CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
58
AFRICA
Background
: The Aristotle complexity score was developed to
predict the risks of congenital heart surgery and evaluate surgi-
cal performance. However, every country has different healthcare
environments, so we evaluated the predictive value of the Aristotle
complexity scoring system in our country based on our institutional
outcomes.
Methods
: Aristotle basic complexity score and comprehensive
scores were prospectively assigned to all consecutive surgical
procedures for congenital heart surgery between January 2008 and
August 2012. We defined the major morbidity based on the Society
of Thoracic Surgeons’ national database. The discriminator power of
the scoring system for mortality and major morbidity was analysed
by the goodness-of-fit test using a logistic regression model.
Results
: We performed 821 surgical procedures for congenital heart
defects. Aristotle basic score was 6.8
±
2.2 and comprehensive score
was 8.2
±
3.0. There were 31 surgical mortalities and major morbidi-
ties developed in 223 cases. The
p
-value of the goodness-of-fit test
for surgical mortality and major morbidities were 0.742 and 0.488,
respectively. The C-index was 0.782 (95% CI: 0.69–0.874), and
0.711 (95 CI: 0.671–0.751).
Conclusions
: Aristotle complexity score is an adequate model to
predict the surgical mortality and morbidity rates in our country. The
system can be used for stratification of the risks of congenital heart
defects.
1564: VENTRICULAR-ARTERIAL COUPLING IN CHIL-
DRENWITH STILL’S MURMUR
Juliane Engel
1
, Sigrid Baumgartner
2
, Silvia Novak
1
, Ulrike Salzer-
Muhar
1
1
Division of Paediatric Cardiology, Medical University of Vienna,
Austria
2
Division of Neonatology, Medical University of Vienna, Austria
Background:
Still’s murmur is the most common innocent heart
murmur in children, but there is no reliable explanation of its origin.
Ventricular-arterial coupling (VAC) is an index describing the cross
talk between the left ventricle (left ventricular contractility E
LV
) and
the arterial system (effective arterial elastance E
A
). It serves as an
important measurement of cardiac performance and cardiac energetics.
Methods:
In our exploratory study, data of 43 children with Still’s
murmur and 42 healthy children without murmur aged two to 10
years (mean age with murmur: 5.17
±
2.0 years; controls: 5.8
±
2.5 years) were analysed regarding blood pressure (BP) and heart
rate (HR), echocardiographic measurements of aortic root (AoD)
and left ventricular end-diastolic (LVIDd) and end-systolic (LVIDs)
dimensions indexed to body surface area, and VAC, thereby includ-
ing the arterial system into the investigation of Still’s murmur and its
possible origin.
Results:
While there was no significant difference regarding BP, HR,
AoD, LVIDd and LVIDs, or their relative proportions, significant
differences could be found in VAC (
p
=
0.005). There was a tendency
towards higher E
A
(
p
=
0.39) and lower E
LV
(
p
=
0.14) in children
with Still’s murmur. Also, there was a significantly higher ejection
fraction (EF%) (
p
<
0.005) and a larger stroke volume (SV per kg
body weight) (
p
<
0.05) in children with murmurs. All differences
were more pronounced in children aged two to six years than in those
aged six to 10 years.
Conclusion:
The low-frequency vibratory murmur seems to be
caused by a combination of lower E
A
, higher E
LV
,and higher ejection
fraction and stroke volume compared to children without murmur.
The fact that all differences were more pronounced in young children
is reaffirmed by the decreasing prevalence of Still’s murmur in older
children.
1568: 30 YEARS OF PAEDIATRIC CARDIAC SURGERY
IN SERBIA AND 10 YEARS OF THE ARTERIAL-SWITCH
OPERATION AT THE MOTHER AND CHILD INSTITUTE
OF SERBIA
Mila Stajevic, Jovan Kosutic, Vladislav Vukomanovic, Igor Sehic,
Igor Krunic, Petar Mracevic, Ivica Despo, Bosiljka Jovicic
Institute for Mother and Child, Medical School, University of
Belgrade, Serbia
Introduction:
The Department for Paediatric Cardiac Surgery was
officialy founded in Belgrade in 1982. Individual attempts to oper-
ate on patients with congenital heart disease prior to 1982 were
performed at adult cardiac surgical centres in Belgrade. The Senning
and Mustard modifications of the atrial-switch technique were the
techniques of choice for treating D-TGA. Until 2001, there were
13 attempts at arterial switching, with three survivors. From 1998
to 2001, the majority of D-TGA patients were routinely sent abroad
for treatment. The arterial-switch procedure has been the standard
operative procedure for patients with D-TGA in our hospital since
May 2003.
Methods:
In the period from May 2003 to June 2012, a total number
of 65 children with D-TGA or D-TGA + VSD patients were operated
on by the arterial-switch technique. Other diagnoses were excluded
from the study. There were two surgeons performing the operation:
the senior surgeon performed 57 operations and the the second one,
only five patients from 2010. Routine pre-operative treatment was
applied to all children. The youngest patient was seven days old, the
oldest 95 days, the body weight varied from 2 300 to 4 900 g. The
coronary artery patterns were identified as normal in 40 patients,
inverted in four, single coronary artery anatomy was diagnosed in
three patients and other forms in 15 patients.
Results:
The overall mortality has fallen from 42% in the first two
years to 3% in the last 24 months. The identified risk factors were
bleeding and coagulation disorders, clinical conditions of the chil-
dren and surgical errors.
Conclusion:
In a 10-year period, the arterial-switch procedure has
become a sucessful technique in our hospital.
1597: VACUUM-ASSISTED CLOSURE IN THE TREATMENT
OF DEEP POST-STERNOTOMYWOUNDS IN NEWBORNS
Theodor Tirilomis, Martin Friedrich, Christian Bireta, Alexander
Emmert, Wolfgang Ruschewski
University of Goettingen, Germany
Introduction:
Deep sternal infections after paediatric open-heart
surgery are rare. Mortality for post-sternotomy mediastinitis contin-
ues to be high. Treatment includes antibiotics, frequent change of
wound dressing, and surgical debridement. The vacuum-assisted
closure (VAC) therapy is a new treatment option. Nevertheless, espe-
cially in newborns, experience in deep wound treatment is limited.
Methods:
In the five-year period from 2007 to 2011, two newborns
developed deep sternal infection after cardiac surgery and were
treated with a vacuum-assisted closure system.
Results:
After primary cardiac surgery, both babies received circu-
latory support (ECMO) and delayed sternal closure. The duration
of the VAC therapy was 21 and eight days. After good granulation
was obtained, the patients underwent conventional wound dressing.
Plastic surgery with muscle flap or skin graft was not required.
Conclusions:
VAC therapy is an effective alternative treatment in
post-sternotomy mediastinitis in neonates, reducing infection and
providing good wound healing.
1618: NECESSITY OF BIOMEDICAL ENGINEERING
SUPPORT FOR HUMANITARIAN MEDICAL MISSIONS IN
DEVELOPING COUNTRIES
David Wieduwilt
1
, Roy Morris
1,2,3
, David Coquat
1
, William Novick
1,4
1
International Children’s Heart Foundation, Memphis TN, USA
2
Biomedical Solutions, Inc, USA
3
University of Arkansas for Medical Sciences, USA
4
University of Tennessee Health Science Center, USA
Background:
Due to less complex technology for medical equipment
