ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Ann Thorac Surg 2009;88:829. doi:10.1016/j.athoracsur.2009.04.033
© 2009 The Society of Thoracic Surgeons
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Glen Van Arsdell
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Van Arsdell, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Van Arsdell, G.
Related Collections
Right arrow Congenital - acyanotic
Right arrow Congenital - cyanotic
Right arrowRelated Article

Original Articles: Pediatric Cardiac

Invited Commentary

Glen Van Arsdell, MD

Division of Cardiovascular Surgery, The Hospital for Sick Children, 555 University Ave, Suite 1525, Toronto, Ontario, Canada M5G 1X8

(Email: glen.vanarsdell{at}sickkids.ca).

I read with interest the article by Chen and colleagues [1].

A 10% incidence of perioperative stroke is a possible partial explanation for less than ideal neurodevelopmental outcomes in congenital heart disease (CHD) [2, 3]. Additional explanations are genetic causes [4], fetal development with CHD, and injury that is not measured by imaging. If we are to improve neurologic outcomes, there are four areas in which practice improvement needs to become uniform or further explored: (1) prenatal diagnosis and maternal care, (2) postnatal preoperative care, (3) operative interventional strategies, and (4) postoperative care. Specifics of these are briefly discussed.

1 Can fetal diagnosis and maternal care for all having CHD impact birth weight and thereby mitigate this as a risk?
2 Can fetal triage to a congenital cardiac liaised high-risk obstetrics and neonatal team preclude cardiorespiratory instability in more babies and thus lessen preoperative stroke?
3 Risk was shown to be modifiable in the operating room. A higher hematocrit (28% vs 26%) on cardiopulmonary bypass (CPB) was associated with a lower incidence of stroke. This corroborates previous findings that hematocrit on CPB is important [5]. Not all factors believed to be a risk in the operating room were actually a risk. Circulatory arrest, as performed and compared, did not impact neurodevelopment. Fruitful areas for further study will include hybrid stage I versus conventional stage I palliation for single ventricle and arch obstruction, further human studies on pCO2 management strategy for CPB, rate of CPB flow, and others.
4 Postoperative measurements, such as systemic oxygen delivery [6], length of stay in the intensive care unit, and other factors are also important and potentially modifiable.

Survival with CHD has become an expectation. It is our duty to ensure that those unfortunate enough to have CHD not only survive, but live. Continued critical data analysis in the areas outlined, trials, and modification of practice will allow us to help our patients live—in the fullest sense.


   References
Top
 References
 

  1. Chen J, Zimmerman RA, Jarvik GP, et al. Perioperative stroke in infants undergoing open heart operations for congenital heart disease Ann Thorac Surg 2009;88:823-829.[Abstract/Free Full Text]
  2. Shillingford AJ, Glanzman MM, Ittenbach RF, et al. Inattention, hyperactivity, and school performance in a population of school-age children with complex congenital heart disease Pediatrics 2008;4:e759-e767.
  3. Gaynor JW, Wernovskiy G, Jarvik GP, et al. Patient characteristics are important determinants of neurodevelopmental outcome at one year of age after neonatal and infant cardiac surgery J Thorac Cardiovasc Surg 2007;133:1344-1353.[Abstract/Free Full Text]
  4. Tabbutt S, Nord AS, Jarvik GP, et al. Neurodevelopmental outcomes after staged palliation for hypoplastic left heart syndrome Pediatrics 2008;121:476-483.[Abstract/Free Full Text]
  5. Jonas RA, Wypij D, Roth SJ, et al. The influence of hemodilution on outcome after hypothermic cardiopulmonary bypass: results of a randomized trial in infants J Thorac Cardiovasc Surg 2003;126:1765-1774.[Abstract/Free Full Text]
  6. Hoffman GM, Mussatto KA, Brosig CL, et al. Systemic venous oxygen saturation after the Norwood procedure and childhood neurodevelopmental outcome J Thorac Cardiovasc Surg 2005;10:1094-1100.

Related Article

Perioperative Stroke in Infants Undergoing Open Heart Operations for Congenital Heart Disease
Jodi Chen, Robert A. Zimmerman, Gail P. Jarvik, Alex S. Nord, Robert R. Clancy, Gil Wernovsky, Lisa M. Montenegro, Diane M. Hartman, Susan C. Nicolson, Thomas L. Spray, J. William Gaynor, and Rebecca Ichord
Ann. Thorac. Surg. 2009 88: 823-829. [Abstract] [Full Text] [PDF]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Glen Van Arsdell
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Van Arsdell, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Van Arsdell, G.
Related Collections
Right arrow Congenital - acyanotic
Right arrow Congenital - cyanotic
Right arrowRelated Article

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS