CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
34
AFRICA
demographics, ECMO type, nutritional fluids, and hours to NS initia-
tion. Protein and calorie delivery were calculated and compared to
international consensus guidelines or age-specific recommendations
where available.
Results:
Fifty-five subjects were analysed, 42 (76%) cardiac and 13
(24%) respiratory ECMO patients. Five (9%) patients received no NS
during their ECMO period, 85% of patients received NS within 24
hours of starting ECMO, with a mean time (
±
SD) to feed initiation
of 8
±
17 hours. In all age categories, recommended target calorie
and protein requirements were not met. There was no significant
difference in protein (
p
=
0.4) and calorie (
p
=
0.08) delivery within
or between any age group. However, ‘respiratory’ ECMO patients
received significantly more calories than the ‘cardiac’ group (44
±
18 vs 29
±
23 kcal/kg,
p
=
0.04
)
. Furthermore, enteral nutrition (EN)
delivered significantly less protein (0.55
±
0.39 g/kg) than parenteral
nutrition (PN) (1.28
±
0.55 g/kg,
p
=
0.02) and combined PN and EN
(1.13
±
0.67 g/kg,
p
≤
0.01).
Conclusion:
We have shown that despite early feed initiation, the
delivery of NS is suboptimal in paediatric patients on ECMO. Future
research focusing on prioritising and optimising NS practice, with
emphasis on EN as the preferred feeding route in this population
should be considered.
818: AN INITIAL EXPERIENCE OF SURGICAL CORREC-
TION OF TOTAL ANOMALOUS PULMONARY VENOUS
DRAINAGE IN A NEW PAEDIATRIC CARDIAC SURGERY
CENTRE
Sandeep Dilip Khanzode, Purushottam K Deshpande, Shrikrishna K
Deshpande, Sachin S Deshpande, Dilip V Gupta, Avantika A Jaiswal
, Mukund K Deshpande, Irshad Ahmed
Dr KG Deshpande Memorial Centre, Nagpur, India
Background:
A low mortality rate with surgery for total anamolous
pulmonary venous drainage (TAPVD) is reported worldwide these
days, but there has been controversy regarding ligation of the vertical
vein in supracardiac and infracardiac TAPVD, and keeping a small
PFO. We report our small initial series of 20 patients.
Methods:
We operated on 20 patients for TAPVD from August 2009
to July 2012. A standard protocol of moderate hypothermia, blood
prime, blood cardioplegia, and conventional and modified ultrafiltra-
tion was used in these surgeries. We ligated the vertical vein in three
of the six supracardiac type of TAPVD patients and one infracardiac
type of TAPVD patient. A small PFO was left in 17 patients.
Results:
We present our results on the surgeries.
Conclusions:
We preferred keeping a small PFO in our patients,
especially those who had severe RV dysfunction due to late pres-
entation and repeated chest infection. These patients had persistent
right-to-left shunt across the PFO for a few postoperative days, which
then reversed to left-to-right shunt. The vertical vein was ligated
only if patients had stable haemodynamics post-operatively. Our
high mortality might be due to lack of nitric oxide at our centre and
also due to the lack of paediatric cardiologists and intensivists (SSD
joined recently). The primary surgeon (SDK) performed echocardi-
ography and managed the ICU as well.
857: A SUCCESSFUL BEATING-HEART SURGERY IN
CONGENITAL HEART DISEASE IN INDONESIA
Ivan Joalsen, Yan Efrata Sembiring, Heroe Soebroto, Paul Tahalele
School of Medicine, Airlangga University, Dr Soetomo Teaching
Hospital, Surabaya, Java, Indonesia
Background:
Reperfusion injury is a well-known phenomenon that
can occur in cardioplegic techniques with cardiopulmonary bypass.
Therefore great effort is made to prevent reperfusion injury. Beating-
heart continous coronary perfusion (BHCCP) surgery is one of the
alternative technique to improve an ischaemic reperfusion injury in
open-heart surgery, in either paediatric or adult patients. It is divided
into antegrade and retrograde perfusion. Keeping the heart beating
results in less myocardial oedema and better myocardial function.
Methods:
We report on eight patients with congenital heart
disease (from December 2011 to June 2012). Five patients suffered
from secundum ASD, one with VSD, and two patients with TOF.
Pre-operative diagnoses were established by echocardiography and
cardiac catheterisation if necessary. All the patients underwent
BHCCP surgery. Echocardiographic examinations play a significant
role in evaluating the heart immediately after surgical repair.
Results:
All the patients who underwent correction using BHCCP
techniques showed good outcomes such as reduced ventilator time
(mean
±
10 hours) and length of stay in ICU (mean
±
2 days), and
less inotropes. Our results indicate that BHCCP surgery is a safe and
reliable technique for treatment of cardiac diseases and it is a good
option in patients with poor LV function.
Conclusion:
After the two-month follow up, all of our patients
showed no significant complications. There were no mortalities, no
neurological deficit, and only one patient with ToF showed a 2-mm
residual VSD.
871: PRETREATMENT BEFORE CORONARY ARTERY
BYPASS SURGERY IMPROVES POSTOPERATIVE
OUTCOMES IN MODERATE CHRONIC OBSTRUCTIVE
PULMONARY DISEASE PATIENTS
Bilgehan Oz, Suat Doganci, Erkan Kaya, Faruk Cingoz, Mehmet
Arslan
GATA Medical Faculty of Military Medicine, Cardiovascular Surgery
Department, Etlik, Ankara, Turkey
Hypothesis:
The aim of this study was to analyse the impact of
different COPD stages on the early surgical outcomes in patients
undergoing primary isolated non-emergency CABG.
Methods:
According to the protocol applied by the Department of
Pulmonary Diseases, two different treatment protocols were used
before and after 2010. Before 2010 no treatment was applied to
patients with moderate COPD before the CABG procedure. After
2010 the pretreatment protocol was begun. Due to this change in pre-
CABG treatment protocol, we organised the study groups. Patients
who underwent surgery between 2008 and 2010 formed group 1 (no
pretreatment group,
n
=
51) and patients who underwent surgery
between 2010 and 2012 formed group 2 (pretreatment group,
n
=
53). These two groups were compared according to the postoperative
morbidity and mortality rates, retrospectively from medical reports.
Results:
Mean age of the patients in both groups were 62.1
±
7.6
and 64.5
±
6.4 years, respectively. Mean Euroscores of the patients
were 5.5
±
2.3 and 5.9
±
2.5, respectively in the two groups. Average
number of grafts were 3.1
±
1.0 and 2.9
±
0.9. Mean extubation times
were 8.52
±
1.3 hours in group 1 and 7.41
±
1.1 hours in group 2 (
p
<
0.05). The number of patient who needed pharmacological inotropic
support were 12 in group 1 and five in group 2 (
p
<
0.05). Duration
of hospital stay of the patients was also shorter in group 2 (9.29 days,
p
<
0.05). While there were seven patients who had pleural effusions
requiring drainage in group 1, there were only two requiring drainage
in group 2 (
p
<
0.05). There were no in-hospital or early mortalities
in either group.
Conclusion:
Pretreatment in moderate-risk COPD patients improved
postoperative outcomes while decreasing the adverse events and
complications. Therefore in patients undergoing elective CABG we
recommend the use of medical treatment.
883: FLUID DYNAMICS AND FLOW PROFILES IN THE
GREAT ARTERIES IN TGA PATIENTS AFTER ARTERIAL-
SWITCH OPERATIONS WITH OR WITHOUT LECOMPTE
MANOEUVRE ON LONG-TERM FOLLOW UP
Carsten Rickers
1
, Hans Sievers
2
, Ahmad Falahatpisheh
3
, Kheradvar
Arash
3
, Michael Jerosch-Herold
4
, Christopher Hart
1
, Dominik
Gabbert
1
, Jens Scheewe
1
, Inga Voges
1
, Hans-Heiner Kramer
1
1
University Hospital Kiel, Paediatric Cardiology, Kiel, Germany
2
University Hospital Luebeck, Cardiac Surgery, Luebeck, Germany
