Boston - American Association for Thoracic Surgery

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89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS2. Single Center Experience in Treatment of Cardiogenic Shock ofAny Etiology in Children by Pediatric Ventricular Assist DevicesRoland Hetzer, * Evgenij V. Potapov, Oliver Miera, Yu-Guo Weng, Michael Hübler,Felix BergerDHZB, Berlin, GermanyInvited Discussant: Charles Fraser, Jr.OBJECTIVE: Pediatric ventricular assist devices (VAD) are superior to ECMO formedium- and long-term support. New devices are in development and will beintroduced into clinical routine soon. We present the development of our clinicalpractice with pulsatile pediatric VAD over almost 20 years.METHODS: Since 1990 and as of October 1, 2008, 95 pediatric Berlin Heart Excorsystems have been implanted in patients below 18 years of age at our institution.The patients were divided into two groups according to the period of treatment:period I – devices implanted between 1990 and 2002 (n = 45) and period II –devices implanted since 2002 (n = 50). We compared our experience during theearlier and later periods.RESULTS: There were no significant differences in the preoperative patient databetween the two periods except for time of support (median 10, range 0–111 daysvs. 37, range 1–420 days, p < 0.001). In period I more patients were supported witha biventricular VAD (64% vs. 26%, p < 0.001). In period II more children wereextubated on the VAD (38% vs. 62%, p = 0.018). Discharge from hospital followingeither weaning from the system or heart transplantation was achieved in 49% inperiod I and in 70% in period II (p = 0.035). Whereas in period I 8% of childrenyounger than 1 year old were discharged home, in period II it increased to 44%(p = 0.088). There was a significant improvement in the discharge rate in period IIin patients with postcardiotomy heart failure (17% vs. 80% p = 0.028).CONCLUSION: Earlier implantation of VAD, substantial modifications in cannulaand pump design, improvement in anticoagulation and the coagulation monitoringregime have led to a significant increase in the survival and discharge rate,especially in children under 1 year of age. Now, the pediatric Berlin Heart ExcorVAD is an established treatment for children suffering from cardiogenic shock ofany etiology.* AATS Member72
AMERICAN ASSOCIATION FOR THORACIC SURGERY3. Long-Term Results of Aortic Valve Sparing Operations in Patientswith Marfan SyndromeTirone E. David, * Susan Armstrong, Manjula Maganti, Jack Colman,Timothy BradleyCardiovascular Surgery, Toronto General Hospital, Toronto, ON, CanadaInvited Discussant: Lars G. SvenssonOBJECTIVE: This study examines the long-term results of aortic valve sparingoperations in patients with Marfan syndrome.METHODS: From 1988 to 2006, 103 consecutive patients with Marfan syndrome(mean age 37 ± 12 years, 72% men) with aortic root aneurysm had aortic valvesparing operations. Emergency surgery was performed in 11 patients: 8 for acutetype A dissection and 3 for unexplained persistent chest pain. Three patients hadchronic type A dissection and previous ascending aorta replacement. Fifteenpatients had moderate or severe aortic insufficiency (AI) and 14 had mitral insufficiency.Reimplantation of the aortic valve was performed in 77 patients and remodelingof the aortic root in 26. Patients were followed prospectively and had annualechocardiographic studies. The mean follow-up was 7.3 ± 4.2 years, and 100%complete.MONDAYMorningRESULTS: There was one operative death and 5 late deaths, 4 due to complicationsof aortic dissections. Patients’ survival at 15 years was 87.2% and that of thegeneral of population matched for age and gender was 95.6%. Three patientsrequired aortic valve replacement: 2 for AI and one for endocarditis. The freedomfrom reoperation on the aortic valve at 15 years was 87.6 ± 7.7%. The latest echocardiographicstudy before death or reoperation showed no AI in 33 patients, trivial in35, mild in 27, mild to moderate in 4, moderate in 2, and severe in 1. The freedomfrom AI of mild to moderate or greater grade at 5-, 10- and 15-year was 100%, 94.5± 5.4%, and 88.2 ±1 1.7% respectively. Remodeling of the aortic root was not anindependent predictor of AI. At the most recent follow-up 97 patients were alive:86 were in functional class I and 11 in class II.CONCLUSION: Aortic valve sparing operations provide excellent long-term valvefunction and low rates of valve-related complications in patients with Marfan syndrome.Complications of aortic dissections remain problematic in these patients.* AATS Member73
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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Boston - American Association for Thoracic Surgery

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