congenitalheartdisease

Frontiers in Medicine: Hybrid and Catheter-based Surgery for Babies with Congenital Heart Defects

by Columbia Surgery on February 9, 2012

Approximately 30,000 children are born each year with congenital heart defects (about one percent of all live births) in the United States, and .2 to .3 of these children will require cardiac surgery. The Congenital Heart Center at NewYork-Presbyterian Morgan Stanley Children’s Hospital (NYP-MSCHONY) brings together an integrated team of specialists to provide seamless collaboration and a continuum of care for these young patients.

Treatment options are tailored to the diagnosis and presentation of symptoms for each patient and any other medical conditions that may need to be taken into consideration. Increasingly, many congenital heart defects can now be effectively treated with minimally invasive catheter-based interventions that reduce both risk and recovery duration. These treatments often require only a single day of hospitalization, and can eliminate the need for open-heart surgery. The Congenital Heart Center has particular expertise in pediatric interventional cardiology, a specialty that involves non-surgical treatment of congenital and acquired cardiovascular disorders.

Additionally, the Congenital Heart Center is also one of only a few in the U.S. to have a hybrid program for infants and children who do require surgery but could benefit from a minimally invasive surgical procedure in combination with catheter-based interventions. Hybrid heart surgery refers to techniques that combine conventional surgical procedures with minimally invasive, catheter-based interventions. These alternatives typically involve only a small incision through the breast bone or right chest, and advantages include less pain, elimination of the heart-lung machine (and its associated risks), a faster return to normal activities, as well as cosmetic advantages.

Congenital Heart Center

Congenital Heart Center

In Surgery, Less is More

According to Emile Bacha, MD, Chief of Congenital and Pediatric Cardiac Surgery, patients at the Congenital Heart Center are always evaluated for less invasive treatment options first. In some cases, a hybrid approach will allow the surgeon to treat a condition with a single operation rather than a series of surgeries, or to treat conditions that would otherwise be inoperable. Dr. Bacha explains, “As with any treatment options, hybrid techniques may not be appropriate for every child. Some babies still benefit from more traditional surgical procedures, and surgeons evaluate each patient to determine which procedure carries the best possible benefits and outcomes.”

Hybrid techniques can offer significant benefits for some patients, including infants with difficult-to-treat conditions. Surgeons at the Congenital Heart Center have been successfully using a less invasive hybrid technique for a very difficult-to-treat defect in newborns known as hypoplastic left heart syndrome (HLHS). To survive, babies born with this anomaly must undergo surgery during the first week of life, and until recently the only treatment available was the Norwood procedure, requiring three difficult standard open operations and carrying a 10-20 percent greater risk of mortality (based upon national statistics). Because infants with HLHS require treatment at a very young age, hybrid procedures can be used to provide immediate interventions and delay more invasive surgeries until infants are older and stronger.

Surgical outcomes are currently comparable between the hybrid approach and the Norwood procedure, but the hybrid approach is thought to be safer for high-risk patients such as in infants with a low birth weight or who are born prematurely, in large part by avoiding the use of a heart-lung bypass machine.

The Congenital Heart Center has been widely recognized for excellence in treating congenital cardiac conditions in infants and children. Minimally invasive and hybrid procedures are just another set of state-of-the-art techniques the Congenital Heart Center is able to employ to minimize risks and maximize positive patient outcomes. Incorporating significant experience, expertise, and tailored treatment plans, the Congenital Heart Center is able to provide exemplary treatment and care for young patients across the spectrum of congenital cardiac conditions.

For more information about pediatric heart surgery, please visit childrensnyp.org, download the NewYork-Presbyterian Congenital Heart Center brochure or call 212.305.2688.

Tagged as: Bacha, congenitalheartdisease, pediatric

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MSCHONY Outcomes Surpass All in NY State

by Columbia Surgery on January 11, 2012

Morgan Stanley Children's Hospital of New York

The Department of Surgery is pleased to announce that Morgan Stanley Children’s Hospital of New York (MSCHONY) has been recognized by the New York State Department of Health (NYS-DOH) in its most recent report on pediatric congenital cardiac surgery for having the lowest risk-adjusted mortality rate (RAMR) in the state. MSCHONY’s pediatric cardiac surgery program was the only hospital in the New York State to have a RAMR significantly below the state average, and the only center to receive recognition for its exceptional outcomes for the past twelve years.

Congenital heart defects encompass a wide range of abnormalities present at birth. According to the National Heart Lung and Blood Institute, these are the most prevalent forms of birth defects, affecting approximately 35,000 newborns annually, or 8 in 1,000 infants. Approximately .2 to .3 percent of cases require corrective surgery.

The “Pediatric Congenital Cardiac Surgery in New York State, 2006-2009” report uses statistical methodologies to standardize data on all pediatric congenital cardiac surgeries statewide, and then compares the mortality rates of each hospital to the statewide risk-adjusted average. This enables outcomes at all ten hospitals in the state approved to perform pediatric cardiac surgery to be compared, while accounting for differences in outcomes based upon various risk factors and other demographic determinants that may influence patient outcomes. In particular, this adjusts for differences in outcomes for hospitals that perform a higher volume of high-risk procedures.

The statewide mortality rate from 2006-2009 was 3.35 percent for all pediatric congenital cardiac surgery patients. At MSCHONY, the risk-adjusted mortality rate was the lowest in the state, at 1.95 percent. The report also indicates that MSCHONY performed 1,624 pediatric congenital cardiac surgeries between 2006 and 2009, or more than twice the number of procedures performed by the second highest volume surgical center.

In this three year period, 31.5 percent of all pediatric congenital cardiac surgeries in New York State were performed at MSCHONY. While experience alone is not a determinant of successful outcomes, MSCHONY has consistently demonstrated superior outcomes along while demonstrating expertise and extensive experience with a wide range of procedures, including high-risk surgeries.

For more information about pediatric congenital cardiac surgery, please visit New York-Presbyterian Morgan Stanley Children’s Hospital of New York (MSCHONY).

Tagged as: congenitalheartdisease, pediatric

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New Ventricular Assist Device, PediMag, Safely Supports Children in Need of Heart Transplantation

by Columbia Surgery on September 23, 2011

Ventricular Assist Devices (VADs) are small pumps that take over the work of the heart in pumping the blood through the body. Patients who need a heart transplant, but for whom there is no donor heart available, might be given a VAD for what’s called a bridge-to-transplant while they wait for a donor.

PediMag, the pediatric version of the adult device, CentriMag, is an external device designed for short-term use in infants with heart failure. PediMag can also be used to support children after heart transplant surgery if they experience organ rejection and need time for their hearts to rest and heal, according to Jonathan M. Chen, MD, Surgical Director of Pediatric Heart Transplantation at Morgan Stanley Children’s Hospital of New York. Dr. Chen has extensive experience treating children with heart failure and has recently authored an account of his first successful use of the PediMag as a biventricular bridge-to-transplant in an infant.

Thoratec PediMag

The PediMag ventricular assist device is slightly smaller than a BlackBerry phone.

Dr. Chen says that although PediMag has been available in Europe for a number of years, it is only now gaining wider use in the U.S. — although in his view this device is clearly safer than other VADS available in the U.S. “Certain other VADs have the advantage that children can go home while using the device. Yet those pumps pose a serious risk of blood clots and stroke,” Dr. Chen explains. Although risk of stroke can be as high as 35% with other devices, “PediMag has a much lower rate of complications related to clot.” Unlike the older mechanical pumps, PediMag and CentriMag use a magnetically levitated, bearingless technology.

In addition to supporting the heart, PediMag can easily be modified so as to provide extracorporeal membrane oxygenation, or ECMO, in cases where a child’s lungs also need support. This flexibility is highly valuable to surgeons like Dr. Chen, whose patients may have both heart and lung failure. Moreover, not only can PediMag be connected to an ECMO circuit, but it can be done very simply and quickly.

This ease of use is a major advance that benefits young patients, according to Dr. Chen. Historically, devices that did the job of PediMag and CentriMag were hulking machines with a vast array of controls, and they were complicated enough that their use was frequently curtailed by lack of expertise. PediMag is far more streamlined, so that once a patient is hooked up, “Practically any doctor or nurse should be capable of handling it,” says Dr. Chen.

Related Link:
Cardiac Device Update: Wireless LVAD in the Pipeline

Tagged as: cardiac, Chen, congenitalheartdisease, ECMO, LVAD, pediatric, VAD

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