Improving surgical outcome following the Norwood procedure

Algra, Selma O.; Breur, Johannes M.P.J.; Evens, F.; Roo, Frank de; Schoof, Paul H.; Haas, Felix

doi:10.1007/s12471-011-0171-8

Cited by 13 publications

(13 citation statements)

References 8 publications

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“…This ignores the fact that occurrence of an event directly related to a cardiac operation can be up to X months after surgery [18]. The importance of a longer follow-up after cardiac surgery to evaluate the potential risks of cardiac surgery is supported by several other reports [19, 20] and was recently confirmed by Siregar et al (Siregar S, Groenwold RH, de Mol BAJM, et al Evaluation of cardiac surgery mortality rates; 30-day mortality or longer follow-up? Eur J Cardiothorac Surg – accepted for publication).…”

Section: Discussionmentioning

confidence: 99%

Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

2013

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ObjectiveThis study evaluates whether a sedentary lifestyle is an independent predictor for increased mortality after elective cardiac surgery.MethodsThree thousand one hundred fifty patients undergoing elective cardiac surgery between January 2007 and June 2012 completed preoperatively the Corpus Christi Heart Project questionnaire concerning physical activity (PA). Based on this questionnaire, 1815 patients were classified as active and 1335 patients were classified as sedentary. The endpoints of the study were hospital mortality and early mortality.ResultsThe study population had a mean age of 69.7 ± 10.1 (19–95) years and a mean logistic EuroSCORE risk of 5.1 ± 5.6 (0.88–73.8). Sedentary patients were significantly older (p = 0.001), obese (p = 0.001), had a higher EuroSCORE risk (p = 0.001), and a higher percentage of complications. Hospital mortality (1.1 % versus 0.4 % (p = 0.014)) and early mortality (1.5 % versus 0.6 % (p = 0.006)) were significantly higher in the sedentary group compared with the active group. However, a sedentary lifestyle was not identified as an independent predictor for hospital mortality (p = 0.61) or early mortality (p = 0.70).ConclusionSedentary patients were older, obese and had a higher EuroSCORE risk. They had significantly more postoperative complications, higher hospital mortality and early mortality. Despite these results, sedentary behaviour could not be identified as an independent predictor for hospital or early mortality.

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Section: Discussionmentioning

confidence: 99%

Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

2013

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“…The abnormal anatomy in HLHS can, however, be surgically modified to one that is life-sustaining which requires three staged palliative surgeries. The stage I operation (Norwood) is the most complex of the three, and carries the highest rate of post-operative morbidity and mortality (4)(5)(6). It is performed within the first days to weeks after birth, and commits the right ventricle (RV) to systemic circulation.…”

Section: Introductionmentioning

confidence: 99%

Regenerative medicine therapy for single ventricle congenital heart disease

et al. 2018

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One of the most complex forms of congenital heart disease (CHD) involving single ventricle physiology is hypoplastic left heart syndrome (HLHS), characterized by underdevelopment of the left ventricle (LV), mitral and aortic valves, and narrowing of the ascending aorta. The underdeveloped LV is incapable of providing long-term systemic flow, and if left untreated, the condition is fatal. Current treatment for this condition consists of three consecutive staged palliative operations: the first is conducted within the first few weeks of birth, the second between 4 to 6 months, and the third and final surgery within the first 4 years. At the conclusion of the third surgery, systemic perfusion is provided by the right ventricle (RV), and deoxygenated blood flows passively to the pulmonary vasculature. Despite these palliative interventions, the RV, which is ill suited to provide long-term systemic perfusion, is prone to eventual failure. In the absence of satisfying curative treatments, stem cell therapy may represent one innovative approach to the management of RV dysfunction in HLHS patients. Several stem cell populations from different tissues (cardiac and non-cardiac), different age groups (adult- neonate-derived), and different donors (autologous allogeneic), are under active investigation. Preclinical trials in small and large animal models have elucidated several mechanisms by which these stem cells affect the injured myocardium, and are driving the shift from a paradigm based upon cellular engraftment and differentiation to one based primarily on paracrine effects. Recent studies have comprehensively evaluated the individual components of the stem cells' secretomes, shedding new light on the intracellular and extracellular pathways at the center of their therapeutic effects. This research has laid the groundwork for clinical application, and there are now several trials of stem cell therapies in pediatric populations that will provide important insights into the value of this therapeutic strategy in the management of HLHS and other forms of CHD. This article reviews the many stem cell types applied to CHD, their preclinical investigation and the mechanisms by which they might affect RV dysfunction in HLHS patients, and finally, the completed and ongoing clinical trials of stem cell therapy in patients with CHD.

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“…Normally, a three-stage surgical repair is performed to obtain separated pulmonary and systemic circulations (figure 1) [1,2]. The technique involves subsequent changes in the circulatory layout, up to a final configuration where the venous return passively flows into the lungs without the need for a pumping chamber, and the functional single ventricle (SV) provides the systemic blood flow.…”

Section: Introductionmentioning

confidence: 99%

A multiscale model for the study of cardiac biomechanics in single-ventricle surgeries: a clinical case

et al. 2015

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One contribution of 11 to a theme issue 'Multiscale modelling in biomechanics: theoretical, computational and translational challenges'. Complex congenital heart disease characterized by the underdevelopment of one ventricular chamber (single ventricle (SV) circulation) is normally treated with a three-stage surgical repair. This study aims at developing a multiscale computational framework able to couple a patient-specific three-dimensional finite-element model of the SV to a patient-specific lumped parameter (LP) model of the whole circulation, in a closed-loop fashion. A sequential approach was carried out: (i) cardiocirculatory parameters were estimated by using a fully LP model; (ii) ventricular material parameters and unloaded geometry were identified by means of the stand-alone, three-dimensional model of the SV; and (iii) the three-dimensional model of SV was coupled to the LP model of the circulation, thus closing the loop and creating a multiscale model. Once the patient-specific multiscale model was set using pre-operative clinical data, the virtual surgery was performed, and the post-operative conditions were simulated. This approach allows the analysis of local information on ventricular function as well as global parameters of the cardiovascular system. This methodology is generally applicable to patients suffering from SV disease for surgical planning at different stages of treatment. As an example, a clinical case from stage 1 to stage 2 is considered here.

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Improving surgical outcome following the Norwood procedure

Cited by 13 publications

References 8 publications

Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

Regenerative medicine therapy for single ventricle congenital heart disease

A multiscale model for the study of cardiac biomechanics in single-ventricle surgeries: a clinical case

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