<p><strong>Aim.</strong> This study was designed to analyse the results of two-stage arterial switch operation (ASO) of “simple” transposition of great arteries in patients with infection, neurological problems or necrotizing enterocolitis, which preclude neonatal surgery. <br /><strong>Methods.</strong> Transthoracic echocardiography data and outcomes of surgery were investigated in 19 patients (study group; #1) after two-stage ASO and 67 patients (control group; #2) after a single-stage ASO. Age of patients at the first stage was 27 (8–55) days and at the second stage 172 (92–256) days. Patients in group 2 were 7 (2–53) days old. All of them were followed up for 21 (4–49) months (group 1) and 40 (7–79) months (group 2) after arterial switch operation. <br /><strong>Results.</strong> There was no operative mortality at both stages in group 1. The duration of ventilation, length of intensive care unit and hospital stay after surgery were considerably lower in group 1. Actuarial sur-vival and freedom from reoperation at 4 years in group 1 accounted for 100%, while in the con-trol group those indicators at 6 years ran to 98.5% and 94%, respectively. The only difference detected by echocardiography was the aortic valve hinge points Z-score (3.9±1.44 vs 3.1±1.27; p=0.025) and sinuses of Valsalva (3.8±1.41 vs 2.8±1.19; p=0.03), which were higher in the 1st group. There was no aortic regurgitation >1 grade in both groups. <br /><strong>Conclusion.</strong> Two-stage repair of “simple” transposition of great arteries, when it’s necessary to delay arterial switch operation on the clinical grounds, can be performed with excellent clinical outcomes. The tendency of group 1 patients to have a larger neo-aortic root does not appear to bear any clinical significance in mid-term follow-up.</p><p>Received 21 December 2016. Accepted 8 May 2017.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest. <br /><strong>Author contributions</strong> <br />Study concept and design: Kornoukhov O.Yu., Ilyin V.N.<br />Data collection and analysis: Kornoukhov O.Yu., Valitova A.A., Kryukov V.A. <br />Drafting the article: Kornoukhov O.Yu.<br />Critical revision of the article: Kornoukhov O.Yu., Ilyin V.N. <br />Final approval of the version to be published: Kornoukhov: O.Yu., Ilyin V.N.</p><p> </p>
<p><strong>Background.</strong> A quality of surgical care evaluation based solely on workload and hospital mortality is incomplete. ECHSA Congenital Database integrated tools provide complexity-adjusted methods to evaluate surgical results and the surgical performance of a hospital, and make it possible to demonstrate hospital service level among other congenital heart programmes.</p><p><strong>Methods.</strong> Data on 2,521 operations in a population of children, including 532 newborns, with congenital heart disease (CHD) were uploaded on the European Congenital Heart Surgeons Association Congenital Database. These data were collected between 2012 and 2018 at the Filatov Children's Hospital. We compared our personal results with database mean values according to the following criteria: 1) proportion of newborns among all paediatric surgical cases, 2) hospital mortality, 3) Aristotle Basic Score (ABS) value, 4) STS-EACTS Mortality Score (MtS) value, and 5) MtS Performance value. All data on the database website were analysed using integrated database tools.</p><p><strong>Results.</strong> The proportion of newborns in the Filatov Children's Hospital was 21.1%, while the database mean value was 18.6%, and hospital mortality values were 3.89% and 3.61%, respectively. The mean ABS in the Filatov Children's Hospital was 6.78 ± 2.08, while that on the database was 6.57 ± 2.12 (Z-score = 0.075). The mean MtS values for the hospital and database were 0.74 ± 0.59 and 0.72 ± 0.64, respectively (Z-score = 0.031). The calculated MtS performance for the Filatov Children's Hospital was 0.72 ± 0.56, while that for all European respondents was 0.54 ± 0.29 (Z-score = 0.603).</p><p><strong>Conclusion.</strong> Cooperation with a multicentre international database, such as ECHSA Congenital Database, provides modern complexity-adjusted tools for evaluation of quality of care for children with CHD. The Filatov Children’s Hospital is a high-volume cardiac surgery centre that demonstrates an adequate survival rate regarding complexity level and surgical risk compared to European respondents of the ECHSA Congenital Database.</p><p>Received 19 October 2020. Revised 18 November 2020. Accepted 19 November 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>
<p><strong>Aim.</strong> A growing interest in the use of sternotomy and perfusion for repair of aortic coarctation in neonates and infants has enabled us to retrospectively review our own experience in this practice. Our purpose was to determine the efficacy of coarctation repair with extended end-to-end anastomosis through left thoracotomy focusing on a re-intervention rate and dynamics of transverse aortic arch growth during long-term follow-up. <br /><strong>Methods.</strong> One hundred and twenty-four patients under 3 months old who underwent coarctation repair (between 2008 and 2016) were enrolled in this study. In 43 patients (35%), aorta coarctation was combined with ventricular septal defect, 49 patients (39.5%) had transversal aortic arch hypoplasia (Z-score less than –2). All operations were carried out by using extended “end-to-end” anastomosis technique via thoracotomy. In patients with concomitant ventricular septal defect, PA-banding was performed simultaneously. Overall follow-up was 3.6 (0.3–8.0) years. <br /><strong>Results.</strong> Early mortality was 1.6%. Late survival rate was 93.5%. Recurrent aortic arch obstruction was revealed in 10 (8%) patients, on the average, in 6.5 (3.5–15) months after coarctation repair. Management of re-stenosis with balloon aortoplasty was effective in all cases and had no complications. A statistically significant growth (p<0.001) of the transverse aortic arch was observed in those patients who had hypoplasia of the arch before surgery. <br /><strong>Conclusion.</strong> Repair of coarctation of the aorta by resection and extended “end-to-end” anastomosis via thoracotomy without perfusion has low operative mortality, an excellent survival rate and a reduced rate of balloon re-intervention. Patients with baseline moderate transverse aortic arch hypoplasia demonstrate a growth of the aorta up to normal values in long-term follow-up. Endovascular balloon dilatation of aortic re-coarctation zone during long-term follow-up is an effective and safe procedure. <br />Received 20 June 2018. Revised 5 September 2018. Accepted 12 September 2018.<br /><strong>Funding:</strong> The study did not have sponsorship.<br /><strong>Conflict of interest:</strong> Authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conception and study design: V.N. Ilyin<br />Data collection and analysis: M.M. Belyaeva, O.Yu. Kornoukhov, Yu.Yu. Kornoukhov, O.I. Kalinina<br />Drafting the article: M.M. Belyaeva <br />Critical revision of the article: V.N. Ilyin, O.Yu. Kornoukhov<br />Final approval of the version to be published: M.M. Belyaeva, V.N. Ilyin, O.Yu. Kornoukhov, Yu.Yu. Kornoukhov, O.I. Kalinina</p>
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