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