CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
24
AFRICA
Methods:
Ninety-three neonates (
<
30 days) undergoing surgery
with hypothermic CPB had prospective data collection for both
cardiac and non-cardiac anaesthetics. End-tidal VAA was recorded
every 15 minutes and inspired VAA concentration in the CPB sweep
gas recorded every 10 minutes. Age-adjusted minimum alveolar
concentration (MAC) hours were calculated. The primary outcome
was the relationship between MAC hours of VAA, and cognitive,
language and motor composite scores of the Bayley scales of infant
development III (BSID) at age 12 months.
Results:
Ninety-three patients had neonatal cardiac surgery, 10 of
these patients died and 24 did not return for 12-month follow up,
leaving 59 undergoing BSID (71% of survivors). After unadjusted
linear regression analysis, higher MAC hours VAA exposure was
associated with lower 12-month BSID cognitive score [Cog
=
107.7 –
(1.5 × MAC hours),
R
=
0.33,
R
2
=
0.11,
p
=
0.01]. There was a trend
towards lower language (
p
=
0.18) and motor (
p
=
0.09) scores with
higher MAC hours. After backward stepwise multivariable analysis,
increasing total MAC hours was associated with lower cognitive
score (
p
=
0.01). Higher MAC hours were associated with lower
language score (
p
=
0.02), but were not associated with lower motor
score (
p
=
0.49).
Discussion:
We demonstrated an association between increasing
exposure to VAA, and lower BSID III scores at 12 months of age,
independent of covariates including cardiac anatomy, CPB time,
regional cerebral oxygen saturation and MRI brain injury. Each addi-
tional MAC hour of VAA exposure was associated with a 1.5-point
decrease in cognitive score. Anaesthetic technique may be an impor-
tant factor in adverse neurodevelopmental outcomes after neonatal
cardiac surgery.
562: EARLY OUTCOMES FROM A NEW REGIONAL
PROGRAMME FOR THE SURGICAL MANAGEMENT OF
HLHS IN AUSTRALIA
David Winlaw
1,2
, Yishay Orr
1
, Stephen Cooper
1
, Richard Hawker
1
,
Philip Roberts
1
, Megan Sherwood
1,2
, Nadia Badawi
1,2
, Richard
Chard
1,2
, Ian Nicholson
1,2
, Gary Sholler
1,2
1
Heart Centre, The Children’s Hospital at Westmead, Sydney,
Australia
2
Sydney Medical School, University of Sydney, Australia
Introduction:
Early survival and quality of outcome after surgery
for hypoplastic left heart syndrome (HLHS) are influenced by
patient-specific factors, the quality of surgery and peri-operative
care. Some skills are common to the care of other complex neonatal
presentations but integrating this expertise is a key challenge for new
programmes. We began offering surgery for HLHS from 2006 and
provided a regional service from January 2009, and we report early
outcomes here.
Methods:
Prospectively collected data for neonates with HLHS
undergoing surgical palliation from January 2006 until June 2011
were analysed. Standard definitions of high- and standard-risk pres-
entations were utilised.
Results:
Thirty neonates underwent surgical palliation of HLHS with
a modified Norwood procedure with an overall survival to stage II
palliation of 80%; 46.7% of our patients were categorised as high
risk, mostly on the basis of low birth weight. Survival to stage II
palliation was 100% in standard-risk patients and 57.1% in the high-
risk group. Survival at one year was 67% and comparable to the SVR
study at 69%.
Conclusion:
Outcomes for this new programme are comparable to
reported outcomes. Excellent outcomes can be achieved in standard-
risk patients. Outcomes in the high-risk group may be improved by
alternative approaches and rigorous case selection. Providing infor-
mation about local outcomes is an important element in counselling
of families with antenatal diagnosis of HLHS.
564: TWO-VENTRICLE REPAIR FOR COMPLEX CONGENI-
TAL HEART DEFECTS THAT ARE PALLIATED TOWARDS
SINGLE-VENTRICLE REPAIR
Raman Krishna Kumar, Brijesh P Kottayil, Gopalraj S Sunil, Mahesh
Kappanayil, Sweta Harish Mohanty, Balu Vaidyanathan, Edwin
Francis, Rakhi Balachandran, Suresh Nair
Amrita Institute of Medical Sciences, Cochin, India
Background:
Complex congenital heart defects that present earlier
in life are sometimes channelled towards single-ventricle repair,
because of anatomical or logistical challenges involved in two-
ventricle correction. Given the long-term functional and survival
advantage, we have been consciously exploring the feasibility of
a biventricular repair when these patients present later for Fontan
completion.
Methods:
Since June 2009, 71 patients were referred for staged
completion of Fontan. Following detailed evaluation that included
3D echo and MRI, 10 patients (group I: median age six years) were
identified and later underwent complex biventricular repair with
take down of Glenn shunt. Non-routable VSD, straddling tricuspid
valve, requirement of complex repair using conduit at a young age,
and ventricle being too small to support the systemic or pulmonary
circulation were the reasons to defer biventricular repair initially. In
two patients, the decision for palliation with Glenn shunt was taken
on the surgical table during previous failed attempts at biventricular
correction. Completion of extracardiac Fontan repair was done in 61
patients (group 2: median age seven years).
Results:
Two-ventricle repair was accomplished in all 10 group 1
patients. The mean cardiopulmonary bypass time (362
±
93 vs 155.9
±
95.7 min,
p
<
0.0001) and mean ICU stay of 7
±
3.6 vs 5.4
±
3 days
were longer in group 1 patients, but were not statistically significant.
One patient developed complete heart block requiring permanent
pacemaker. Late patch dehiscence occurred in another (awaiting
repair). At a median follow up (15 months), there was no mortality
among group 1 patients and all except one were symptom free. There
were two early deaths (3.2%) in group 2.
Conclusion:
Two-ventricular repair, although surgically challenging,
should be considered in all patients with two functional ventricles who
come for Fontan completion. Comprehensive pre-operative imaging
and meticulous planning helps in identifying suitable candidates.
567: SHORT-TERM RESULTS OF TETRALOGY OF FALLOT
REPAIR INTHE HOSPITAL INFANTIL DE MEXICO FEDER-
ICO GAMEZ
Karla Delahanty-Pedroza, Lorenzo Reyes-de la Cruz, Norma A.
Balderra¡bano-Saucedo, Alexis Arevalo-Salas, Begoa Segura-
Stanford, Rosario Becerra-Becerra, Alejandro Bolio-Cerda¡n,
Alfredo Vizca¬no-Alarcan, Sergio Ruiz, Julio Erdmenger-Orellana
Hospital Infantil de Maxico Federico Gamez, Mexica
Background:
Tetralogy of Fallot (TOF) accounts for 3.5% of all the
patients with congenital heart defects. Complications associated with
the repair vary according to surgical technique and patient-specific
factors. The present study was conducted to investigate the short-
term clinical outcomes of TOF repair and to identify risk factors
associated with complications and death.
Methods:
Between 2006 and December 2010 we retrospectively
reviewed the outcomes of 78 patients operated for tetralogy of Fallot
at the Hospital Infantil de Mexico Federico Gómez.
Results:
Seventy-eight patients were operated on during the period
of study. The mean age at diagnosis was 1.2 years; the mean age
at surgery was 2.7 years. Fifteen patients had received a previous
systemic–pulmonary fistula (19%). The type of surgery was infun-
dibuloplasty in 44 patients (55.7%), with a transannular patch in 27
(34.2%), with a valved conduit in two (2.5%), with valve replace-
ment in two (2.5%), with homograft in two (2.5%), and one patient
underwent a monocusp valve formation (1.3%). The extracorporeal
circulation mean time was 133 minutes and the aortic clamp of 79
minutes. The mechanical ventilation time was 2.29 days. The mean
