Use of ventricular assist devices in children across the United States: analysis of 7.5 million pediatric hospitalizations.

Background: Recently, there has been a surge of interest by clinicians, industry, and the government in the development and use of ventricular assist devices (VAD) in children. Despite this rapidly expanding interest, the incidence of VAD use in children across the United States is unknown. The Healthcare Cost and Utilization Project (H-CUP) Kids' Inpatients Database (KID) was analyzed to characterize the current utilization of VADs in children nationwide.

Is resternotomy in cardiac surgery still a problem?

Multiple factors contribute to the growing number of reoperations for congenital and acquired cardiovascular diseases in the United States. Although the hazards are well-recognized, the health economic burden of resternotomy (RS) remains unclear and may be difficult to quantify. Contrary to published studies citing low frequencies of catastrophic hemorrhage and mortality, survey responses from practicing surgeons disclose higher rates of complications.

Tetralogy of Fallot repair: the Right Ventricle Infundibulum Sparing (RVIS) strategy.

Despite the excellent operative survival for tetralogy of Fallot (TOF) repair, well-documented long-term complications and reduced life expectancy remain challenges for these patients and their clinicians. In an attempt to change the natural history of repaired TOF, we at Texas Children's Hospital (Houston, TX) have developed a management strategy not focused on age, but rather focused on preserving the right ventricular (RV) infundibulum. The RV infundibulum sparing (RVIS) repair of TOF consists of a transatrial and transpulmonary approach to close the ventricular septal defect and resect RV infundibular muscle coupled with a mini (< 5 mm) transannular patch or no ventricular incision.

Empowering a database with national long-term data about mortality: the use of national death registries.

The interest of professional medical societies in research about outcomes, mixed with the recent accessibility to management of data on the internet, has moved many societies to create national databases or registries for their specialty. In societies with procedure-based specialties such as surgery, these databases will help with the care of patients by predicting prognosis, defining risk-factors, and aiding with the selection of patients who are the best candidates for these procedures. These databases eventually will also help to establish standards of care.

Repeat sternotomy in congenital heart surgery: no longer a risk factor.

Background: The risk of repeat sternotomy (RS) is often taken into account when making clinical management decisions. Current literature on RS suggests a risk of approximately 5% to 10% for major morbidity. We sought to establish the true risk of RS in a contemporary pediatric series.

Extubation in the operating room after Fontan's procedure: effect on practice and outcomes.

Background: Timely extubation is a well-accepted strategy in the postoperative intensive care unit management of Fontan patients to minimize the deleterious effects of positive-pressure ventilation. In October 2002, this strategy was extended to extubating selective Fontan patients in the operating room (EOR). This retrospective study examines how EOR has affected outcomes and practice in our Fontan population.

Perimount bovine pericardial valve to restore pulmonary valve competence late after right ventricular outflow tract repair.

Objective: No ideal option exists for restoring pulmonary valve competence late after repair of the congenitally abnormal right ventricular outflow tract (RVOT). This has driven a continued search for new alternatives. Texas Children's Hospital has recently used the Carpentier-Edwards Perimount RSR Pericardial Aortic Prosthesis (Edwards Lifesciences, Irvine, Calif, USA) for this indication and reports the initial experience.

Over two decades of pediatric heart transplantation: how has survival changed?

Objective: In 1984, the first successful infant heart transplant was performed at Texas Children's Hospital. This study analyzes the 21-year experience with pediatric heart transplantation at Texas Children's Hospital to assess whether and how survival has changed over time.

Methods: Between November 1, 1984, and October 3, 2005, 164 consecutive orthotopic heart transplants were performed on 154 patients.

Pediatric mechanical circulatory support.

Over the past two decades clinicians and researchers have sought to bring mechanical circulatory support (MCS) to pediatric patients with heart failure. ECMO, IABPs, and VADs have all been used in infants and children as a bridge to myocardial recovery or as a bridge to transplant. However, until recently, a commitment by industry, government, and researchers towards the development of pediatric MCS has not been present, especially in the United States.

Interrupted aortic arch repair: aortic arch advancement without a patch minimizes arch reinterventions.

Background: Surgical repair of interrupted aortic arch (IAA) remains challenging and is associated with significant mortality and incidence of late arch obstruction, as recently reported by the Congenital Heart Surgeons' Society (CHSS). In particular, the CHSS reported that any technique other than direct anastomosis with patch augmentation is a risk factor for arch reintervention. The experience at Texas Children's Hospital with IAA repair using an aortic arch advancement technique without a patch was examined.

Encouraging results for the Contegra conduit in the problematic right ventricle-to-pulmonary artery connection.

Objective: The Contegra conduit was developed for right ventricular outflow tract reconstruction. This report evaluates the Contegra conduit, with focus on certain subpopulations in which conduits are known to perform poorly (ie, patients with previous homograft conduits and infants).

Methods: A retrospective review of 76 patients who had 77 Contegra conduits placed for right ventricular outflow tract reconstruction (January 2001 through August 2005) was completed.

Salvaging the failing Fontan: lateral tunnel versus extracardiac conduit.

Background: Since Fontan revision has been demonstrated to provide hemodynamic and symptomatic improvement in select patients with failing Fontan circulations, we now believe it is important to determine if one type of revision (lateral tunnel [LT] or extracardiac conduit [ECC]) provides superior outcomes.

Methods: Thirty-five Fontan revisions were performed (Jun 1997 to Dec 2004): 19 ECC (54%) and 16 LT. Preoperative variables were similar: New York Heart Association (NYHA) IV (LT = 4 vs ECC = 2, p = not significant [NS]), preoperative arrhythmias (LT = 13 vs ECC = 16, p = NS) and systemic right ventricle (LT = 4 vs ECC = 2, p = NS).