Bicuspidalization seems to be a viable alternative to combat limited supply of small-sized allografts with acceptable survival and reintervention rates comparable to non-bicuspidalized allografts.
Aims
Congenital heart disease (CHD) is the most common congenital malformation. Despite the worldwide burden to patient wellbeing and health system resource utilization, tracking of long-term outcomes is lacking, limiting the delivery and measurement of high-value care. To begin transitioning to value-based healthcare in CHD, the International Consortium for Health Outcomes Measurement aligned an international collaborative of CHD experts, patient representatives, and other stakeholders to construct a standard set of outcomes and risk-adjustment variables that are meaningful to patients.
Methods and results
The primary aim was to identify a minimum standard set of outcomes to be used by health systems worldwide. The methodological process included four key steps: 1) develop a working group representative of all CHD stakeholders; 2) conduct extensive literature reviews to identify scope, outcomes of interest, tools used to measure outcomes, and case-mix adjustment variables; 3) create the outcome set using a series of multi-round Delphi processes; and 4) disseminate set worldwide. The WG established a 15-item outcome set, incorporating physical, mental, social, and overall health outcomes accompanied by tools for measurement and case-mix adjustment variables. Patients with any CHD diagnoses of all ages are included. Following an open review process, over 80% of patients and providers surveyed agreed with the set in its final form.
Conclusion
This is the first international development of a stakeholder-informed standard set of outcomes for CHD. It can serve as a first step for a lifespan outcomes measurement approach to guide benchmarking and improvement among health systems.
Introduction Coarctation of the aorta in children under 3 months of age is usually treated surgically. However, there are clinical scenarios in which stenting of native or recurrent coarctation may become necessary in this age group. Case reports Four cases illustrate possible indications: left ventricular dysfunction increasing the operative risk, thrombus formation after coarctation surgery, patient size (i.e. in premature babies), and retrograde arch obstruction after hybrid palliation of hypoplastic left heart syndrome. In all babies, coarctation stenting was carried out successfully without complications. Conclusion Coarctation stenting can be carried out safely in small children. Usually, the stent has to be removed or redilated later. Results are encouraging.
Objectives Pulmonary atresia (PA) with ventricular septal defect (VSD)
and systemic-pulmonary collateral arteries (SPCA’s) has a variable
anatomy with regard to the pulmonary vasculature, asking for an
individualized surgical treatment. A protocol was applied consisting of
staged unifocalization and correction. Methods Since 1989 39 consecutive
patients were included (median age at first operation 13 months). In
selected cases a central aorto-pulmonary shunt was performed as first
procedure. Unifocalization procedures were performed through a lateral
thoracotomy. Correction consisted of shunt takedown, VSD closure and
interposition of an allograft between the right ventricle and the
reconstructed pulmonary artery. Postoperatively and at follow up
echocardiographic data were obtained. Results In 39 patients 66
unifocalization procedures were performed. Early mortality was 5%.
Seven patients were considered not suitable for correction, four of them
died. One patient is awaiting further correction. Correction was done
successfully in 28 patients. Operative mortality was 3% and late
mortality 11%. Median follow-up after correction was 19 years. Eleven
patients needed homograft replacement. Freedom from conduit replacement
was 88%, 73% and 60% at 5, 10 and 15 years respectively. Right
ventricular function was reasonable or good in 75 % of the patients.
Conclusions After complete unifocalization 30/37 patients (81%) were
considered correctable. The main reasons for palliative treatment
without correction were pulmonary hypertension and/or inadequate
outgrowth of pulmonary arteries. Staged approach of PA, VSD and SPCA’s
results in adequate correction and good functional capacity. RV function
after correction remains reasonable or good in the majority of patients.
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