Summary

The evolving demographics, outcomes, and anesthetic management of pediatric heart transplant recipients are reviewed. As survival continues to improve, an increasing number of these patients will present to our operating rooms and sedation suites. It is therefore important that all anesthesiologists, not only those specialized in cardiac anesthesia, have a basic understanding of the physiologic changes in the transplanted heart and the anesthetic implications thereof.

Pediatric heart transplantation: demographics, outcomes, and anesthetic implications*

Insight Into the Role of the Child Opportunity Index on Surgical Outcomes in Congenital Heart Disease.

https://www.advancesinpediatrics.com/article/S0065-3101(07)00007-2/pdf

Evaluation of the Quality of Care in Congenital Heart Surgery: Contribution of the Aristotle Complexity Score

Infants of birth weight ≤2500 g are termed low birth weight (LBW). These children often have considerable morbidity from prematurity and intra-uterine growth restriction. Additionally, LBW infants have increased risk for cardiac and noncardiac congenital anomalies and may require surgery. Primary rather than palliative surgical repair of cardiac lesions has been preferred in recent years. However, LBW remains a risk factor for increased mortality and morbidity after open-heart surgery (OHS). There is a paucity of information about the anesthetic challenges presented by LBW infants undergoing OHS. This review summarizes the perioperative issues of relevance to anesthesiologists who manage these high-risk patients. Emphasis is placed on management concerns that are unique to LBW infants. Retrospective data from the authors' institution are provided for those aspects of anesthetic care that lack published studies. Successful outcome often requires substantial hospital resources and collaborative multi-disciplinary effort.

Perioperative management of low birth weight infants for open‐heart surgery

Outcomes of Infant Cardiac Surgery for Congenital Heart Disease Concomitant With Persistent Pneumonia: A Retrospective Cohort Study.

Objective: There is ample evidence, that premature and low birth-weight children have a poor outcome after congenital heart surgery. Aim of the present study was to characterize which perioperative factors influence significantly the outcome of these babies and if the RACHS-1 and the Aristotle score are compatible for this complex kind of heart surgery. Method: In a retrospective study we investigated 108 children which were operated in a 10 year period with a weight at operation less than 3000g. There were 43 premature babies. The mean weight at operation was 2.5±0.5kg, the mean age at operation was 36, 8±55 days. There were 50% treatments categorized in risk group 4 and 6 and 54% in the complexity levels 4 and 6. There were 81 operations (75%) with CPB. Results: The 30 day mortality rate was 18%. The overall mortality rate was 30%. Correlations between mortality rates and risk groups and complexity levels respectively were significant (p=0.005; p=0.041). Other significant factors were preoperative acidosis (p=0, 017) and prostaglandin infusion (p=0.001), an over 7 day ICU stay after operation (p=<0.001) and a re-operation (p=0.031). Also age at operation (p=0.021) and CPB time (p=0.004) were significant factors for poor outcome. Conclusion: The results demonstrate that correction of congenital heart defects in children weighing less than 3kg depend on several factors. The risk groups of the RACHS-1 study and the complexity-levels of the Aristotle score are useful tools for the preoperative risk assessment.

Low weight in congenital heart surgery: is it the right way?

Surgical treatment of cardiac myxomas: 16 years experience of 78 patients

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Low weight in congenital heart surgery: is it the right way?

Surgical treatment of cardiac myxomas: 16 years experience of 78 patients