Fontan Completion for Younger than 3 Years of Age: Outcome in Patients with Functional Single Ventricle.

Most single ventricle patients undergo Fontan procedure earlier in current era. However, optimal timing of Fontan completion after an intermediate staging surgery is controversial. We present children who had Fontan surgeries younger than 3 years of age comparing the data with older patients. Between 2000 and 2013, 45 patients with functional single ventricle underwent extracardiac total cavopulmonary connection (TCPC) using GORE-TEX(®) conduit at a single institution. Children were divided into group A (age < 36 months; n = 15) and group B (age ≥ 36 months; n = 30), and retrospectively reviewed. Median follow-up was 2.9 [interquartile range (IQR) 2-4.4] years. There were two hospital deaths and one late death (all in group B, p = 0.286). One TCPC was taken down in group A. The median intensive care unit and hospital stay were 90 (IQR 46-140) h and 21 (IQR 16-33) days for group A versus 65 (IQR 45-115) h and 29 (IQR 20.8-38.5) days for group B, respectively (p = 0.322 and p = 0.057). Ventricular ejection fraction and GORE-TEX(®) conduit size were similar in both groups. The time of chest drain stay was significantly lower in group A (median 12 days, IQR 7-22) than in group B (22 days, IQR 16-32.5) (p = 0.014). Extracardiac TCPC can be performed earlier with good intermediate results. Earlier Fontan procedure might be advantageous for reducing chest drains stay.

Sustainable knowledge transfer in pediatric cardiac surgery: a team approach to shared learning.

The study assesses the impact of a program using a model of knowledge transfer on the long-term development of a pediatric cardiac service in Lithuania. A team from the United Kingdom evaluated Lithuanian pediatric cardiac services and provided support in areas targeted for improvement. The total number of infant operations performed in Lithuania from 1990 to 2008, together with in-hospital mortality rates, was broken down into 3 time periods and analyzed to estimate the efficacy of the program: (1) 1990-1998, before the program; (2) 1999-2002, during the program; (3) 2003-2008, following the end of the program. Lithuanian results in children older than 1 year were comparable with other European centers. However, only 315 infant and neonatal cardiac procedures were performed between 1990 and 1998, and there was an in-hospital mortality of 34.2%. Between 1999 and 2002, the UK team performed 23 highly complex demonstration procedures (in-hospital mortality, 13%). During the same period the Lithuanian team performed 305 additional operations in neonates and infants, and in-hospital mortality decreased to 18.7%. From 2003 to 2008 results continued to improve-559 infant operations were performed, with in-hospital mortality of 11.3% (P < .0001). Knowledge transfer has led to substantial and sustainable long-term improvement in the results of infant cardiac surgery in Lithuania. Demonstrating techniques and care on a limited number of more complex cases is an efficient way of transferring knowledge and skills to the developing pediatric cardiac centers.

[Surgical treatment of critical aorta coarctation in neonates]. / Naujagimiu aortos koarktaciju chirurginis gydymas.

UNLABELLED: Coarctation of the aorta is relatively common defect accounting for 5-8% of all congenital heart defects. Newborns very often, about in 50% of cases, are in cardiogenic shock. From 1991 to 2003, 26 neonates with coarctation of the aorta underwent surgical repair at Heart Surgery Center of Vilnius University: 12 with isolated coarctation of the aorta and 14 with leading heart pathology. Age of patients was from 2 to 30 days. Weight was from 2.8 to 4.7 kg. Fifty percent of neonates were on ventilatory and inotropic support. All neonates were operated using surgical technique "end-to-end" or extended "end-to-end" in case of aortic arch hypoplasia. All neonates with isolated coarctation of the aorta survived; with leading heart pathology mortality was 14.3%. From 26 operated neonates 2 had recoarctation, 1 - reoperation and 2 - balloon aortoplasty. Our patients were free from spinal chord ischemia and brain damage. CONCLUSIONS: Neonatal coarctation of the aorta needs an urgent surgical treatment. Surgery remains a gold standard for the treatment of aorta coarctation. Preferable technique is "end-to-end" anastomosis or extended coarctation resection with "end-to-end" anastomosis for hypoplastic aortic arch. Associated cardiac pathology increases risk of operation.

[Congenital heart surgery in neonates]. / Naujagimiu igimtu sirdies ydu chirurgija.

From January 1974 trough August 2002 184 neonates with congenital heart disease underwent surgical repair in Heart Surgery Clinic of Vilnius University. It came to 3.8% of all 4813 procedures of congenital heart diseases performed. Number of neonates operations considerably increased in the latter's years, because special Department with proper technique was established. One hundred and seven neonates were operated without cardiopulmonary bypass with 36.4% postoperative mortality rate. Seventy seven neonates underwent surgery repair with cardiopulmonary bypass. Postoperative mortality rate was 67.5% in this group. Mean age of patients was 11.96+/-0.28 days. Unsatisfactory results of neonates operations with cardiopulmonary bypass, especially such as left heart hypoplasia syndrome is the main problems. The group of specialists performing repair of congenital heart diseases is working actively in the heart Surgery Clinic of Vilnius University. Improvement of surgery methods and results, following the best Heart Surgery Clinics of the world, is the main purpose of this group.