CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
33
were female. The instrument was applied by a nurse from the service
after receiving information on postoperative care as service protocol.
The instrument was applied 30 to 60 minutes after surgery. The aver-
age time of application was 4
±
2.3 minutes. Content validity was
0.85, reliability 0.70.
Discussion:
The construction and validation of an instrument to
assess the degree of understanding of postoperative care in cardio-
vascular surgery found that educational interventions made by the
nursing service provided clear concepts for achieving patient care
at home.
780: IMPROVEMENTS IN RESULTS OF NEONATAL AND
INFANT CARDIAC SURGERY: A JOURNEY AT A SMALL
CENTRE
Sandeep Dilip Khanzode, Purushottam K Deshpande, Shrikrishna K
Deshpande, Sachin S Deshpande, Dilip V Gupta, Avantika A Jaiswal,
Mukund K Deshpande, Irshad Ahmed
Deshpande Memorial Centre, Nagpur, India
Background:
Mortality in congenital cardiac surgery (CCS) in
centres worldwide is very low. Every new centre has to match the
benchmark in quicker time. This requires a team effort. We describe
our efforts to improve the results of CCS at our centre.
Methods:
Our centre started CCS for the first time in central India.
The surgeon carried out the roles of cardiologist, surgeon and inten-
sivist. The anesthesiologist carried out the roles of anesthetist, perfu-
sionist and intensivist. We operated on 350 patients with congenital
heart diseases. In the initial period, we started with hypothermic
perfusion, blood prime, cold-blood cardioplegia, conventional and
modified ultrafiltration. We did intra-operative epicardial echocardi-
ography to confirm proper surgical correction. Our intubation times,
re-intubation rates and tracheostomy rates were high. After a visit
to two centres, we modified our prime by increasing the albumin
content and changing the modified ultrafiltration circuit. We intro-
duced bubble CPAP (continuous positive airway pressure) as a step
down from mechanical ventilation in neonates and infants less than
4 kg weight. We improved our neonatal nursing care with emphasis
on hand hygeine.
Results:
We present our results on the different types of surgery.
Conclusions:
Our mortality rate for patients with weight
<
8 kg was
significantly higher but there was significant improvement in our
results after modifications were done in our practice.
785: MODIFIED SINGLE-PATCH REPAIR OF COMPLETE
ATRIO-VENTRICULAR SEPTAL DEFECT IS PERFORMED
MORE EFFICIENTLY WITH NO DETRIMENTAL EFFECT
ON LEFT VENTRICULAR OUTFLOW SIZE AND ATRIO-
VENTRICULAR VALVE COAPTATION RESERVE
Shinya Ugaki, Nee Scze Khoo, David B Ross, Ivan M Rebeyka, Ian
Adatia
Stollery Children’s Hospital, Mazankowski Heart Institute, University
of Alberta, Edmonton, Canada
Objectives:
Concerns have been raised about left ventricular outflow
tract (LVOT) narrowing and increased left atrio-ventricular valve
regurgitation (LAVV) following atrio-ventricular septal defect
(AVSD) repair with a modified single-patch technique. Therefore,
we sought to compare the effects of modified single and two-patch
surgical repair of complete AVSD on the LVOT diameter and the
LAVV coaptation.
Methods:
We retrospectively reviewed postoperative two-dimension-
al echocardiograms of all AVSD patients who underwent modified
single- or two-patch repair between 2005 and 2011. We measured
leaflet coaptation length and tenting height of the LAVV in the apical
four-chamber view. The LVOT was measured in the long-axis view.
Results:
Fifty-one patients underwent AVSD repair (single patch,
n
=
29, two-patch,
n
=
22) with 46 having adequate images for analysis.
Five patients were re-operated after single-patch repair [three residual
ventricular septal defect (VSD) and LAVV regurgitation, one residual
VSD and right AVV regurgitation, one pacemaker implantation]. One
patient after two-patch repair had re-operation for a residual VSD.
The difference in re-operation rates was not significant (
p
=
0.22).
Patient characteristics, LVOT and leaflet findings are summarised
Conclusions:
The modified single-patch repair was performed with
significantly shorter bypass and myocardial ischaemic time, without
significant difference in post-operative LVOT diameter or LAVV
leaflet coaptation length. Further investigation of re-operation rates
may be warranted.
802: RISK OF PROCEDURAL SEDATION AND ANAES-
THESIA IN CHILDREN WITH IDIOPATHIC PULMONARY
ARTERIAL HYPERTENSION
Michelle Rose, Peta Alexander, Bronwyn Norman, Michael Cheung,
Adam Skinner, Robert Weintraub
The Royal Children’s Hospital, Melbourne, Australia
Background:
Children with idiopathic pulmonary arterial hyper-
tension (IPAH) are at high risk of complications while undergoing
general anaesthesia (GA) or procedural sedation (PS). We aimed to
determine the incidence of related complications.
Methods:
A retrospective review was carried out on patients with
IPAH undergoing GA or PS between 1980 and 2012, at a single
tertiary paediatric centre. Data collected included measures of
disease severity, clinical management and complications occurring
within 30 days from GA or PS. Era of management (1980–1999 and
2000–2012) was based on availability of PAH specific therapies.
Major complications were defined as need for cardiopulmonary
resuscitation or death within 30 days.
Results:
A total of 26 patients (15 current and 11 historic) under-
went intervention with GA or PS. Of these, 11 patients, median age
at diagnosis 11.2 years (IQR 5.6, 11.9) underwent 17 procedures
at median age 9.6 years (IQR 7.5, 11.9) in the historical era. In the
current era, 15 patients, median age 6.9 years (IQR 4.8, 11.3;
p
=
0.5)
underwent 59 procedures at median age 11.3 years (IQR 7.26, 14.44;
p
=
0.45). Duration of follow up was limited in the historical control
group to median 0.75 years (IQR 0.1, 2.77) compared to the current
era of 5.1 years (IQR 3.1, 9.6;
p
=
0.006). Historic patients underwent
an average of 1.55 procedures vs 3.93 for current patients (
p
=
0.01).
Severity of PAH and WHO functional class were similar between the
two eras. Major complications occurred in 3/59 (5%) procedures in
the current era compared to 7/17 (41%) procedures in the historic
era (
p
<
0.002). Nine of 10 patients with complications had features
consistent with acutely elevated pulmonary arterial pressures. Three
of the four deaths occurred under GA and one after PS.
Conclusions:
Children with IPAH undergo more interventions using
GA or PS in the current era. The risk of major complications has
reduced significantly but remains unacceptably high in this vulner-
able patient group.
805: EVALUATION OF NUTRITIONAL SUPPORT DELIV-
ERY IN CRITICALLY ILL INFANTS AND CHILDREN ON
EXTRA-CORPOREAL MEMBRANE OXYGENATION
Annabel Doolan, Jemma Woodgate, Tom Dickson, Andreas Schibler
Queensland Paediatric Cardiac Service, Mater Children’s Hospital,
Brisbane, Australia
Background:
Early nutritional support (NS) is an essential compo-
nent of care in the paediatric intensive care unit (PICU), particularly
for patients on extra-corporeal membrane oxygenation (ECMO),
where considerable nutritional and metabolic burdens exist. Our
study is the first to systematically audit NS within a paediatric
ECMO population and proposes the hypothesis that NS is suboptimal
in this patient group.
Methods:
A retrospective audit was conducted in all patients receiv-
ing ECMO between October 2008 and August 2011 in our tertiary
care PICU. Medical records were reviewed to collect data, including:
