197 cases with congenital cardiac defects operated in …kisi.deu.edu.tr/kivanc.metin/surgery for...

197 cases with congenital cardiac defects operated in Ege Sağlık

Hospital between

Age 0.02 -62 years (11.67± 14.11), median 5.75

Weight 3.5-86 kg (28.15 ± 22.3), median 17.8 kg,

Height 55-194 cm (116.76 ± 37), median 110 cm.

157 pediatric (0-18 yrs) cases (% 79.7)

40 adult cases ( % 20.3)

114 F (% 57.9), 83 M (% 42.1)

74.1 %

25.9 %

68 pts: % 34.5 ASD

25 pts: % 12.7 VSD

19 pts: % 9.6 CoA-PDA-APW

26 pts: % 13.2 TOF

5 pts: % 2.5 AVSD

27 pts: % 13.7 Complex cyanotic Heart Disease

5 pts: % 2.5 ASD-VSD-PH

8 pts: % 4.1 LVOTO-AS

2 pts: % 1 RVOTO-PS

3 pts: % 1.5 ASD-PS

2 pts: % 1 VSD-ASD

3 pts: % 1.5 VSD-PS

1 pt: % 0.5 VSD-AS-AR

3 pts: % 1.5 Partial AVSD

25 pts TOF: % 49

4 pts AVSD: % 8.2

21 pts DORV/TGA-VSD-PS/TA-Arterial malposition-VSD-ASD/TAPVC (Cardiac type)-VSD-ASD-PDA/ VSD-p.atresia-MAPCA/ AVSD-PDA/ Dx-c-TGA-VSD-ASD-PS-AV valve insufficiency/ Dextromesocardia-DORV (Transpozed type),L-sided absence of AV valve, AV kapak regurgitation % 40.8

1 case Partial AVSD: % 2

49 % 40.8 %

8.2 %

ASD: 38 pts (24.1 %)

VSD: 23 pts (14.6 %)

PDA-CoA-APW: 18 pts (11.4 %)

TOF: 23 pts (14.6 %)

Complex Cyanotic Heart

Disease: 27 pts (17.1 %)

24.1 %

14.1 %

11.4 % 14.6 %

17.1 %

29 pts: % 72.5 ASD

2 pts: % 5.3 VSD

1 pt: % 2.56 PDA

3 pts: % 5.3 TOF

3 pts: % 1.5 Partial AVSD

1 pt: % 2.5 AVSD

1 pt: % 2.5 RVOTO-PS

197 cases:

Standart technique: 170 (86.3%)

Minimally invasive: 27 (13.7%)

86.3 %

13.7 %

Palliative surgery: 25 (12.7%)

Total correction:172 (87.3%)

12.7 %

87.3 %

Aortic cross clamping time:7-127 min (34.92±21.07. Median 30)

Cardiopulmonary by-pass time: 10-270 min (72.66±38.28. Median 62.5)

Hypothermic CPB: 20-36 ºC (30.92±2.88. Median 32)

Antegrade cold blood cardioplegia & topical slushed ice. Total amount of perfused

cardioplegia 100-3500 ml (823.57±636.46. Median 532.5)

Total amount of Plegisol cardioplegic solution: 15-700 ml (167.5±131.

Median 100)

Minimum Htc level during CPB: 16-47% (25.29±4.64. Median 25%)

Blood addition to prime solution: 0-2.5 Units (0.75±0.63. Median 0.6 U)

Perioperative urine output: 0-2000 ml (280.51±370. Median 100 ml)

Perioperative ultrafiltration 31 (% 15.7)

Transfusion in the ICU: 57 cases ( % 28.9)

84.3 %

15.7 %

71.1 %

28.9 %

Fast track

◦ Early extubation

◦ Early discharge from the ICU

◦ Less risk for sternal dehiscense and rib fractures

◦ Early hospital discharge

◦ Earlier return to routine daylife

Ann Thorac Surg 2002; 74: 1318-22.

Acta Chir Belg 2004: 104:440-4.

Chest 2001;119:622-7.

Less sternal deformity

Med Sci Monit, 2003; 9(3): CR109-113

Total time of mechanical ventilation: 0-408 hrs (20.18±53. Median 6 hrs)

Total length of ICU stay: 1-480 hrs (51.93±65.65. Median 27 hrs)

Duration of positive inotropic support: 0-379 hrs

(20±56.49) median 20 hrs.

CVP: 0-17.2 (4.7±3.33) median 5.3 cmH2O

Fever in the ICU (>38.3 ºC) 30 cases (% 15.1)

No fever in 167 cases (84.9%)

Hospitalization: 1-24 (7.4±3.37) median 7 days

Hospital mortality 5,5% (11 cases)

Reoperations

6 cases.

Hospital mortality: 1 case

85.7 %

51 cyanotic patients

Palliation:

20 cases (39%)

Total correction:

31 cases (61%)

61 % 39 %

88,3 %

11,7 % 6 hospital mortality in 51

cyanotic cases (11,7%)

Number of operations in years

2004: 52 pts % 26.4

2005: 44 pts % 22.7

2006: 26 pts % 13.2

2007: 30 pts % 15.2

2008: 18 pts % 9.1

2009: 24 pts % 12.2

2010: 3 pts % 1.5

ASD

31 cases (% 45.6) adult

37 cases (% 54.4) pediatric

22 cases (% 32.4) male

46 cases (% 67.6) female

ASD

Age: 0.5-62 yrs (20.3±17.07), median 14 yrs

Body weight: 7.4-86 kg (41.37±23.83), median 46 kg

Height: 67-194 cm (137.85±32.59), median 151 cm

Type of surgical repair

Patch repair: 42 cases (61.8%)

Primary repair: 26 cases (38.2%)

61.8 %

38.2 %

Standart median sternotomy: 41 cases (60.3%)

Minimally invasive surgery: 27 cases (39.7%)

60.3 %

39.7 %

...innovative and less invasive

approaches in cardiac surgery...

Ann Thorac Surg 1998; 65: 1535-9.

Ann Thorac Surg 1997; 226: 421-8

Techniques to improve the

surgical results without

compromising morbidity and

mortality of the treament

Better cosmetic results

Easy reoperations

Ann Thorac Surg 1999; 68: 2209-14.

Eur J Cardiothorac Surg 1998; 14(Suppş): S126-9.

Ann Thorac Surg 2003; 76: 1101-6.

92.4

%

62.5

%

37.5

%

7.6

%

Minimal invasive surgery:

25 ASD (92.59%),

2 partial AVSD (7.41%)

Age: 2.58-43 yrs (22.52±13.8), median 25 yrs,

Body weight: 12.9-82 kg (45.55 ±20.98),

Height: 88-194 cm (146,51 ± 27,11), median

155 cm

92.59 %

Male:22 cases (41.5%)

Female: 24 cases (58.5%)

Male: 5 cases (18.5%)

Female: 22 cases (81.5%)

(+) 75.6%

(-) 24.4%

(+) 73.1%

(-) 26.9%

75.6 %

24.4 %

73.1 %

26.9 %

(+) 51.22%

(-) 48.78%

(+) 55.56%

(-) 44.44%

Standard Minimal inv

4485 € 3637 €

All operated ASD patients (68), including 41 cases with standart sternotomy and 27 minimally invasive cases were reviewed:

• Sex,

• age,

• body weight,

• height,

• minimum htc level during

cardiopulmonary by-pass,

• technique of cardioplegia,

• aortic cross clamping time,

• perfusion time,

• perioperative urine output,

• time of mechanical ventilatory

support

• Time positive inotropic infusion,

duration of ICU and hospital stay.

• Independent T test ( 95% CI)

• ICU stay (p: 0.001)

• Perioperative urine output

(p:0.049)

Sternotomy

Insertion of cardioplegia cannula

LSPV vent

VCI Cannula

Aort

VCS Cannula