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Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual

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https://www.readbyqxmd.com/read/28007073/closing-in-on-the-pumpkin-trial-of-the-jarvik-2015-ventricular-assist-device
#1
REVIEW
J Timothy Baldwin, Iki Adachi, John Teal, Christopher A Almond, Robert D Jaquiss, M Patricia Massicotte, Kurt Dasse, Flora S Siami, Victor Zak, Jonathan R Kaltman, William T Mahle, Robert Jarvik
The Infant Jarvik ventricular assist device (VAD; Jarvik Heart, Inc., New York, NY) has been developed to support the circulation of infants and children with advanced heart failure. The first version of the device was determined to have elevated hemolysis under certain conditions. The objective of this work was to determine appropriate modifications to the Infant Jarvik VAD that would result in acceptably low hemolysis levels. In vitro hemolysis testing revealed that hemolysis was related to the shape of the pump blade tips and a critical speed over which hemolysis would occur...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007072/tetralogy-surgery-back-to-baltimore-70-years-later-melbourne-heritage-and-group-tribute-to-juan-comas
#2
REVIEW
George E Sarris
Surgery for Tetralogy of Fallot progressed rapidly from the palliative arterio-pulmonary Blalock-Taussig shunt, introduced in Baltimore 70 years ago, to the "classic" complete transventricular repair technique, with which excellent early results were achieved soon thereafter. However, as duration of follow-up increased, so did the awareness of development of troubling late complications, including severe pulmonary insufficiency, right ventricular dilatation and dysfunction, and tricuspid valve insufficiency, all contributing to increasing incidence of late reoperations, as well as to arrhythmias and sudden death...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007071/valve-sparing-or-valve-reconstruction-options-in-tetralogy-of-fallot-surgery
#3
REVIEW
Emile Bacha
This review deals with a relatively new field in congenital heart surgery, valve preservation or, in cases of more severe pulmonary valve stenosis or dysplasia, valve reconstruction during tetralogy of Fallot repair. We describe the stepwise approach utilized, starting with simple maneuvers such as commissurotomy and valve dilation for mild pulmonary stenosis to commissurotomy and intraoperative balloon dilation for moderate stenosis, and finally transection of the annulus and valve reconstruction using a patch that acts as a modified monocusp...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007070/the-american-board-of-thoracic-surgery-congenital-fellowship-have-we-lost-our-international-heritage
#4
REVIEW
Vaughn A Starnes, Maura E Sullivan
Since 2005 there have been very few (if any) individuals trained outside of the United States in congenital surgery. Confining congenital training to only programs in the US has with it some unintended consequences. First, we need to recognize that progress is made around the world and not only in the US. Second, we decrease our opportunity to establish international peers, which leads to less opportunity for multi-institutional and multi-national studies and intellectual isolation. Third, we are in a new age of globalization...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007069/the-acgme-fellowship-in-congenital-cardiac-surgery-the-graduates-perspective
#5
REVIEW
Carlos M Mery, Lauren C Kane
The creation of structured fellowship programs in congenital heart surgery (CHS) in the United States appears to have improved the training of congenital heart surgeons. However, the transition process between fellowship and clinical practice and the lack of senior mentorship continue to be major problems. We report the results of a survey of all graduates of accredited programs in CHS. A total of 35/51 (69%) graduates responded to the survey. Of 34 that are in practice, 31 (91%) did not feel ready to engage in solo CHS after completion of training...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007068/congenital-heart-surgery-subspecialty-certification-how-is-it-working-the-american-board-of-thoracic-surgery-perspective
#6
REVIEW
James S Tweddell
Congenital heart surgery is among the most challenging fields in all of medicine. The unique skills and knowledge base required prompted the American Board of Thoracic Surgery (ABTS) to establish the Subspecialty Certificate in Congenital Heart Surgery (CHS). Standards for operative experience and fellowship training programs were established by the ABTS and the Accreditation Council for Graduate Medical Education. Since 2009, 188 Subspecialty Certificates in CHS have been granted, including 38 earned through the fellowship training pathway...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007067/aortic-arch-advancement-and-ascending-sliding-arch-aortoplasty-for-repair-of-complex-primary-and-recurrent-aortic-arch-obstruction
#7
REVIEW
Luis E De León, E Dean McKenzie
The optimal treatment of patients with complex coarctation of the aorta and hypoplastic aortic arch is controversial. Children undergoing repair of obstructive arch lesions are at lifelong risk of recurrence. Multiple techniques have been described to address complex primary and recurrent coarctation. Our approach at Texas Children's Hospital (Houston, TX) has been to address these lesions in an anatomic fashion via median sternotomy, under cardiopulmonary bypass using the techniques of aortic arch advancement and ascending sliding arch aortoplasty...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007066/valve-sparing-aortic-root-replacement-in-pediatric-patients-lessons-learned-over-two-decades
#8
REVIEW
Luca A Vricella, Duke E Cameron
Valve-sparing aortic root replacement has been utilized in children with aneurysms of the proximal aorta as a valid alternative to composite mechanical or biologic prostheses. While the majority of pediatric patients with aortic root aneurysms have various forms of connective tissue disorders, other diagnostic groups have emerged, such as patients with various forms of congenital heart disease and non-syndromic thoracic aortic aneurysms. We present our experience with valve-sparing procedures in pediatric patients, highlighting the technical aspects of the operation as well as some of the pitfalls and complications we have encountered over the last two decades...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007065/a-word-of-caution-in-public-reporting
#9
REVIEW
Thomas L Spray, J William Gaynor
Public reporting in its current form will lead to confusion amongst physicians, administrators, families, and the media. It is unclear that we are giving the families information they really need. At the current time there is no evidence that public reporting really leads to improved outcomes. Rather, it may lead to risk aversion and limit access to care. This is a problem not just for congenital heart surgery but for the entire field of medicine and the care that we provide to our patients. We must be very careful that we don't create a system where we are afraid to take on a patient with increased risk of mortality because it may affect our overall ranking...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007064/the-society-of-thoracic-surgeons-congenital-heart-surgery-database-public-reporting-initiative
#10
REVIEW
Jeffrey P Jacobs
Three basic principles provide the rationale for the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (CHSD) public reporting initiative: (1) Variation in congenital and pediatric cardiac surgical outcomes exist. (2) Patients and their families have the right to know the outcomes of the treatments that they will receive. (3). It is our professional responsibility to share this information with them in a format they can understand. The STS CHSD public reporting initiative facilitates the voluntary transparent public reporting of congenital and pediatric cardiac surgical outcomes using the STS CHSD Mortality Risk Model...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007063/the-neonatal-arterial-switch-operation-technical-pearls
#11
REVIEW
Charles D Fraser
The neonatal arterial switch operation has become the standard of care for transposition of the great arteries, including transposition with intact ventricular septum, transposition with ventricular septal defect with or without aortic arch hypoplasia, and double outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing anomaly). While technically demanding, the operation is enormously gratifying and exciting for the congenital heart surgeon. In the current era, outcomes and expectations for the neonatal arterial switch operation are extremely high with many centers, including our own, reporting 30-day or hospital survivorship approaching 100%...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007062/rescuing-the-late-failing-fontan-focus-on-surgical-treatment-of-dysrhythmias
#12
REVIEW
Carl L Backer
Patients with a failing Fontan frequently have dysrhythmias. This review will focus on the treatment of those dysrhythmias based on the 140 patients who have had a Fontan conversion with arrhythmia surgery at Ann & Robert H. Lurie Children's Hospital of Chicago (Chicago, IL). Important technical points to be emphasized are the following:• Atrial fibrillation is extremely common in patients with a failing Fontan and strong consideration should be given to a Cox-maze III during any Fontan conversion• Sinus node dysfunction is common post-conversion and all patients should receive a dual-chamber epicardial pacemaker• Careful preoperative imaging with either computed tomographic or magnetic resonance imaging is needed to predict re-entry problems at the time of repeat sternotomy• If the patient has protein-losing enteropathy, ascites, or a right or indeterminate ventricular morphology, strong consideration should be given to heart transplantation rather than a Fontan conversion and arrhythmia surgery...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007061/the-evolution-of-an-adult-congenital-heart-surgery-program-the-emory-system
#13
REVIEW
Brian Kogon, Joshua Rosenblum, Bahaaldin Alsoufi, Subhadra Shashidharan, Wendy Book
The Emory Adult Congenital Heart (Emory University, Atlanta, GA) program was founded in 2001. In 2004, the surgical component transitioned from a pediatric facility to an adult facility. The aim of this article is characterize the program as a whole, outline changes in the program, and discuss the challenges of the transition process. Between 2001 and 2015, changes in program structure and personnel were evaluated. There has been significant growth of the program between 2001 and 2015. There are currently 19 half-day clinics per week, with 2,700 clinic visits per year...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007060/mechanical-circulatory-support-of-the-fontan-patient
#14
REVIEW
Ronald K Woods, Nancy S Ghanayem, Michael E Mitchell, Steven Kindel, Robert A Niebler
Because of the inadequacies inherent to a circulation supported by a single ventricle, many Fontan patients will experience failure of their circulation. To date, there is no medical regimen that reliably and consistently restores circulatory function in these patients. Because of the shortage of donor organs and the fact that many of these patients present with features that either preclude or render heart transplantation a high risk, there is an intense need to better understand how mechanical circulatory support (MCS) may benefit these patients...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007059/current-status-of-pediatric-ventricular-assist-device-support
#15
REVIEW
Iki Adachi, Sarah Burki, Charles D Fraser
The last decade has witnessed significant advancement in the field of ventricular assist device (VAD) support. Although device options for pediatric patients were previously severely limited because of body size constraints, this frustrating situation has gradually been changing, owing to ongoing device miniaturization. Recognition of the superiority of VAD support compared with conventional extracorporeal membrane oxygenation support has spurred enthusiasm for VAD support in children. In this article, we discuss the current status of pediatric VAD support; where do we stand now and where will we be heading? Because this field is rapidly changing, it is anticipated that this article will provide a general overview of what is currently occurring in the field of pediatric VAD support...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007058/the-50-50-cc-total-artificial-heart-trial-extending-the-benefits-of-the-total-artificial-heart-to-underserved-populations
#16
REVIEW
Dennis Wells, Chet R Villa, David Luís Simón Morales
While use of the total artificial heart (TAH) is growing, the use of the device is not uniform across the gender and age spectrum because the vast majority of implants are in adult males. SynCardia has recently developed a smaller 50 cc TAH that was designed to accommodate patients with a body surface area as low as 1.2 m(2) (potentially even lower using virtual implantation). Herein, we describe the early use of the 50 cc TAH (10 implants in the US and 18 outside the US). Twenty-eight devices have been implanted worldwide...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/28007057/introduction
#17
EDITORIAL
Charles D Fraser
No abstract text is available yet for this article.
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/27060049/mechanical-pulmonary-valve-replacement
#18
REVIEW
John M Stulak, Bassem N Mora, Sameh M Said, Hartzell V Schaff, Joseph A Dearani
Although most valve operations performed annually address lesions of the aortic or mitral valves, the frequency of pulmonary valve replacement (PVR) is increasing because most patients with congenital heart disease are surviving into the adult years. The vast majority of patients, especially children that require PVR, obtain a tissue valve because of the relative good durability and the lack of a need for anticoagulation. Because the need for repeat operation is inevitable for most patients, and the population of adults with congenital heart disease continues to grow, there are increasing situations in which a mechanical pulmonary prosthesis may be appropriate...
2016: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/27060048/preservation-of-the-pulmonary-valve-during-early-repair-of-tetralogy-of-fallot-surgical-techniques
#19
REVIEW
Vladimiro L Vida, Alvise Guariento, Fabio Zucchetta, Massimo Padalino, Biagio Castaldi, Ornella Milanesi, Giovanni Stellin
During the last decade interest in preserving pulmonary valve (PV) function has stimulated a few surgeons to apply valve-sparing techniques in repairing tetralogy of Fallot (TOF), with the aim of preserving long-term right ventricular function. Since June 2007, we embarked upon a program for preserving PV function in selected patients during TOF repair. More recently, the introduction of more complex PV plasty techniques allowed us to further extend the applicability of PV preservation techniques. We believe that preservation of PV function during early repair of TOF, by combining different intraoperative surgical maneuvers, can be extended to almost all patients with classic TOF...
2016: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/27060047/transcatheter-hybrid-aortic-valves-in-the-young
#20
REVIEW
Mirko Doss, Thomas Walther
Transcatheter aortic valve implantation (T-AVI) has been established as an alternative to conventional aortic valve replacement. The number of procedures is steadily rising and has reached comparable implant rates to conventional aortic valve replacement. The success of T-AVI is easily explained by their true minimally invasive nature, ease of use, and excellent hemodynamics. Whilst their use was initially limited to high-risk patients, current trends show that more and more intermediate-risk patients are now treated with theses prostheses...
2016: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
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