CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
50
AFRICA
Objectives:
To examine changes in Fontan surgerical practice in a
population-based dataset and to analyse factors impacting on early
outcomes.
Methods:
The databases of all congenital cardiac centres in Australia
and New Zealand were screened for patients who had undergone a
Fontan procedure. A total of 1 087 patients were identified and 1
030 had sufficient available peri-operative data to be included in the
audit. Peri-operative characteristics were analysed for their impact
on mortality in hospital or within 30 days, Fontan failure (death,
revision, takedown or mechanical support), prolonged or significant
pleural effusion (lasting
>
30 days or requiring re-operation) and
prolonged length of stay (
>
30 days).
Results:
Since its introduction in 1975, the Fontan procedure has
been increasingly performed in Australia and New Zealand with a
peak of 2.5 Fontan procedures per one million inhabitants in 2006.
The extracardiac technique (EC) has now been exclusively adopted:
234 atrio-pulmonary (AP) connections, 1975–1995; 288 lateral
tunnel (LT), 1988–2006; and 508 EC, 1997–2011. The proportion of
patients with hypoplastic heart syndrome (HLHS) rose throughout
the study period (1% prior to 1991, 3% 1991–2000, 17% after 2000).
After risk adjustment, early outcomes were similar between LT and
EC and worse for AP. The only additional independent risk factors for
mortality and Fontan failure were dextrocardia (OR 3.2,
p
=
0.06 and
OR 2.7,
p
=
0.03) and pulmonary artery pressure (PAP)
≥
15 mmHg
(OR 3.2,
p
=
0.02 and OR 2.4,
p
=
0.01). HLHS morphology was an
independent risk factor for prolonged hospital stay and significant
effusions (OR 3.4,
p
<
0.001 and OR 3.2,
p
=
0.01, respectively).
Conclusion:
The Fontan procedure is increasingly performed and is
consuming a larger proportion of resources because its rise is driven
by the larger proportion of patients surviving with HLHS. HLHS
patients stay longer in hospital because of prolonged effusions. Early
outcomes were similar after the LT and EC techniques.
1332: POSTOPERATIVE RESULTS OF SECONDER-
LY REPAIR OF RECURRENT RIGHT VENTRICULAR
OUTFLOW TRACT LESION USING THE EPTFE MONO-
CUSPED OUTFLOW PATCHING FOR OLDER CHILDREN
AND ADULTS
Takako Nishino, Hitoshi Kitayama, Toshihiko Saga, Toshio Kaneda,
Kousuke Fujii, Shintaro Yukami, Naoya Miyashita
Kinki University School of Medicine, Japan
Background
: Chronic pulmonary insufficiency is a common prob-
lem after relieving right ventricular outflow tract obstruction. The
importance of a competent pulmonary valve to preserve cardiac
performance has been emphasised. However, controversy remains
with regard to the best prosthesis to implant. We have expanded the
use of ePTFE monocusp for re-operation for recurrent right outflow
tract lesion in older children and adults.
Objective
: The aim of this study was to evaluate the long-term results
of ePTFE monocusped pulmonary valve, and to show the validity of
the use of the ePTFE monocusp for older children and adults.
Methods:
From 1997, 24 patients (mean 16.9
±
6.8 years, range
11–36) underwent redo RVOT reconstruction using ePTFE mono-
cusp at our institution. The primary diagnoses were TOF in 13, PA
VSD in three, DORV in two, TGA in three, truncus in one, PA IVS
in one, and LTGA in one. Seven had had valved conduit repair, and
two
in
situ
PVR. The patients underwent re-operation in the early
postoperative period (within five years), and pre-adolescents (under
10 years old at re-operation) were excluded. The follow-up period
was 11.2
±
3.3 years.
Results
: There was one late death due to non-cardiac disease. One
patient had RVOT revision due to IE. Another patient had BCPS
followed by RV aneurysmectomy and CRTD implantation due to
RV failure. The ePTFE monocusp of both patients functioned well
at re-intervention. Except for the patient who had BCPS, all patients
showed good QOL at the last follow up. Actuarial freedom from
re-intervention for RV lesion was 91.4
±
5.7%, and freedom from
ePTFE valve-related re-operation was 100% at 10 years.
Conclusions
: Long-term results after pulmonary valve repair using
the ePTFE monocusp were satisfactory. The ePTFE monocusp could
be the first choice for even older children and adults.
1336: CHRONIC THORACIC PAIN IN CHILDREN AFTER
CARDIAC SURGERY
Anders Due Kristensen, Mette Ha’j Lauridsen, Vibeke E Hjortdal,
Troels S Jensen, Lone Nikolajsen
Aarhus University Hospital, Aarhus, Denmark
Background:
Chronic pain after cardiac surgery in adults is common
but has gained little attention in children. The aim was to investigate
the prevalence and character of chronic pain after cardiac surgery via
median sternotomy in children.
Methods:
We carried out a prospective clinical examination with
quantitative sensory testing three months after surgery, and a retro-
spective survey of children who had undergone cardiac surgery
10–60 months earlier. The questionnaire assessed pain descrip-
tors, situations or activities that could worsen pain, and analgesic
consumption. Faces pain scales (Bieri) were used to rate the pain
intensity.
Results:
Fourteen children were examined three months after surgery.
One child reported pain. Brush allodynia and pin-prick hyperalgesia
were present in five and nine children respectively, hypo-aesthesia
to cold (20°C) was present in three children, and one child had cold
allodynia in the scar area. The average pressure pain threshold was
80.4 kPa (range 34.3–127.7 kPa); 171 questionnaires were sent out,
and 121 questionnaires (70.8%) were eligible for analysis. Worst
pain intensity in the week after surgery was 5.6 (mean). Pain ‘during
the recent week’ was rated positive by 26 children. Pain was evoked
by pressure against the wound in 23 and by physical activity in 15
children. Itch and pressing were the most frequent pain descriptors
chosen by 25 and 20 children, respectively. One child used paraceta-
mol once a week. A history of two sternotomies increased the risk of
complaints of pain; 15 complaints in 26 children compared with 28
complaints in 79 children who had undergone sternotomy only once.
More than two sternotomies did not relatively increase the number
of complaints.
Conclusions:
The prevalence of chronic pain following cardiac
surgery via median sternotomy in children was lower than in the
adult population. The pain may have a neuropathic component, but
appeared to be mild.
1348: ARTERIAL-SWITCH OPERATION FOR COMPLEX
TRANSPOSITION OF THE GREATARTERIES: OUTCOMES
IN ADULT PATIENTS
Alban-Elouen Baruteau, Virginie Lambert, André Capderou, Jérôme
Petit, Lucille Houyel, Bertrand Stos, Régine Roussin, Mohamedou
Ly, Emmanuel Le Bret, Emre Belli
Marie Lannelongue Hospital, Pediatric Cardiac Surgery, Paris,
France
Arterial switch operation (ASO) is the leading procedure for treat-
ment of complex forms of transposition of the great arteries (TGA)
associated with ventricular septal defect with/without aortic arch
obstruction. This prospective study evaluates the status of survivors
at adult age.
Methods:
Among 688 patients who were operated on at our hospital
for complex TGA between 1982 and 2011, 103 had reached adult age
(
>
18 years). All had haemodynamically significant ventricular septal
defect, 23 had an aortic arch obstruction including coarctation (22
patients), and interrupted aortic arch (one). In 20 patients (19.4%),
a two-stage management was performed after an initial palliative
pulmonary artery banding and aortic arch repair when necessary.
Results:
During a mean follow up of 19.2
±
4 years, two late deaths
occurred (1.94%, 95 CI: 1.92–2.02%), respectively, at five and 10
months postoperatively, both patients awaiting re-operation for severe
aortic valve insufficiency. Actuarial survival was 97.1% at 10, 20 and
