Małgorzata Pawelec-Wojtalik

Infection Risk Factors in Pediatric Cardiac Surgery

Cardiac operations were preformed in 499 children from January 1998 through December 1999. Their median age was 263 days. A positive culture from blood, bronchoalveolar lavage, wound, or central catheter was obtained in 110 patients (22%). Age, sex, presence of pulmonary hypertension, body surface area, ratio of body surface area to oxygenator surface area, whether heart surgery was open or closed, and the duration of the operation, cardiopulmonary bypass, intubation, and intensive care were analyzed. Patients who developed infections were significantly younger, with smaller body surface areas and disparity with the oxygenator surface area, longer operative and bypass times, extended intubation, and prolonged intensive care. There was a significant correlation between infection and pulmonary hypertension. Sex and type of operation were not predictors of infection.

Mid-term experience with valved bovine jugular vein conduits.

From June 1999 to January 2004, 43 children underwent implantation of a valved bovine jugular vein conduit and correction of complex congenital heart defects. Median age was 1.98 years (range, 11 days – 13.3 years). There were 7 early deaths (16.3%) unrelated to conduit failure or thrombosis. Median follow-up of 36 survivors was 24 months (range, 1–48 months, quartile range, 12–48 months), total follow-up was 78 patient-years. There were 3 late deaths (8.3%) due to infection, pulmonary thromboembolism, and sudden cardiac arrest after re-operation to repair a right ventricular outflow tract aneurysm. There were 2 conduit explantations due to dysfunction and suspected endocarditis. Three patients underwent balloon dilatation of distal stenoses. The mean peak gradient through the pulmonary anastomosis was 15 mm Hg (range, 3–42 mm Hg) among patients free from re-intervention. No severe valve regurgitation was observed. Freedom from re-intervention was 72% at 48 months. This conduit remains a good alternative to homografts. Causes of distal stenosis must be clarified, guidelines for prophylactic anticoagulation must be created, and the role of percutaneous balloon dilatation established.

Arterial switch operation in neonates with complex congenital heart defects.

The aim of the study was to analyze short-term results of the arterial switch operation in 29 neonates with simple transposition of the great arteries (group A) and 18 (group B) with complex heart defects: transposition with a ventricular septal defect (10), coarctation of the aorta (5), or Taussig-Bing anomaly (3). The operations were usually performed on the 7th day of life (2nd–30th day), after a Rashkind procedure when necessary. The mean weight was 3,530 ± 780 g, body surface area was 0.219 ± 0.032 m2. Delayed sternal closure was necessary in 7 patients from group A (24%) and 8 from group B (44%) because of hemodynamic instability after weaning from extracorporeal circulation; these neonates had significantly lower body weights and smaller body surface areas. Perioperative mortality was 13.8% (4 patients) in group A and 27.8% (5 patients) in group B. Correction of complex transposition tends to be associated with a higher operative risk than simple transposition, but the difference was not significant.