CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
18
AFRICA
for early re-intervention, time to extubation, maximum vasoactive
inotropic score and length of hospital stay were studied as primary
outcomes.
Results:
Twenty neonates (median age five days; range 3–14 days)
with PA IVS underwent a MBTs procedure (shunt size 3–3.5 mm).
The PDA was closed surgically in 10 patients and left open in 10.
Compared with patients in whom the PDA was left open, neonates
with surgically closed PDA had a higher operative mortality (40 vs
0%,
p
=
0.02). A trend toward a higher vasoactive inotropic score in
the group with a closed PDA was observed (17 vs 10.2,
p
=
0.08).
The need for re-intervention and length of hospital stay did not differ
between the two groups (
p
=
0.63 and
p
=
0.59, respectively). Higher
diastolic arterial pressures and lower arterial oxygen saturation to
fraction of inspired oxygen ratio (SatO
2
/FiO
2
) were observed in the
group with a closed PDA during the first 24 postoperative hours.
Conclusions:
In our limited retrospective cohort, PDA closure
during MBTs in newborns with PA IVS was associated with
increased hospital mortality.
360: MORBIDITY AND MORTALITY IN PAEDIATRIC
HEART TRANSPLANTS: A 25-YEAR SINGLE-CENTRE
EXPERIENCE
David Yang, Jessica Houk, Mark Turrentine, Mark Rodefeld, Robert
Darragh, Randy Caldwell, John Brown
Indiana University School of Medicine, Indiana, USA
Background:
The outcomes of paediatric cardiac transplantation
continue to improve. We retrospectively reviewed our outcomes over
the last 25 years to determine the risk factors for poor outcomes in
our patient population.
Methods:
Since 1985, 126 heart transplants in 120 patients (69
males) have been performed. Median age at transplantation was 3.6
years (range: four days to 17.8 years). The primary indications for
transplantation included CHD (
n
=
61), cardiomyopathy (
n
=
58), and
re-transplantation (
n
=
7). Pre-operatively, 40% (
n
=
51) had previ-
ous surgical interventions. Pre-, peri- and postoperative data were
analysed to identify risk factors.
Results:
Early and late mortality were 7% (
n
=
9) and 39% (
n
=
49), respectively. Actuarial survival at one, five, 10 and 20 years
was 86, 73, 62 and 46%, respectively. The diagnosis of CHD and
transplantation prior to the year 2000 were independent risk factors
for early mortality. At median follow up of 76.7 months (range 0–294
months), 17% (
n
=
22) required further cardiac intervention, includ-
ing the 5% (
n
=
6) who needed subsequent re-transplantation. There
were no risk factors associated with late mortality or need for further
surgical intervention.
Conclusions:
Paediatric patients transplanted for CHD and those
transplanted prior to the year 2000 were independent risk factors for
early mortality. Further review of the specific CHD diagnoses and
immunosuppression management protocols will be compared to see
if they affected outcomes.
387: MANAGEMENT OF WOUND INFECTIONS POST
CARDIAC SURGERY IN PAEDIATRICS
Ayman Al Masri, R Gobinath, Osama Abo alfotoh, Hesham
Menshawy, Ahmed Dohain Nasreldeen Almeeri, Faisal Al Saiede,
Vadim Lyubomudrov, Abdulla El Sanae
Paediatric Anesthesia Department, Chest Disease Hospital, Kuwait
Background:
The spectrum of sternal wound infections after cardiac
surgery ranges from superficial infections to a deep sternal infection
known as mediastinitis. Mediastinitis is an uncommon and clinically
relevant source of postoperative morbidity and mortality in paediatric
patients after cardiac surgery.
Methods:
A retrospective observational study was carried out in our
paediatric intensive care unit, in which more than 800 patients post
cardiac surgery were assessed for risks of sternal wound infection
(SWI). We identified all patients diagnosed with mediastinitis after
cardiac surgery from January 2009 to June 2012. Staging of wound
care using a standard protocol of antibiotics and selected dressings
was done.
Results
: Major risk for sternal wound infection was associated with
delayed sternal closure. Chest wound infection developed in 40 of
800 (5%) children after median sternotomy or lateral thoracotomy.
Superficial wound infection developed in 30 (3.751%) children and
10 (1.25%) had deep infection. Children with sternal wound infection
were younger, had delayed sternal closure, longer periods of ventila-
tion and inotropic support, and longer intensive care unit and total
postoperative hospital stay. Staging of wound care proved effective
and successful.
Conclusion:
Infections continue to be a significant cause of morbid-
ity in paediatric cardiac surgery patients. Knowledge of risk factors
for infection could be useful in preventative and treatment strategies
for these high-risk groups. Paediatric strategies differ from adult
programmes. Standardised protocol, timely diagnosis, timely wound
debridement and liberal use of specific antibiotic mixes with selected
dressings can potentially minimise the morbidity and mortality rates
in paediatric postoperative cardiac patients
390: EVALUATION OF TWO-STAGE ARTERIAL SWITCH
AS A TREATMENT STRATEGY IN THE MANAGEMENT OF
DELAYED PRESENTATION OF TRANSPOSITION OF THE
GREAT ARTERIES WITH A REGRESSED LEFT VENTRI-
CLE
Mohammad Asim Khan, Salman Ahmed Shah, Masood Sadiq
The Children’s Hopsital and Institute of Child Health, Lahore,
Pakistan
Background
: Management of transposition of the great arteries with
intact ventricular septum (TGA/IVS) is currently an arterial-switch
operation (ASO) performed in the first two weeks of life. Two-stage
ASO is one form of treatment in infants with TGA presenting late.
Methods
: From December 2009 to date, a total of eight patients with
TGAIVS presented late and were not deemed suitable for immediate
ASO due to left ventricular regression, and were selected for a two-
stage ASO. Serial echocardiography was used to assess the increased
thickness of the left ventricular (LV) posterior wall. A stage II ASO
was done a few weeks later. A retrospective review of patient charts
was done. Effects of variables such as age, BSA and time interval
between two procedures on mortality rate were analysed. Data were
formulated into a structured database, and statistical analyses were
performed with the statistical package SPSS for Windows.
Results
: Eight patients underwent stage I, which had an in-hospital
mortality of 12.5% (1/8), while the interval mortality between both
stages was also 12.5% (1/8). Two patients died from non-cardiac
complications due to aspiration-related pulmonary sepsis. One
patient had a failed stage I (12.5%) due to acute LV failure and had to
undergo a Senning atrial switch as a salvage operation. One patient is
currently waiting for stage II definitive repair after a successful stage
I. The mean interval between the two stages was 3
±
1 weeks. Four
patients have undergone a successful stage II ASO with zero mortal-
ity. All patients had remarkably rapid recoveries and short hospital
(6
±
2 days) stay.
Conclusion
: Early experience indicates that in a developing country
such as Pakistan, a rapid two-stage arterial switch is an acceptable
treatment option. Patients who survived stage I and the intervening
period had excellent results with stage II.
397: TOTAL ANOMALOUS PULMONARY VENOUS
CONNECTION: MANAGEMENT AND OUTCOME, EXPERI-
ENCE FROM CHILDREN’S HOSPITAL, LAHORE, PAKI-
STAN
Mohammad Asim Khan, Tariq Waqar, Masood Sadiq
The Children’s Hospital and Institute of Child Health, Lahore,
Pakistan
