Day 1 :
Keynote Forum
Bob Kiaii
University of Western Ontario, Canada
Keynote: Twenty-years of experience with robotic-assisted Coronary artery bypass grafting with post-operative angiography
Time : 10:00-10:45
Biography:
Bob Kiaii is working as a Professor in the Department of Surgery and Chair of the Division of Cardiac Surgery at the Schulich School of Medicine at the University of Western Ontario. He is a Cardiac Surgeon and the Chief of the Division of Cardiac Surgery and Director of the Minimally Invasive Robotic Cardiac Surgery Program at the London Health Sciences Centre. He is also one of the Founding Members of Canadian Surgical Advanced Technology and Robotics (CSTAR) of the Lawson Health Research Institute. He has performed ground-breaking minimally invasive robotic-assisted cardiac procedures including the first North American simultaneous integrated coronary artery revascularization procedure on September 1, 2004.
Abstract:
Objective: Minimally Invasive coronary artery bypass grafting (CABG) is a rapidly evolving technology that has been shown to increase patient satisfaction and to reduce surgical morbidity and recovery times. Therefore, we present out institutional experience with minimally invasive robotic-assisted CABG with post-operative cardiac catheterization.
Methods: The study cohort includes all patients who underwent robotic-assisted CABG between September 1998 and March 2018. Anastomoses were manually constructed through a small anterior non-rib spreading incision or closed chest robotic assistant without cardiopulmonary bypass on the beating heart and all internal thoracic arteries were harvested with robotic-assistance. Angiographic confirmation of graft patency was performed either immediately within the same operative suite equipped with angiographic equipment or next day in the cardiac catheterization lab.
Results: Since 1998, a total of 645 patients underwent robotic-assisted minimally invasive CABG. Total of 484 patients were males and mean age was 60 years. There were two deaths (0.4%) secondary to respiratory complications and six wound infections (1.2%). Seven (1.4%) patients required re-exploration for bleeding. Median length of stay in the intensive care unit was one day and length of hospital stay was four days. The patency rate of left internal thoracic artery (LITA) grafts to the left of the anterior descending artery (LAD) was 97% with eight occluded grafts, which underwent revision.
Conclusion: Robotic-assisted CABG is a safe and feasible alternative approach to surgical revascularization. It has the potential of reducing morbidity of surgery by reducing infection and bleeding. Post-operative assessment with cardiac catheterization enables the achievement of a very high post-operative patency rate.
Keynote Forum
Michael McGillion
McMaster University, Canada
Keynote: Remote automated postoperative monitoring: Need for and state of the science
Time : 11:05-11:55
Biography:
Michael McGillion is an Associate Professor and Assistant Dean (Research) in the School of Nursing at McMaster University. He holds the Heart and Stroke Foundation/Michael G DeGroote Endowed Chair of Cardiovascular Nursing Research at McMaster and is a Scientist at the Population Health Research Institute in Hamilton, Ontario. His program of research focuses on remote automated monitoring and virtual nursing recovery support models to improve hemodynamic, pain and related recovery outcomes following cardiac, vascular and other forms of surgery. He is Co-Chair of the Heart and Stroke Foundation Pan-Canadian Council on Mission: Priorities in Advice, Science and Strategy (CoMPASS).
Abstract:
Although surgery has the potential to improve quality and duration of life, it can also precipitate major complications. Current systems for monitoring patients after surgery, both on surgical wards and after transition to home, are not adequate. In operating rooms and intensive/post anesthetic care units, there is continuous hemodynamic surveillance. Yet, when patients are transferred to surgical wards, most will have their vital signs evaluated only every 4 to 12 hours. This scenario leads to thousands of cases of undetected hemodynamic compromise, associated with poor clinical outcomes. This state of the science talk, focused on perioperative digital health, will review remote automated postoperative monitoring and virtual care models, as well as lessons learned for moving the field forward. Key considerations for overcoming current barriers to implementation in Canada will also be presented.
Keynote Forum
Tofy Mussivand
University of Ottawa, Canada
Keynote: Coronary artery disease detection by blood flow turbulence
Time : 11:55-12:45
Biography:
Tofy Mussivand achievements and sustained outstanding scientific excellence through research, innovations, discoveries, publications, teaching, and mentoring have led to significant and meaningful contributions to the accumulation, transfer, dissemination, technologies, products and utilization of knowledge that have shaped the present and future of medical devices, with major impacts on health care worldwide. Prof. Mussivand is an internationally acclaimed and renowned scientist, problem solver, educator, humanitarian and inventor. He is an inspiring leader who through sustained creative innovations; hard work and perseverance grew to be one of the world’s most prominent and respected scientists.
Abstract:
Generally, blood flow throughout the circulatory system, is laminar. In a laminar flow, each particle is moving in parallel in a smooth path through the vessel with constant velocity at any point. The highest velocity is in the center. Under certain conditions such as high velocity and low blood viscosity (as in anemia caused by reduced hematocrit), stenosis, and other cardiovascular diseases, laminar flow can be disrupted and become turbulent. A turbulent flow is chaotic, irregular, with fluctuating velocity at any point with eddies, whirlpools, microbruits, and specific acoustic signatures. Turbulent flow increases shear forces activating platelets and thrombus development, can damage red blood cells. Turbulent blood flow impacts the endothelial lining causing initiation of atherosclerosis. Aging and calcification, cause hemodynamic (velocity, shear stress) changes. Assessing the degree of turbulent is highly desirable. Turbulence can be predicted by (Reynolds number) Re=p d V/n Where Re: Reynolds number. Below 2000 laminar, above 2500 usually turbulent. p: fluid's density, d: diameter of the vessel, V: flow velocity and n: viscosity. Turbulent flow properties can be used for diagnosis of cardiovascular disease (stenosis, murmur and anemia). Several technologies have been developed for detecting turbulent. The Ottawa heart Institute is testing one of these technologies. So far, 290 patients are enrolled in the study and the results are promising. A multi-center clinical trial is planned.
Keynote Forum
Jun Feng
Brown University, USA
Keynote: Microvascular dysfunction in diabetic patients after cardiac surgery
Time : 13:30-14:15
Biography:
Jun Feng is currently an Associate Professor of Surgery (Research) at Warren Alpert Medical School of Brown University and at Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital. He is also the Director and Senior Research Scientist of Cardiothoracic Surgery Research Laboratory at Rhode Island Hospital. He serves as Principal Investigator on grants funded by National Institute of Health (2 active R01s and 2-NIH-COBRE-pilot projects), American Heart Association (Grant-In-Aid, active), and Rhode Island Foundation. He also serves as Co-investigator on a number of grants funded by the National Institute of Health and other research-funding organizations. He has published more than 120 peer-reviewed/editorial articles/book chapters and 140 abstracts as correspondent author, first author and co-author. He has served as an Editorial Member, Editorial Commentator and Peer Reviewer for several scientific journals in Cardiovascular Research and Medicine.
Abstract:
Diabetes mellitus (DM) is associated with severe autonomic dysfunction and vasomotor dysregulation. DM has been associated with increased morbidity and mortality in patients undergoing any cardiac surgical procedures and following coronary artery bypass grafting (CABG) specifically. In particular, these changes are more profound in patients with poorly controlled diabetes. Diabetes is associated with vascular dysfunction in all tissues, including the microvasculature. DM is associated with significant changes in vascular reactivity of coronary/peripheral microcirculation, vascular permeability, gene/protein expression, and programmed cell death, as well as with increased morbidity and mortality after surgical procedures. Many of the microvascular and macrovascular complications of diabetes are related to increased oxidative/nitrosative stress, hyperglycemia, and changes in vascular signaling. Recently, we reported differential microvascular regulation before and after CP/CPB, correlating to the extent of serum glucose control. Alterations in vasomotor regulation can lead to vasoplegia, a common complication of CP/CPB seen in up to 25% of patients. Vasoplegia manifests with decreased systemic vascular resistance and hypotension. These patients are at increased risk of morbidity and mortality following cardiac surgery and CP/CPB. The incidence of postoperative vasodilatory shock is higher in patients with diabetes for a number of reasons. Vasoplegia has traditionally been treated with vasopressors, such as phenylephrine, and vasopressin. These medications must be administered carefully to avoid potentially dangerous side effects, including peripheral ischemia of the extremities and mesenteric ischemia, leading to tissue necrosis, mucosal injury and metabolic acidosis. In addition, peripheral vascular responses to vasoactive agents such as phenylephrine may affect the coronary circulation in a differential manner from the rest of the body by increasing systemic blood pressure suddenly while reducing coronary artery blood flow. A better understanding of the regulation of the microvasculature may lead to improved outcomes in the patients with and without diabetes.
- Cardiology | Cardiac Surgery | CAD/Ischemic Heart Disease | Valvular Heart Disease | Diabetes, Obesity & Stroke | Cardiac Imaging | Interventional Cardiology
Location: BAR LOUNGE
Chair
Bob Kiaii
University of Western Ontario, Canada
Session Introduction
Diamond Fernandes
Heart Fit Clinic, Canada
Title: Navigating Cardiovascular Disease - Where is the Gap Between Family Doctors and Cardiologists?
Time : 14:15-15:00
Biography:
Diamond Fernandes is your authority on cardiac rehabilitation and prevention. He is a graduate of the University of Calgary, and certified by the American College of Sports Medicine. He started his career with Total Cardiology Rehabilitation in Calgary, and was then recruited to go to Dubai, UAE. From there, he went on to manage the Kelowna (BC) Cardiac Rehabilitation program before starting the Heart Fit Clinic in Calgary, AB. He serves on the executive board for the Canadian Association of Cardiovascular Prevention and Rehabilitation (CACPR). He is the published author of the book "Beating Heart Disease" and is the director of the Heart Fit Clinic. His focus is on an integrative approach to helping people prevent, halt, and reverse heart disease.
Abstract:
Biography:
Gibran Roder Feguri has completed his PhD from Federal University of Mato Grosso and is pursuing his Post-doctoral studies. He is a specialist in Cardiovascular Surgery and Artificial Cardiac Stimulation by the Brazilian Society of Cardiovascular Surgery (BSCVS). He is currently the Head of the Medical Residency Program in Cardiovascular Surgery at the General University Hospital (HGU/UNIC) and is a Professor at the same institution. He has published more than 10 papers in reputed journals and has been serving as a Reviewer in the Brazilian Journal of Cardiovascular Surgery, among others.
Abstract:
Background: A strategy of limited preoperative fasting, with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA), has seldom been tried in surgery.
Aim: The aim of this study was to evaluate clinical variables, mortality and effects on the metabolism and inflammation after coronary artery bypass grafting (CABG)/cardiopulmonary bypass (CPB) in combination, if preoperative fasts are curtailed in favor of CHO loading, and ω-3 PUFA are infused intraoperatively.
Methods: Fifty-seven patients were randomly assigned to receive 12.5% maltodextrin (200ml, 2h before anesthesia), (CHO, n=14); water (200ml, 2h before anesthesia), (controls, n=14); 12.5% maltodextrin (200ml, 2h before anesthesia) plus intraoperative ω-3 PUFA (0.2g/kg) (CHO+W3, n=15); or water (200ml, 2h before anesthesia) plus intraoperative ω-3 PUFA (0.2g/kg) (W3, n=14). Insulin resistance and glucose control were analyzed.
Results: Two deaths occurred (3.5%), but there were no instances of bronchoaspiration and mediastinitis. Patients given preoperative CHO loads experienced fewer instances of hospital infection (P<0.05) and were less reliant on vasoactive amines during surgery (RR=0.60, 95% CI: 0.38-0.94; P=0.020), and while recovering in ICU (P=0.008). Groups given ω-3 PUFA experienced significantly fewer instances of POAF (RR=4.83, 95% CI: 1.56-15.02; P=0.001). Patients given preoperative CHO loads also got better glycemic control in ICU (P=0.015) and less need for exogenous insulin (P=0.018). Patients in the W3 Group presented lower values of the ultrasensitive CRP with 36 h of PO (P=0.008).
Conclusion: When implemented in conjunction with CHO loading and infusion of ω-3 PUFA during surgery, expedited recovery from CABG was observed.
Ravi Kumar Baral
Tribhuwan University, Nepal
Title: Right anterior minithoracotomy with conventional mechanical heart valve prosthesis initial experiences
Biography:
Ravi Kumar Baral is a young and vibrant Cardiac Surgeon working in a position of Assistant Professor in the Department of Cardiothoracic and Vascular Surgery at University Hospital. He has completed his MCh in Cardiothoracic and Vascular Surgery in the year 2015. He has special interest in aortic surgery and mini-invasive cardiac surgery. He has performed more than 60 cases of mini atrial septal defect surgeries before moving into more complex valvular surgeries through a mini-invasive approach.
Abstract:
Background: Heart valve surgery from minithoracotomy has become in most centers worldwide but still is not much popular in our part of world in view of high cost involved. Suture less heart valve cost a lot in our part of world and has become most limiting factor for use of minithoracotomy in heart valve surgeries. We in our center have reexplored use of the conventional valve from right minithoracotomy aortic position.
Method: It is a review of a prospectively collected data of patient undergoing mini aortic valve replacement over one-year period. We have used conventional mechanical heart valve in aortic position in rheumatic aortic stenosis and regurgitation.
Result: Total 20 AVR has been performed from right anterior mini thoracotomy over one year. 12 (60%) of patient were male, one of the patient got reexplored from same incision for mediastinal bleeding. Mean total pump run and aortic cross clamp time was 96 and 88 minutes respectively.
Aris Lacis
Children Hospital, Latvia
Title: Autologous bone marrow-derived mononuclear cells delivery in wide spectrum of pathologies
Biography:
Aris Lacis, cardiac surgeon, professor, MD, PhD graduated Riga Medical Institute in 1961. General and thoracic surgeon in P. Stradina University Hospital in Riga (1964–1969). Cardiac surgeon in the Latvian Centre for Cardiovascular Surgery (1969–1994). Since 1994 until 2012 – the head of Pediatric Cardiology and Cardiac Surgery Clinic in University Children’s Hospital, Riga; since 2012 – a consulting professor of this Clinic. 2008–2013 – President of Latvian Association for Cardiovascular Surgeons. 2012–2016 – President of Latvian Association for Pediatric Cardiology. Author of 395 scientific publications, 3 monographs and 13 patents. Investigator in more than 10 clinical trials including cardio-surgical procedures performed under deep hypothermia, hybrid procedures etc. In May 2009 have been used transcutan intramyocardial delivery techniques for treatment 3 months aged patient (idiopathic dilated cardiomyopathy) using autologous bone marrow derived progenitor cells. In November 2010 the first patient with end stage pulmonary hypertension received intrapulmonary implantation autologous stem cells.
Abstract:
Context: The promising field of regenerative medicine is working to restore structure and function of damaged tissues and organs. The adult heart represents an attractive candidate for cell-based technologies. While there is a wealth of preclinical and clinical data showing the safety, feasibility, and efficacy of stem cells in adults with acute myocardial infarction and heart failure, less is known about possible implementation of stem cell therapy in infants and children with heart failure due to dilated cardiomyopathy and pulmonary arterial hypertension. The challenges facing cardiac stem cell therapy are multiple. There are uncertainties around the destiny of stem cells after their injection into the blood stream. In particular, it regards migration and homing of implanted cells in the target tissues. As yet unclear is the possible role of sympathetic nervous system in the context of osteoreflexotherapy. There is still no definitive answer to the question on which is the preferred type of stem cells to be use for transplantation in different settings. Since 2008, at first we used autologous bone marrow-derived mononuclear cells (BM-MNCs) in patient with acute myocardial infarction. We have investigated the use of stem cells not only for myocardial regeneration, but also in patients with diabetes mellitus and osteoarthritis in adult patients. Since 2009, we started stem cells implantation for pediatric patients.
Objective: To determine the role of BM-MNCs in management of wide spectrum of pathologies, including critically ill pediatric patients suffering from idiopathic dilated cardiomyopathy and severe pulmonary arterial hypertension and adult patients with acute myocardial infarction and heart failure and adult patients with osteoarthritis.
Design, Settings, Participants: Two patients (9 and 15 years old) with trisomy 21 and severe pulmonary arterial hypertension due to uncorrected large ventricular septal defects received intrapulmonary BM-MNCs implantation. Radionuclide scintigraphy showed improvement of lungs vascularization during 36 months follow-up. Seven patients (4 months – 17 years) with dilated idiopathic cardiomyopathy received intramyocardial BM-MNCs injections. During follow-up (up to 10 years), we observed improvement of left ventricular ejection fraction (LVEF), decrease of left ventricular end diastolic dimension by echocardiography and cardio-thoracic index at chest X-ray exams, reduction of serum brain natriuretic peptide serum levels and decrease of the stage of heart failure from stage IV to stage I, by NYHA classification. No periprocedural harmful side effects were observed. Two children had heart transplantation (on the 2nd and 4th year after stem cells implantation). We performed BM-MNCs intracoronary infusion in 101 adult patients with acute myocardial infarction with reduced LVEF and in 14 patients with chronic heart failure. Our results showed statistically significant improvement in LVEF at 12 months. We also infused BM-MNCs to the pancreas directly via branches of splenic artery or superior pancreaticoduodenal artery we have performed single intra-articular BM-MNCs injections in 70 patients with knee or hip joint osteoarthritis (stage II–III). No adverse effects after the BM-MNC injection were observed. Preliminary analysis showed decrease in pain and other symptoms and statistically significant improvement by clinical scoring system using different questionnaires.
Conclusions: The results are promising and we suggest that BM-MNCs might be used for the stabilization of the adult and pediatric patients to improve symptoms and outcomes or serve as a bridge for heart or lung transplantation or delay joint replacement surgery. It also could be recommended in cases if other more traditional treatment options fail or are contraindicated.
- Cardiology | Cardiac Surgery | Congenital Heart Disease and Pediatrics | Heart Disease & Failure | Hypertension and Healthcare | Cardiac Imaging |Interventional Cardiology
Location: BAR LOUNGE, Holiday Inn Express & Suites Montreal Airport
Chair
Lale Hakami
Ludwig Maximilians University, Germany
Session Introduction
Diamond Fernandes
Heart Fit Clinic, Canada
Title: Beating heart disease - Is it even possible? How can we treat stable cardiovascular disease?
Biography:
Diamond Fernandes is your authority on cardiac rehabilitation and prevention. He is a graduate of the University of Calgary, and certified by the American College of Sports Medicine. He started his career with Total Cardiology Rehabilitation in Calgary, and was then recruited to go to Dubai, UAE. From there, he went on to manage the Kelowna (BC) Cardiac Rehabilitation program before starting the Heart Fit Clinic in Calgary, AB. He serves on the executive board for the Canadian Association of Cardiovascular Prevention and Rehabilitation (CACPR). He is the published author of the book "Beating Heart Disease" and is the director of the Heart Fit Clinic. His focus is on an integrative approach to helping people prevent, halt, and reverse heart disease.
Abstract:
Bo Dong and Qingyu Wu
Tsinghua University, China
Title: Surgical results of Ebstein’s anomaly based on pathology and techniques
Biography:
Dr. Bo Dong graduated from China Medical University in 2009 and got the Bachelor's Degree in Medicine. Then he completed further training in 2011 and got the Master Degree in Surgery. After that he was admitted to School of Medicine in Tsinghua University, majoring in cardiac surgery. Under the guidance of Prof. Qingyu Wu, he received surgical training in The First Hospital of Tsinghua University, Beijing, China. In 2015, he went to Frontier Lifeline Hospital in Chennai, India, to learn techniques in cardiac surgery and research, guided by the pioneer in Indian medical history—Dr. K.M.Cherian. Besides clinical training, he also got involved in animal research on vein graft restenosis after CABG.
Abstract:
Objective: The objective of this study was to evaluate the outcomes of patients who underwent the different techniques according to the pathology of Ebstein anomaly (EA).
Methods: From March 2004 to February 2017, 228 patients (mean age, 19.8±15.4 years; range, 7 months-64 years) with EA underwent 232 cardiac operations at our hospital. Twenty-nine patients had a prior cardiac procedure before. Among the patients in first procedures, 92 patients (46.2%) were categorized to Carpentier type C and 63 patients (31.7%) were type D, 7 patients (3.5%) had isolated anterior leaflet downward displacement. Anatomical repair were performed in 179 patients (Type B, n=35; type C, n=92; Type D, n=29; unclassifiable, n=7; reoperation, n=16), 1½ ventricle repair in 37 (Type D, n=33; reoperation, n=4), tricuspid valve repair in 3 (Type A, n=2; Type B, n=1), tricuspid valve replacement in 10 (7 reoperations), and Fontan procedure in 3 (TCPC, n=2; Glenn, n=1). Atrialized right ventricle was presented in 194 cases (168 excised, 6 incorporated). The pathology of 199 patients who underwent first procedures at our center described in Table 1.
Results: The mortality was 1.7% (n=4: anatomical repair, n=3; 1½ ventricle repair, n=1). Among these, 1 pathology type was Carpentier type C and 3 were type D. 1 A-V block (0.4%) newly occurred. 214 patients were available to follow up. The range of follow-up duration was 10 months to 13 years (mean, 7.3±3.2 years). Late survival was 99% (2 late deaths) at 10 years. Three patients received reoperation (reoperation rate, 1.3%; TVR, n=1; 1½ ventricle repair, n=2). Mean New York Heart Association class improved from 3.5 to 1.1.
Conclusions: The principle of the techniques is to reconstruct the tricuspid valve and right ventricle anatomically. For most cases, the anatomical repair was demonstrated with low mortality, less complications and excellent durability at long-term follow-up. The Carpentier classification cannot categorize all the patients. It is critical to choose applicable surgical techniques individually according to the pathologic morphology for EA surgical results. If the tricuspid valve is severely hypoplastic, 1½ ventricle repair and valve replacement may be alternative.
Lale Hakami
Ludwig Maximilians University (LMU), Germany
Title: Is previous heart surgery a risk factor for heart-lung-transplantation?
Biography:
Lale Hakami has her expertise in Pediatric Cardiac Surgery in infants and newborn. She is a German-Board-Certified Cardiac Surgeon with a sub specialization in Pediatric Cardiac Surgery. From 2006-2008, she was the Junior Consultant of the Congenital Heart Surgery at the University Hospital Erlangen/Germany. From 2008-2009, she was Research Fellow at the Children's Hospital Boston/USA. From 2009 to 2011, she was the Director of Pediatric Cardiac Surgery in Mainz/Germany. From 2011-2014, she was the Senior Consultant in Children Heart Center in Linz/Austria. From 2014, she has been the Senior Consultant at the University Hospital Munich/Germany and University Lecturer of Pediatric Cardiac Surgery at Ludwig-Maximilians-University Munich/Germany (LMU). Her particular experience is in single ventricle physiology and heart transplantation in infants and newborn.
Abstract:
Introduction: Since the 1980s, heart-lung transplantation has been an effective method for the treatment of cardio-pulmonary diseases. Heart-lung transplantation is often the last choice to prolong the life or improve the quality of life of patients with complex congenital heart disease (CCHD) with “Eisenmenger-reaction” and pulmonary arterial hypertension. Especially in patients with CCHD, who underwent previous operations (group-A) and without any previous operation in group-B and were in end stage cardiopulmonary failure.
Methods: The study examined 51 patients, who were heart-lung transplanted in our hospital. We compared the patients into two groups: Group I in children younger than 18 years and group II in adults older than 18 years. Particular postoperative parameters were collected by the inspection of files. Using the Chi-square test the significance of the results was shown. Survival is shown in Kaplan Meier curves and checked with the Log-Rank test.
Results: Among the 51 patients, there are 17 children and 34 adults. In the adult population, the incidence of congenital heart disease is dominant. In the children sample, there are also patients with pulmonary arterial hypertension. Fifteen with CCHD were in group-A, (4 children and 11 adults). The overall survival of the patients with a previous operation was 0.16 years in the median. The survival of group-B was in the median 8.03 years (p-value: 0,027). Six of the 15 group-A died within the first 30 years. In the group-B, four out of 36 died (p-value: 0.018).
Discussion: In the Chi-square test, a significantly higher 30-day mortality rate for the patients with previous operation. On the one hand, this could be caused by complicated anatomy and strong adhesions. On the other hand, there is a significantly higher rate of postoperative bleeding and early complications after heart-lung transplantation in the patients group with a previous operation, which could also be a cause for the higher 30-day mortality. In addition, the sample shows a clear advantage of the patient group with no previous operation in relation to the overall survival.
Lale Hakami
Ludwig Maximilians University (LMU), Germany
Title: Single center results after cardiac transplantation in infants and small children
Biography:
Lale Hakami has her expertise in Pediatric Cardiac Surgery in infants and newborn. She is a German-Board-Certified Cardiac Surgeon with a sub specialization in Pediatric Cardiac Surgery. From 2006-2008, she was the Junior Consultant of the Congenital Heart Surgery at the University Hospital Erlangen/Germany. From 2008-2009, she was Research Fellow at the Children's Hospital Boston/USA. From 2009 to 2011, she was the Director of Pediatric Cardiac Surgery in Mainz/Germany. From 2011-2014, she was the Senior Consultant in Children Heart Center in Linz/Austria. From 2014, she has been the Senior Consultant at the University Hospital Munich/Germany and University Lecturer of Pediatric Cardiac Surgery at Ludwig-Maximilians-University Munich/Germany (LMU). Her particular experience is in single ventricle physiology and heart transplantation in infants and newborn.
Abstract:
Objectives: Heart transplantation is the last surgical option for infants and young children with congenital heart failure after failed conventional repair or palliative procedures. We aim to present our results in a retrospective and descriptive analysis.
Methods: Eighteen heart transplantations on children (nine females and nine males) were performed from 1988 to 2015. The range of age was between 0 days and three years. Indications for a transplantation were hypoplastic left heart syndrome (n=14), non-compaction-syndrome (n=2), Bland-White-Garland-syndrome (n=1) and transposition of the great arteries (n=1). Fourteen children (78%) had a previous cardiac surgery. Four patients (22%) required mechanical circulatory support for bridging: ECMO (n=2; 11%), or LVAD and ECMO (n=2; 11%). Fifteen (83%) underwent a biatrial method, three (17%) a bicaval one.
Results: The median waiting time after listing was 68 days (min: 0 days, max: 386 days, standard deviation (SD): 102.8 days). The overall survival was 61%, 13 children (72%) survived the first year. Two patients (11%) had transplantation. The median time patients spent at intensive care unit was 17 days (min: 1 day; max: 121 days). They were respirated for seven days (min: 1 day; max: 91 days). Perioperative factors we analyzed were: the median myocardial ischemia time was 236 minutes. The median aortic clamp time was 95 minutes; the median time of circulatory arrest was 60 minutes. Three children (17%) got a pericardial effusion. Two patients (11%) suffered each: bleeding, cardiac arrhythmias, diaphragmatic paresis and cerebral complications. Five (28%) got a lymphoproliferative disease. Seven children (39%) got a coronary graft vasculopathy. Two (11%) needed interventional therapy. Three (17%) got a cardiac pace maker. According to our data, six children had a rejection which called for treatment.
Conclusion: Heart transplantation is still the best therapeutic option after end-stage heart failure in children. Cumulative results suggest one additional year of life in more than 70% and a survival of more than 20 years are possible. These results were comparable to those of the ISHLT registry in pediatrics.