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Ono M, Burri M, Mayr B, Anderl L, Cleuziou J, Strbad M, Hager A, Hörer J, Lange R. Flow Dynamics of Bilateral Superior Cavopulomonary Shunts Influence Outcomes After Fontan Completion. Pediatr Cardiol 2020; 41:816-826. [PMID: 32157396 PMCID: PMC7256021 DOI: 10.1007/s00246-020-02318-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/13/2020] [Indexed: 11/25/2022]
Abstract
Bilateral superior vena cava (SVC), which occurs following bilateral bidirectional cavopulmonary shunt (BCPS), is an anomaly marked by unique hemodynamics. This study aimed to determine its effects on outcomes after Fontan completion. Among 405 patients who underwent BCPS and total cavopulmonary connection (TCPC) between 1997 and 2017, 40 required a bilateral-BCPS. The dominant SVC prior to TCPC was identified according to the direction of blood flow in the central pulmonary artery, and its relationship to the inferior vena cava (IVC) was classified as a concordant or discordant relationship. Preoperative factors were analyzed to identify the risk factors for specific adverse outcomes. The length of intensive care unit (ICU) stay after TCPC was longer in the 40 patients who underwent bilateral-BCPS than in those who underwent unilateral BCPS (p = 0.024), and the survival rate was lower in the former group than in the latter group (p = 0.004). In the patients who underwent bilateral-BCPS, the dominant SVC was concordant with the IVC in 30 patients and discordant in 10 patients. With regard to whether certain morphological, hemodynamic, and flow dynamics-related variables were risk factors for adverse outcomes following TCPC, a discordant relationship between dominant SVC and IVC was identified as an independent risk factor for both a longer ICU stay (p = 0.037, HR 2.370) and worse survival (p = 0.019, HR 13.880). Therefore, in patients with a bilateral SVC who have previously undergone bilateral-BCPS, a discordant relationship between dominant SVC and IVC might contribute to worse outcomes following TCPC.
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Vida VL, Triglia LT, Zanotto L, Zanotto L, Bertelli F, Padalino M, Sarris G, Protopapas E, Prospero C, Pizarro C, Cleuziou J, Myers PO, Prêtre R, Poncelet AJ, Meyns B, Van den Bossche K, Accord RE, Gil-Jaurena JM, Sakurai T, Stellin G. Late management of the aortic root after repair of tetralogy of Fallot: A European multicentre study. J Card Surg 2019; 35:40-47. [PMID: 31899837 DOI: 10.1111/jocs.14316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We sought to determine the indications, type, and outcomes of reoperations on the aortic root after repair of tetralogy of Fallot (TOF). METHODS Eleven centers belonging to the European Congenital Heart Surgeons Association contributed to the data collection process. We included 36 patients who underwent surgical procedures on the aortic root, including surgery on the aortic valve and ascending aorta, between January 1975 and December 2017. Original diagnoses included TOF-pulmonary stenosis (n = 18) and TOF-pulmonary atresia (n = 18). The main indications for reoperation were aortic insufficiency (n = 19, 53%), aortic insufficiency and dilatation of the ascending aorta (n = 10, 28%), aortic root dilatation (n = 4, 11%), and ascending aorta dilatation (n = 3, 8%). RESULTS The median age at reoperation was 30.4 years (interquartile range 20.3-45.3 years), and mechanical aortic valve replacement was the most common procedure performed. Five patients died early after reoperation (14%), and larger ascending aorta diameters were associated with early mortality (P = .04). The median age at the last follow-up was 41.4 years (interquartile range 24.5-51.6 years). Late death occurred in five patients (5/31, 16%). Most survivors (15/26, 58%) were asymptomatic at the last clinical examination (New York Heart Association, NYHA class I). The remaining patients were NYHA class II (n = 7) and III (n = 3). The most common symptoms were fatigue (n = 5), dyspnea (n = 4), and exercise intolerance (n = 3). CONCLUSIONS Reoperations on the aortic root are infrequent but may become necessary late after TOF repair. The main indications for reoperation are aortic insufficiency, either isolated or associated with a dilatation of the ascending aorta. The surgical risk at reoperation was high and the presence of ascending aorta dilation is related to higher mortality.
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Vitanova K, Shiraishi S, Mayr B, Beran E, Cleuziou J, Strbad M, Röhlig C, Hager A, Hörer J, Lange R, Ono M. Impact of Characteristics at Stage-2-Palliation on Outcome Following Fontan Completion. Pediatr Cardiol 2019; 40:1476-1487. [PMID: 31342112 DOI: 10.1007/s00246-019-02172-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
The optimal timing of stage-2-palliation (S2P) in single left ventricle is not clear. The aim of this study was to identify S2P related factors associated with outcomes after total cavopulmonary connection (TCPC), particularly relative to the dominant systemic ventricle. A total of 405 patients who underwent both S2P and TCPC at our institute between 1997 and 2017 was included. Patients were divided into two groups, dominant right ventricle (RV type, n = 235) and dominant left ventricle (LV type, n = 170). S2P related factors associated with mortality, postoperative ventricular function, and late exercise capacity following TCPC, were analyzed. The median age at S2P was 4 [3-7] and 6 [3-11] months in RV and LV type patients, respectively (p = 0.092). Survival after TCPC was similar in RV and LV type patients (p = 0.280). In those with RV type, risk factors for mortality following TCPC were older age (p < 0.001), heavier weight (p = 0.001), higher PAP (p < 0.001), higher TPG (p = 0.010), and lower SO2 (p = 0.008) at S2P. In those with LV type, no risk factor was identified. Risk factors for postoperative impaired ventricular function were older age and higher weight at S2P in both RV and LV type patients. Older age at S2P was also identified as a risk for inferior peak oxygen uptake (VO2) years after TCPC both in RV and LV type patients. Older age at S2P was associated with higher mortality after Fontan completion only in RV type patients. However, it was associated with postoperative ventricular dysfunction and lower exercise capacity after TCPC in both RV and LV type patients.
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Kaltenecker E, Schleihauf J, Meierhofer C, Shehu N, Mkrtchyan N, Hager A, Kühn A, Cleuziou J, Klingel K, Seidel H, Zenker M, Ewert P, Hessling G, Wolf CM. Long-term outcomes of childhood onset Noonan compared to sarcomere hypertrophic cardiomyopathy. Cardiovasc Diagn Ther 2019; 9:S299-S309. [PMID: 31737538 DOI: 10.21037/cdt.2019.05.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background To compare outcome and cardiac pathology between patients with Noonan syndrome (N-HCM) and sarcomere protein-associated (S-HCM) childhood onset hypertrophic cardiomyopathy (HCM). Methods Clinical data were recorded from medical charts. Primary endpoint was survival. Secondary endpoints were survival without hospitalization, without intervention or without arrhythmic events. Functional clinical status and results from genetic testing, imaging, electrocardiographic (ECG) studies, cardiopulmonary exercise testing (CPET) and histopathology were compared between groups. Results Childhood HCM was diagnosed in 29 N-HCM and 34 S-HCM patients. Follow-up time was greater than 10 years in more than half of all patients. Mortality was below 7% and not different between groups. Children with N-HCM presented at a younger age and there was less time of survival without hospitalization for heart failure or intervention in N-HCM compared to S-HCM patients. Clinical functional status improved over time in N-HCM patients. On long-term follow-up, left ventricular posterior wall thickness indexed to body surface area decreased in N-HCM and increased in S-HCM patients. There was a trend to lower risk for severe arrhythmic events in N-HCM patients and only S-HCM individuals received an implantable cardioverter-defibrillator. There were no differences between groups in ventricular function, ECG and CPET parameters. Myocardial fibrosis as assessed by histopathology of myocardial specimens and cardiovascular magnetic resonance with late gadolinium enhancement or T1 mapping was present in both groups. Conclusions When compared to S-HCM patients, children with N-HCM have increased morbidity during early disease course, but favorable long-term outcome with low mortality, stagnation of myocardial hypertrophy, and low risk for malignant arrhythmias.
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Jewgenow P, Schneider H, Bökenkamp R, Hörer J, Cleuziou J, Foth R, Horke AP, Eicken A, Paul T, Sigler M. Subclinical thrombus formation in bioprosthetic pulmonary valve conduits. Int J Cardiol 2019; 281:113-118. [DOI: 10.1016/j.ijcard.2019.01.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/19/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
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Ono M, Georgiev S, Burri M, Mayr B, Cleuziou J, Strbad M, Balling G, Hager A, Hörer J, Lange R. Early extubation improves outcome following extracardiac total cavopulmonary connection. Interact Cardiovasc Thorac Surg 2019; 29:85-92. [DOI: 10.1093/icvts/ivz010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/28/2018] [Accepted: 01/03/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
The aim of this study was to investigate the impact of an early extubation strategy on the outcome following extracardiac total cavopulmonary connection.
METHODS
From 1999 through 2017, 458 patients underwent extracardiac total cavopulmonary connection; 257 (56%) patients were managed with an early extubation strategy adopted in 2009 (group A). Their outcome was compared with those of 201 (44%) patients treated before 2009 (group B). In group A, the outcome of unstable patients, defined as >75th percentile for volume administered and inotrope scores, was compared with those of stable patients.
RESULTS
Ventilation time (median: 4 h vs 16 h, P < 0.001), fluid volume administered during the first 24 h (mean: 110 ml/kg vs 164 ml/kg, P = 0.003), chest tube duration (median: 3 days vs 4 days, P = 0.028) and length of intensive care unit stay (median: 6 days vs 7 days, P = 0.001) were less in group A than in group B. The reintubation rate (7% vs 6%, P = 0.547) and early mortality (0.8% vs 1.5%, P = 0.465) were similar between groups. The 80 unstable group A patients received more inotropic support (P < 0.001) and fluid volume (P < 0.001) than stable patients, but the ventilation time (6 h vs 5 h, P = 0.220), the reintubation rate (10% vs 6%, P = 0.283) and the length of intensive care unit stay (7 days vs 6 days, P = 0.590) were similar. In unstable patients, mean arterial pressure before extubation was significantly lower than stable patients (P = 0.001). However, mean arterial pressure in unstable patients increased significantly (P < 0.001) soon after extubation, and became similar to the value in stable patients.
CONCLUSIONS
Early extubation following extracardiac total cavopulmonary connection improves postoperative haemodynamics and recovery regardless of the initial haemodynamic status.
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Padalino MA, Franchetti N, Sarris GE, Hazekamp M, Carrel T, Frigiola A, Horer J, Roussin R, Cleuziou J, Meyns B, Fragata J, Telles H, Polimenakos AC, Francois K, Veshti A, Salminen J, Rocafort AG, Nosal M, Vedovelli L, Protopapas E, Tumbarello R, Merola A, Pegoraro C, Motta R, Boccuzzo G, Sojak V, Rito ML, Caldaroni F, Corrado D, Basso C, Stellin G. Anomalous aortic origin of coronary arteries: Early results on clinical management from an international multicenter study. Int J Cardiol 2019; 291:189-193. [PMID: 30772012 DOI: 10.1016/j.ijcard.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/04/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. METHODS This is a retrospective clinical multicenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. RESULTS Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15-53), while 61 were Medical (median age 15 years, IQR: 8-52), in whom AAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p < 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1-23 years), 89.9% of survivors are in NYHA ≤ II, while only 3 elderly surgical patients died late. Return to sport activity was significantly higher in Surgical patients (48.1% vs 18.2%, p < 0.001). CONCLUSIONS Surgery for AAOCA is safe and with low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA.
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Stanner C, Horndasch M, Vitanova K, Ono M, Strbad M, Heßling G, Lange R, Cleuziou J. Pacemaker Implantation in the First Year of Life: A Midterm Analysis. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schleihauf J, Cleuziou J, Wolf CM. Surgical septal myectomy for obstructive hypertrophic cardiomyopathy during infancy. Transl Pediatr 2019; 8:90-91. [PMID: 30881903 PMCID: PMC6382502 DOI: 10.21037/tp.2018.12.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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60
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Mayr B, Vitanova K, Lang N, Strbad M, Voss B, Lange R, Cleuziou J. Long-Term Outcome after Mitral Valve Repair in Children Up to the Age of 10 Years. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vitanova K, Georgiev S, Lange R, Cleuziou J. Influence of Shunt Type on Pulmonary Artery Growth after Norwood Procedure. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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62
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Cleuziou J, Vitanova K, Sigler M. Autotissue Matrix Patch for Aortic Arch Reconstruction in Congenital Heart Disease—Histology of a Series of Human Explants. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mrad Agua K, Burri M, Cleuziou J, Beran E, Meierhofer C, Nagdyman N, Lange R. Preoperative predictability of right ventricular failure following surgery for Ebstein’s anomaly. Eur J Cardiothorac Surg 2018; 55:1187-1193. [DOI: 10.1093/ejcts/ezy425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/18/2018] [Accepted: 11/08/2018] [Indexed: 11/12/2022] Open
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Padalino M, Franchetti N, Boccuzzo G, Hazekamp M, Carrel T, Frigiola A, Rito ML, Horer J, Cleuziou J, Meyns B, Fragata J, Polimenakos A, Francois K, Veshti A, Salminen J, Rocafort AG, Nosal M, Guariento A, Vida V, Stellin G. OC68 SURGERY FOR ANOMALOUS AORTIC ORIGIN OF CORONARY ARTERIES (AAOCA). A MULTICENTER STUDY FROM THE EUROPEAN CONGENITAL HEART SURGEONS ASSOCIATION (ECHSA). J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549879.49449.8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ono M, Beran E, Burri M, Cleuziou J, Pabst von Ohain J, Strbad M, Röhlig C, Hager A, Hörer J, Schreiber C, Lange R. Long-term outcome of preadolescents, adolescents, and adult patients undergoing total cavopulmonary connection. J Thorac Cardiovasc Surg 2018; 156:1166-1176.e4. [DOI: 10.1016/j.jtcvs.2018.03.155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 03/15/2018] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
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Tanase D, Ewert P, Hager A, Georgiev S, Cleuziou J, Hess J, Eicken A. Infective endocarditis after percutaneous pulmonary valve implantation – A long-term single centre experience. Int J Cardiol 2018; 265:47-51. [DOI: 10.1016/j.ijcard.2018.04.094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/04/2018] [Accepted: 04/20/2018] [Indexed: 12/25/2022]
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Cleuziou J. Is there any progress in the search for the ideal conduit for reconstruction of the right ventricular outflow tract in young children? Transl Pediatr 2018; 7:226-228. [PMID: 30159249 PMCID: PMC6087829 DOI: 10.21037/tp.2018.06.02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Sideris K, Vodiskar J, Lange R, Cleuziou J. A persistent giant Eustachian valve: functional tricuspid atresia in a newborn. Interact Cardiovasc Thorac Surg 2018; 26:1043-1045. [PMID: 29361049 DOI: 10.1093/icvts/ivy004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/30/2017] [Indexed: 11/13/2022] Open
Abstract
Persistent right valve of the systemic venous sinus is a rare anomaly with anatomical variations. This anomaly may present as an obstructive structure that can inhibit the antegrade flow through the tricuspid valve. We report on a 4-day-old neonate who presented with pronounced peripheral and central cyanosis. Echocardiographic examination showed a giant Eustachian valve moving towards the tricuspid valve during late systole and leading to complete obstruction of the inflow. Blood flow was redirected through the persistent foramen ovale, producing a right-to-left shunt.
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Vitanova K, Pabst von Ohain J, Ono M, Tanase D, Burri M, Lange R, Cleuziou J. Incidence and Risk Factors for Right Ventricular Outflow Tract Obstruction after the Arterial Switch Operation. Thorac Cardiovasc Surg 2018; 67:37-43. [DOI: 10.1055/s-0038-1645877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background The aim of this study was to evaluate the incidence and risk factors for the development of right ventricular outflow tract obstruction (RVOTO) after the arterial switch operation (ASO).
Methods Between 1983 and 2014, a total of 688 patients underwent ASO. RVOTO was defined as any obstruction of the right ventricular outflow tract (RVOT) requiring reintervention.
Results RVOTO developed in 79 patients (11%) at a median time of 3.8 years (range, 1 day–23.6 years) after ASO. Freedom from RVOT reintervention was 96 ± 1, 89 ± 1, and 83 ± 2% at 1, 10, and 25 years, respectively. Independent risk factors for the development of RVOTO in a Cox's regression model were side-by-side great arteries (p < 0.001), aortic arch anomalies (p < 0.001), use of a pericardial patch for augmentation of the coronary buttons (p < 0.001), and a peak gradient more than 20 mm Hg over the RVOT at discharge (p < 0.001).
Conclusion The incidence of RVOTO after ASO is not negligible. Complex morphology, such as side-by-side great arteries and aortic arch anomalies influences the development of RVOTO.
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Schleihauf J, Cleuziou J, Pabst von Ohain J, Meierhofer C, Stern H, Shehu N, Mkrtchyan N, Kaltenecker E, Kühn A, Nagdyman N, Hager A, Seidel H, Lange R, Ewert P, Wolf CM. Corrigendum to: 'Clinical long-term outcome of septal myectomy for obstructive hypertrophic cardiomyopathy in infants' [Eur J Cardiothorac Surg 2018;53:538--44]. Eur J Cardiothorac Surg 2018; 53:694. [PMID: 29211880 DOI: 10.1093/ejcts/ezx441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Puluca N, Burri M, Cleuziou J, Krane M, Lange R. Consecutive operative procedures in patients with Marfan syndrome up to 28 years after initial aortic root surgery. Eur J Cardiothorac Surg 2018; 54:504-509. [DOI: 10.1093/ejcts/ezy065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/17/2018] [Indexed: 11/12/2022] Open
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Ono M, Beran E, Burri M, Cleuziou J, Pabst von Ohain J, Röhlig C, Strbad M, Hager A, Hörer J, Lange R. Outcomes of a total cavopulmonary connection in patients with impaired ventricular function†. Eur J Cardiothorac Surg 2018; 54:55-62. [DOI: 10.1093/ejcts/ezx505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/20/2017] [Indexed: 11/14/2022] Open
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Vitanova K, Leopold C, von Ohain JP, Wolf C, Beran E, Lange R, Cleuziou J. Reasons for Failure of Systemic-to-Pulmonary Artery Shunts in Neonates. Thorac Cardiovasc Surg 2018; 67:2-7. [PMID: 29351695 DOI: 10.1055/s-0037-1621706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Systemic-to-pulmonary artery shunt placement is an established palliative procedure for congenital heart disease. Although it is thought to be a simple operation, it is associated with significant morbidity and mortality. METHODS Data for all neonates who underwent surgery for a systemic-to-pulmonary artery shunt between 2000 and 2016 were reviewed. The study endpoints were shunt failure and shunt-related mortality. Shunt failure was defined as a shunt dysfunction because of thrombosis or stenosis requiring intervention or reoperation; shunt mortality was defined as death because of a shunt dysfunction. RESULTS A total of 305 shunts (central shunt, n = 135; Blalock-Taussig shunt, n = 170) were implanted in 280 patients. The median patients' age at the time of surgery was 9 days (1-31 days). The median shunt size was 3.5 mm (3-4 mm). Twenty-four patients (8%) were diagnosed with a shunt failure, with a median time of 7 days (0-438 days). Freedom from shunt failure at 1 year was 91.6% ± 2%. A shunt-related mortality was ascertained for 12 patients (4%). Freedom from shunt-related mortality at 1 year was 96% ± 1%. Perioperative platelet transfusion (p = 0.01), central shunt (p = 0.02), 3-mm shunt size (p = 0.02), and postoperative extra corporeal membrane oxygenation (ECMO) (p < 0.01) were identified as risk factors for shunt failure. Platelet transfusion (p = 0.04) and postoperative ECMO (p < 0.01) were further identified as risk factors for shunt mortality. CONCLUSION Based on these data, we recommend implanting a modified Blalock-Taussig shunt of at least 3.5 mm in neonates. Perioperative platelet transfusion and postoperative ECMO increase the risk of shunt failure.
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Matsushima S, Burri M, Strbad M, Ruf B, Lange R, Cleuziou J. Twenty-Year Experience with the Konno Operation: A Definitive Option for Multilevel Left Ventricular Outflow Tract Obstruction. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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75
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Burri M, Mrad A, Cleuziou J, Lange R. Type of Ebstein’s Surgery Affects Reoperation Rate. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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