Day 2 :
Keynote Forum
Lale Hakami
Ludwig Maximilians University, Germany
Keynote: Could ABO-incompatible heart transplantation (HTX) in infants and newborns be a good option to decrease the death risk on waiting list? A meta-analysis
Biography:
Introduction: Due to an increasing waiting time for available donor organs in pediatric heart transplantation (pHTx), ABO-incompatible HTx (HTxi) may be a satisfying option and probably an unpreventable one. There is an immunological window of tolerance during the human embryonic development which persists into the time of infancy. It has the potential of developing natural antibodies to ABO-antigens. This process plays a significant role in ABOi organ transplantation and could maintain long-term tolerance to a certain degree in the setting of HTxi.
Methods: This systematic review and meta-analysis aims at providing an overview of the reported outcome of infants and small children with end stage heart failure after undergoing a HTx. A systematic literature search for publications reporting the outcome after pHTx published between 2001 and 2017 was conducted. Studies written in English with a study size of more than 10 patients were included. The primary outcome was mortality at HTx-listing and one year after ABO-compatible HTx (HTxc) or HTxi. Exploratory data analysis of four studies was analyzed. Two types of model (fixed effect model and random effect model) were represented. Primary outcome measure was all cause mortality or delisting on the HTx list.
Results: Total mortality on HTx list in all groups was: I2=89.9%, 95% CI=64%, 99.3%. Delisted from HTx list because of recovering or worsening of clinical status before HTx: I2=72.6%, 95% CI=16.8%, 97.5%. HTxc: I2=99%, 95%CI=97.3%, 99.8. Twelve months survival after HTx was: I2=87.5%, 95% CI=56.1%, 99.1%. 86% of the patients survived 12 months after HTx in average with a 95% confidence interval of 0.84, 0.88.
Conclusion: HTxi is a good option with similar results compared to HTxc in infants. It might avoid the long waiting time and minimizes the risk of death on the waiting list. However, long-term results are yet to be determined, as well as complications and risks. Aspects such as renal function, infections, graft vasculopathy, the risk for malignancy and chronic rejection after HTxi remain to be examined closely.
Abstract:
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.
- 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.