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Marshall V WH, McConnell P. Surgical Considerations in Adult Congenital Heart Disease Heart Failure. Heart Fail Clin 2024; 20:199-208. [PMID: 38462324 DOI: 10.1016/j.hfc.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Surgical intervention is often used in the management of heart failure in patients with adult congenital heart disease. This review addresses anatomic variations and complications due to prior surgical interventions, including sternal reentry, collateral vessels, and the neo-aortic root after the Damus-Kaye-Stansel procedure. Surgical considerations for systemic atrioventricular valvular surgery, Fontan revision, and advanced heart failure therapies including ventricular assist devices, heart transplant, and combined heart-liver transplant are discussed, with a focus on unique patient populations including those with systemic right ventricles and those with Fontan circulation.
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Affiliation(s)
- William H Marshall V
- Department of Internal Medicine, Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, Wexner Medical Center at The Ohio State University, 473 West 12th Avenue Suite 200, Columbus, OH 43210, USA; The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Patrick McConnell
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, The Heart Center, 700 Children's Drive, 4th Floor Tower, Columbus, OH 43105, USA; Department of Surgery, Division of Cardiac Surgery, The Ohio State University, Columbus, OH, USA
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Jung SY, Choi JY. Sexual Health Issue in Adult Congenital Heart Disease to Improve the Quality of Life. Korean Circ J 2022; 52:243-245. [PMID: 35257535 PMCID: PMC8907991 DOI: 10.4070/kcj.2022.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Se Yong Jung
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Division of Pediatric Cardiology, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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Kainuma A, Sanchez J, Ning Y, Kurlansky PA, Axsom K, Farr M, Sayer G, Uriel N, Takayama H, Naka Y, Takeda K. Outcomes of Heart Transplantation in Adult Congenital Heart Disease With Prior Intracardiac Repair. Ann Thorac Surg 2021; 112:846-853. [DOI: 10.1016/j.athoracsur.2020.06.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/10/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
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Pabst von Ohain J, Sarris G, Tobota Z, Maruszewski B, Vida VL, Hörer J. Risk evaluation in adult congenital heart surgery: analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database risk models on data from the European Congenital Heart Surgeons Association Congenital Database. Eur J Cardiothorac Surg 2021; 60:1397-1404. [PMID: 34058002 DOI: 10.1093/ejcts/ezab229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We sought to evaluate the predictive power of the Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) mortality score and the adult congenital heart surgery (ACHS) mortality score for the adults undergoing congenital heart operations entered into the European Congenital Heart Surgeons Association (ECHSA) database. METHODS The data set comprised 17 662 major operations performed between 1997 and 2019, on patients 18 years of age or older, in European centres participating in the ECHSA database. Each operation was assigned a STAT mortality score and category and an ACHS mortality score. Operative mortality was based on the 30-day status and on the status at hospital discharge. The discriminatory power of the STAT and ACHS scores was assessed using the area under the receiver operating characteristic curve (c-index). RESULTS A total of 17 214 (97.46%) operations were assigned ACHS scores. The 3 most frequent primary procedures were closure of the atrial septal defect (19.0%), aortic valve replacement (8.8%) and non-valve-sparing aortic root replacement (6.1%). Operative mortality for ACHS-coded operations was 2.07%. The procedures with the highest mortality were atrial septal defect creation/enlargement (19.0%), lung transplantation (18.8%) and heart transplantation (18.2%). A total of 17 638 (99.86%) operations were assigned a STAT score and category. The operative mortality for STAT-coded operations was 2.27%. The c-index for mortality was 0.720 for the STAT mortality score and 0.701 for the ACHS score. CONCLUSIONS The ACHS mortality score and the STAT mortality score reached similar, moderate predictive power in adult patients undergoing congenital heart surgery in ECHSA database.
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Affiliation(s)
- Jelena Pabst von Ohain
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Munich, Germany.,Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich, Munich, Germany
| | - Georgios Sarris
- Department of Pediatric Heart Surgery, Athens Heart Surgery Institute, Athens, Greece
| | - Zdzislaw Tobota
- Department for Pediatric Cardiothoracic Surgery, Paediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Paediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Vladimiro L Vida
- Paediatric and Cardiac Surgery Unit, Department of Cardio-Thoracic Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - J Hörer
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Munich, Germany.,Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich, Munich, Germany
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Fedevych O, Dhannapuneni R, Guerrero R, Lotto A. Native Pulmonary Valve Restoration Late Following Transannular Patch Repair of Tetralogy of Fallot. World J Pediatr Congenit Heart Surg 2021; 12:677-679. [PMID: 33947283 DOI: 10.1177/2150135120981056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a surgical case of native pulmonary valve (PV) restoration in a 16-year-old boy with a previous history of transannular patch repair of tetralogy of Fallot in infancy. The PV was restored by approximation of split anterior commissure in the presence of developed and pliable leaflets well preserved after initial surgery. Postoperative echocardiogram showed a competent valve with peak velocity of 2.8 m/s. At six-week follow-up, the patient remained well, and echocardiogram demonstrated a competent PV with decreased velocity of 2.1 m/s across it. We encourage a mindful preservation of PV leaflets whenever it is possible at time of initial repair to implement this relatively easy operation to restore PV function later in life.
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Affiliation(s)
- Oleg Fedevych
- Cardiac Services, 4593Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, United Kingdom
| | - Ramana Dhannapuneni
- Cardiac Services, 4593Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, United Kingdom
| | - Rafael Guerrero
- Cardiac Services, 4593Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, United Kingdom
| | - Attilio Lotto
- Cardiac Services, 4593Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, United Kingdom.,Faculty of Health, Liverpool John Moores University, Kingsway House, Liverpool, United Kingdom
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Pabst von Ohain J, Tonino E, Kaemmerer H, Cleuziou J, Ewert P, Lange R, Hörer J. German Heart Centre Munich-45 years of surgery in adults with congenital heart defects: from primary corrections of septal defects and coarctation to complex reoperations. Cardiovasc Diagn Ther 2021; 11:492-502. [PMID: 33968628 DOI: 10.21037/cdt-20-831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Our historical overview in the form of a cohort study aimed to describe the changes in the cardiac operations in adults with congenital heart disease (ACHD), over 45 years in the German Heart Centre in Munich. Methods The study population comprised all consecutive patients aged 18 or more, who underwent surgery for congenital heart disease (CHD) at the German Heart Centre Munich, between 1974 and 2018. Operations were coded according to the Adult Congenital Heart Surgery (ACHS) score. Two-tailed chi-square test was used for testing on differences in the frequency of procedural groups between the decades. Results During the examined 45-year period, 2,882 operations were performed on ACHD. The number of operations per year increased with a correlation coefficient r=0.533, P<0.001. Overall operative mortality was 3.2%. There was no significant difference in mortality over the decades. The percentage of primary CHD diagnosis being the indication for the operation was 99% in the 1970s and decreased significantly to 56% in the 2010s, P<0.001. There was a significant decrease in the relative frequency of atrial septal defect closures from 45% in the 1970s and 1980s to 9% in 2010s (P<0.001). Coarctation repair made up 15% of all operations in the 1970s, then dropped significantly to 1% in the 2010s (P<0.001). The percentage of reoperations increased significantly from 7% in the 1970s to 50% in 2010s (P<0.001). Conclusions The spectrum of cardiac surgery in ACHD changed significantly over the last 45 years, from primary repair of septal defects and coarctation of the aorta in the 1970s to complex reoperations in the 2010s.
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Affiliation(s)
- Jelena Pabst von Ohain
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-Universität, Munich, Germany
| | - Eleonora Tonino
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-Universität, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Julie Cleuziou
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-Universität, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Paediatric Heart Surgery, German Heart Centre Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Paediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilian-Universität, Munich, Germany
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Kainuma A, Ning Y, Kurlansky PA, Axsom K, Farr M, Sayer G, Uriel N, Lewis MJ, Rosenbaum MS, Kalfa D, LaPar DJ, Bacha EA, Takayama H, Naka Y, Takeda K. Cardiac transplantation in adult congenital heart disease with prior sternotomy. Clin Transplant 2021; 35:e14229. [PMID: 33476438 DOI: 10.1111/ctr.14229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Adult congenital heart disease (ACHD) patients who require orthotopic heart transplantation are surgically complex due to anatomical abnormalities and multiple prior surgeries. In this study, we investigated these patients' outcomes using our institutional database. METHODS ACHD patients who had prior intracardiac repair and subsequent heart transplant were included (2008-2018). Adult patients without ACHD were extracted as a control. A comparison of patients with functional single ventricular (SV) and biventricular (BV) hearts was performed. RESULTS There were 9 SV and 24 BV patients. The SV group had higher central venous pressure/pulmonary capillary wedge pressure (P = .028), hemoglobin concentration (P = .010), alkaline phosphatase (P = .022), and were more likely to have liver congestion (P = .006). Major complications included infection in 16 (48.5%), temporary dialysis in 12 (36.4%), and graft dysfunction requiring perioperative mechanical support in 7 (21.2%). Overall in-hospital mortality was 15.2%. Kaplan-Meier analysis showed a higher, but not statistically significant, survival after 10 years between the ACHD and control groups (ACHD 84.9% vs. control 67.5%, P = .429). There was no significant difference in 10-year survival between SV and BV groups (78% vs. 88%, P = .467). CONCLUSIONS Complex ACHD cardiac transplant recipients have a high incidence of early morbidities after transplantation. However, long-term outcomes were acceptable.
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Affiliation(s)
- Atsushi Kainuma
- Department of Cardiovascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yuming Ning
- Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, NY, USA
| | - Paul A Kurlansky
- Department of Surgery CT, Columbia University Medical Center, New York, NY, USA
| | - Kelly Axsom
- Department of Medicine Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Maryjane Farr
- Department of Medicine Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Gabriel Sayer
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Nir Uriel
- Department of Medicine Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Matthew J Lewis
- Department of Medicine Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Marlon S Rosenbaum
- Department of Medicine Cardiology, Columbia University Medical Center, New York, NY, USA
| | - David Kalfa
- Pediatric Cardiac Surgery, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA
| | - Damien J LaPar
- Department of Surgery CT, Columbia University Medical Center, New York, NY, USA
| | - Emile A Bacha
- Pediatric Cardiac Surgery, Columbia University Medical Center, Morgan Stanley Children's Hospital, New York, NY, USA
| | - Hiroo Takayama
- Department of Cardiovascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Yoshifumi Naka
- Department of Cardiovascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- Department of Cardiovascular Surgery, Columbia University Medical Center, New York, NY, USA
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Congenital heart disease in adults (when kids grow up) pediatric geriatric anesthesia. Curr Opin Anaesthesiol 2020; 33:335-342. [PMID: 32371630 DOI: 10.1097/aco.0000000000000849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review focuses on the new development of adult congenital heart disease (ACHD) patients in the areas of imaging, percutaneous interventions, ventricular assist devices and transplantation. RECENT FINDINGS Since the last ACHD publication in the journal, several advances have been made in the evaluation and treatment of these patients. As CHD patients' longevity increases pregnancy, comorbities and acquired heart disease become a concern. Recent data show that the incidence of complications in low-risk CHD is not higher that the regular population. In addition, breakthrough research in percutaneous valve implantation has been published showing good outcomes but needing intensive care recovery in a significant number of patients. In the ACHD heart failure population, assist device and transplant fields mounting evidence shows that these therapies should not be the last resort since low-risk ACHD patient may have similar outcomes to those with acquired heart disease. Finally risk stratification is important in ACHD to define better ways to recover from surgery and anesthesia. SUMMARY The field of anesthesia for ACHD is growing with new indications for diagnostic, interventional and surgical procedures. Tailoring cardiac and noncardiac care to the different risk profile in ACHD patients will be defined in the next few years. VIDEO ABSTRACT Motta summary clip: http://links.lww.com/COAN/A65.
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Transplantation in Congenital Heart Disease: A Challenge. Transplant Proc 2020; 52:577-579. [PMID: 32046860 DOI: 10.1016/j.transproceed.2019.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/26/2019] [Accepted: 12/26/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart failure is the leading cause of death in grown-up congenital heart disease patients (GUCH). Although heart transplantation (OHT) remains the gold standard in end-stage heart failure, the ratio of GUCH patients undergoing this procedure remains low. OBJECTIVE Describe the cohort of GUCH patients undergoing heart transplantation at a third-level hospital. METHODS A retrospective review of GUCH patients undergoing OHT between 1997 and 2019 was conducted at a single tertiary university hospital. We included different preoperative (demographic and clinical data, cardiac catheterization data from the last routine hemodynamic monitoring) and postoperative variables (complications, survival). RESULTS Fourteen patients were enrolled. The median age was 25.5 years (range, 20.7-32.2). Eight patients (57.1%) were male. The median preoperative left ventricular ejection fraction was 37% (range, 22.5%-55%). As for preoperative hemodynamic evaluation, the median for the mean arterial pulmonary pressure was 19 mm Hg (range, 12-22.5), for the capillary wedge pressure was 16 mm Hg (range, 13.5-19.5), and for pulmonary vascular resistance was 1.83 Wood units (range, 1-4). After OHT, 6 patients (42.9%) suffered an infection, the most common of which was respiratory (3 out of 6). Four patients (28.6%) needed renal replacement therapy, and 4 patients (28.6%) presented liver failure. Four patients (28.6%) developed graft failure, thus requiring mechanical support with extracorporeal membrane oxygenation during a median of 6 days (range, 1-17.5). Survival rate of patients under extracorporeal membrane oxygenation was 50%, and overall survival rate was 78.6%. CONCLUSION OHT represents a good option for GUCH patients, with good overall survival rates.
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