Journal article
Birth in the Operating Room for Immediate Cardiac Surgery: A Rare but Effective Strategy
World journal for pediatric & congenital heart surgery, Vol.15(6), pp.714-721
11/2024
DOI: 10.1177/21501351241269881
PMID: 39252613
Abstract
Background: With significant advancements in fetal cardiac imaging, patients with complex congenital heart disease (CHD) carrying a high risk for postnatal demise are now being diagnosed earlier. We sought to assess an interdisciplinary strategy for delivering these children in an operating room (OR) adjacent to a cardiac OR for immediate surgery or stabilization. Methods: All children prenatally diagnosed with CHD at risk for immediate postnatal hemodynamic instability and cardiogenic shock who were delivered in the operating room (OR) between 2012 and 2023 in which the senior author was consulted were included. Results: Eight patients were identified. Six (75%) patients were operated on day-of-life zero, all requiring obstructed total anomalous pulmonary venous return (TAPVR) repair. Of these six patients, 2 (33%) required a simultaneous Norwood procedure, 2 (33%) required pulmonary artery unifocalization and modified Blalock-Taussig-Thomas shunt, and 2 (33%) patients had repair of obstructed mixed TAPVR. The remaining 2 patients potentially planned for immediate surgery had nonimmune hydrops fetalis and went into cardiogenic shock at 12 and 72 hours postnatally, requiring a novel Norwood procedure with left-ventricular exclusion for severe aortic/mitral valve insufficiency. The median ventilation and inpatient durations were 19 [IQR: 11-26] days and 41 [IQR: 32-128] days, respectively. Three(38%) patients required one or more in-hospital reoperations. Subsequent staged procedures included Glenn (n = 5), Fontan (n = 3), biventricular repair (n = 2), ventricular assist device placement (n = 1), and heart transplant (n = 1). Median follow-up was 5.7 [IQR:1.3-7.8] years. The five-year postoperative survival was 88% (n = 7/8). Conclusion: While children with these diagnoses have historically had poor survival, the strategy of birth in the OR adjacent to a cardiac OR where emergent surgery is planned is a potentially promising strategy with excellent clinical outcomes. However, this is a high-resource strategy whose feasibility in any program requires thoughtful assessment.
Details
- Title: Subtitle
- Birth in the Operating Room for Immediate Cardiac Surgery: A Rare but Effective Strategy
- Creators
- Spencer J. Hogue - Cincinnati Children's Hospital Medical CenterAmir Mehdizadeh-Shrifi - Cincinnati Children's Hospital Medical CenterKevin Kulshrestha - Cincinnati Children's Hospital Medical CenterJames F. Cnota - Cincinnati Children's Hospital Medical CenterAllison Divanovic - Cincinnati Children's Hospital Medical CenterMarco Ricci - Cincinnati Children's Hospital Medical CenterAwais Ashfaq - Cincinnati Children's Hospital Medical CenterDavid G. Lehenbauer - Cincinnati Children's Hospital Medical CenterDavid S. Cooper - Cincinnati Children's Hospital Medical CenterDavid L. S. Morales - Cincinnati Children's Hospital Medical Center
- Resource Type
- Journal article
- Publication Details
- World journal for pediatric & congenital heart surgery, Vol.15(6), pp.714-721
- Publisher
- SAGE PUBLICATIONS INC
- DOI
- 10.1177/21501351241269881
- PMID
- 39252613
- ISSN
- 2150-1351
- eISSN
- 2150-136X
- Language
- English
- Electronic publication date
- 09/10/2024
- Date published
- 11/2024
- Academic Unit
- Cardiothoracic Surgery
- Record Identifier
- 9984702957502771
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