[Congenital heart disease: surgical results in a public hospital in Argentina]. / Cardiopatías congénitas: resultados quirúrgicos en un hospital público en Argentina.

OBJECTIVE: To describe the results of congenital heart surgery at the Hospital de Pediatría J. P.Garrahan. METHODS: Between 2004 and 2009, 2942 patients, median age 2.5 years (1 d to 22.5 y), median weight 11.5 kg (1.6 kg to 96 kg), and 84% with cardiopulmonary bypass, were analyzed. Adjusted mortality risk analysis using RACHS and Aristotle score was performed. Newborn surgery and one stage repair in Fallot and ventricular septal defect with coarctation were analyzed as subgroupes. RESULTS: Mortality was 5.5%. Required mechanical ventilation 45%, 5% peritoneal dialysis, 12% delayed sternal closure and 8.4% reoperation. Twenty five percent with previous surgery, and 10% in poor clinical conditions. RACHS-1 categories morality distribution were 0.4% in one, 2.4% in two, 7.1% in three, 14% in four y 34 % in 5 and 6. One stage repair was performed in 84% of Fallots and 90% of ventricular septal defects with coarctation, with 3.2% and 10% mortality rate respectively. Two hundred and five newborns were operated with cardiopulmonary bypass with a mortality rate of 15% in the last year. CONCLUSIONS: Almost every congenital heart disease can be repaired without previous palliation, with satisfactory results in our institution. Poor clinical conditions significantly increased morbidity and mortality.

Cardiopatías congénitas: resultados quirúrgicos en un hospital público en Argentina / Congenital heart disease: surgical results in a public hospital in Argentina

Objetivo: Describir los resultados en cirugía cardiovascular del Hospital de Pediatría J. P. Garrahan. Métodos: Se analizaron 2942 pacientes entre 2004 y 2009; de los cuales, 84% con circulación extracorpórea, mediana de edad 2.5 años, rango de un día a 22.5 años y peso 11.5 kg (1.6 kg a 96 kg); con cirugías previas 25% y 10% malas condiciones preoperatorias. Se analizó la mortalidad por RACHS-1 y Aristóteles, la cirugía neonatal, la cirugía en un tiempo de Fallot y de comunicación interventricular con coartación de aorta. Resultados: La mortalidad fue 5.5%. Requirió ventilación mecánica 45%, 5% diálisis peritoneal, 12% cierre esternal diferido y 8.4% reoperación. De los Fallot 84% y 90% de las comunicaciones interventriculares con coartación se repararon en un tiempo, con 3.2% y 10% de mortalidad respectivamente. Se operaron 205 neonatos con bomba y con 15% de mortalidad en el último año. Las malas condiciones previas aumentaron la morbilidad, (Odds ratio 3.63 IC 95%, 2.27 -4.81) y la mortalidad (Odds ratio 6.47 IC 95%, 4.36 - 9.60). La mortalidad por RACHS fue 0.4% en categoría uno, 2.4% en la dos, 7.1% en la tres, 14% en la cuatro y 34% en la cinco y seis. Conclusiones: En nuestra institución la mayoría de las cardiopatías se resuelven en un tiempo con resultados satisfactorios. Las malas condiciones preoperatorias aumentan significativamente la morbimortalidad.

Objective: To describe the results of congenital heart surgery at the Hospital de Pediatría J. P.Garrahan. Methods: Between 2004 and 2009, 2942 patients, median age 2.5 years (1 d to 22.5 y), median weight 11.5 kg (1.6 kg to 96 kg), and 84% with cardiopulmonary bypass, were analyzed. Adjusted mortality risk analysis using RACHS and Aristotle score was performed. Newborn surgery and one stage repair in Fallot and ventricular septal defect with coarctation were analyzed as subgroupes. Results: Mortality was 5.5%. Required mechanical ventilation 45%, 5% peritoneal dialysis, 12% delayed sternal closure and 8.4% reoperation. Twenty five percent with previous surgery, and 10% in poor clinical conditions. RACHS-1 categories morality distribution were 0.4% in one, 2.4% in two, 7.1% in three, 14% in four y 34 % in 5 and 6. One stage repair was performed in 84% of Fallots and 90% of ventricular septal defects with coarctation, with 3.2% and 10% mortality rate respectively. Two hundred and five newborns were operated with cardiopulmonary bypass with a mortality rate of 15% in the last year. Conclusions: Almost every congenital heart disease can be repaired without previous palliation, with satisfactory results in our institution. Poor clinical conditions significantly increased morbidity and mortality.

Clinical experience with Berlin Heart Excor in pediatric patients in Argentina: 1373 days of cardiac support.

The objective of this study was to describe our experience (1373 days of support) with the Berlin Heart Excor (BH) ventricular-assist device (VAD) as bridging to cardiac transplantation in pediatric patients with end-stage cardiomyopathy. This study involved a retrospective observational cohort. Records of patients supported with the BH VAD were reviewed. Data regarding age, sex, weight, diagnosis, preoperative condition, single versus biventricular support, morbidity, and mortality were collected. Criteria for single versus biventricular support and intensive care unit management were registered. The procedure was approved by our Institutional Ethics Committee, and informed consent was obtained. Between March 2006 and March 2010, 12 patients with diagnosis of dilated (n = 10) and restrictive (n = 2) cardiomyopathy were supported. Median age was 56.6 months (range 20.1-165.9); mean weight was 18.3 kg (range 8.5-45); and nine patients were female. Every patient presented with severe heart failure refractory to pharmacological therapy. Biventricular support was necessary in four patients. Nine patients underwent heart transplantation. No child was weaned off the BH VAD because of myocardial recovery. Mean length of support was 73 days (range 3-331), and the total number of days of support was 1373. Three patients had fatal complications: 2 had thrombo-hemorrhagic stroke leading to brain death, and one had refractory vasoplegic shock. The BH VAD is a useful and reasonable safe device for cardiac transplantation bridging in children with end-stage heart failure. Team experience resulted in less morbidity and mortality, and time for implantation, surgical procedure, anticoagulation monitoring, and patient care improved.