Forty patients with mitral valve disease requiring mitral valve replacement and in atrial fibrillation were included in the study. Twenty patients underwent the Maze procedure using diathermy and 20 using high-frequency ultrasound (Harmonic scalpel probe). All Maze lines were made endocardially from within the cavum of the left atrium isolating the pulmonary veins. All patients were assessed by standard 12 lead electrocardiogram (ECG) in the postoperative period as well as in each follow up visit. Left atrial appendage was ligated in those having left atrium (LA) clot. RESULTS: Sinus rhythm was restored in 95% of patients in the immediate postop period in diathermy group as compared to 90% in the high-frequency ultrasound group. At 3 months, 90% were in sinus rhythm in the diathermy group and 85% in the high frequency ultrasound (HFU) group. Statistically significant differences between groups were observed in the following variables: cardiopulmonary bypass (CPB) time (p = 0.011), cross clamp time (p = 0.019), maze time (p = 0.00), and in hospital stay (p = 0.05). CONCLUSION: Both energy sources were safe, time sparing, effective, and simple; however, the diathermy took less time to perform maze than the HUF and the total CPB time and cross clamp time was less in the diathermy group.