German Pediatric Heart Center

Sankt Augustin, Germany

German Pediatric Heart Center

Sankt Augustin, Germany
SEARCH FILTERS
Time filter
Source Type

PubMed | Hospital Of Santa Marta, University of Padua, Copenhagen University, University of Oslo and 16 more.
Type: Journal Article | Journal: Heart (British Cardiac Society) | Year: 2016

The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX.A retrospective international study was conducted by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%).The most prevalent indication for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p<0.001). Fontan takedown was mostly performed in the early postoperative phase after Fontan completion, while Fontan conversion and HTX were mainly treatment options for late failure. Early (30days) mortality was high for Fontan takedown (ie, 26%). Median follow-up was 5.9years (range 0-23.7years). The combined end point mortality/HTX was reached in 44.7% of the Fontan takedown patients, in 26.3% of the Fontan conversion patients and in 34.0% of the HTX patients, respectively (log rank p=0.08). Survival analysis showed no difference between Fontan conversion and HTX (p=0.13), but their ventricular function differed significantly. In patients who underwent Fontan conversion or HTX ventricular systolic dysfunction appeared to be the strongest predictor of mortality or (re-)HTX. Patients with valveless atriopulmonary connection (APC) take more advantage of Fontan conversion than patients with a valve-containing APC (p=0.04).Takedown surgery for failing Fontan is mostly performed in the early postoperative phase, with a high risk of mortality. There is no difference in survival after Fontan conversion or HTX.


Pieper D.,Witten/Herdecke University | Mathes T.,Witten/Herdecke University | Asfour B.,German Pediatric Heart Center
BMC Pediatrics | Year: 2014

Background: The volume-outcome relationship is supposed to be stronger in high risk, low volume procedures. The aim of this systematic review is to examine the available literature on the effects of hospital and surgeon volume, specialization and regionalization on the outcomes of the Norwood procedure.Methods: A systematic literature search was performed in Medline, Embase, and the Cochrane Library. On the basis of titles and abstracts, articles of comparative studies were obtained in full-text in case of potential relevance and assessed for eligibility according to predefined inclusion criteria. All relevant data on study design, patient characteristics, hospital volume, surgeon volume and other institutional characteristics, as well as results were extracted in standardized tables. Study selection, data extraction and critical appraisal were carried out independently by two reviewers.Results: We included 10 studies. All but one study had an observational design. The number of analyzed patients varied from 75 to 2555. Overall, the study quality was moderate with a huge number of items with an unclear risk of bias. All studies investigating hospital volume indicated a hospital volume-outcome relationship, most of them even having significant results. The results were very heterogeneous for surgeon volume.Conclusions: The volume-outcome relationship in the Norwood procedure can be supported. However, the magnitude of the volume effect is difficult to assess. © 2014 Pieper et al.; licensee BioMed Central Ltd.


Nagel B.,Medical University of Graz | Janousek J.,University Hospital Motol | Koestenberger M.,Medical University of Graz | Maier R.,Medical University of Graz | And 4 more authors.
Circulation Journal | Year: 2014

Background: Adults with transposition of the great arteries (TGA) after atrial switch repair have an increased risk for arrhythmia and sudden cardiac death. We analyzed whether a remote monitoring (RM) system as part of an implantable cardiac device contributes to timely recognition and improved treatment of critical arrhythmias in these patients. Methods and Results: All consecutive TGA patients (n=11) requiring a pacemaker or cardiac resynchronization therapy with or without implantable cardioverter defibrillator between 2008 and 2011 were included. RM-detected arrhythmia, abnormality of device integrity and reaction time from event transmission until acknowledgement via email and clinical decision making were analyzed and compared to a control group (n=21). In 10 patients (91%) 17 arrhythmias were detected, 8 patients (80%) indicated no symptoms. In the RM group time interval from transmission to acknowledgement was 2.4 days (range, 0-4.5 days). Clinical decision-making was advanced by a mean of 77.5 days (range, 10-197 days) compared with conventional follow-up and identified adaption of anti-arrhythmic medication in 8, electrical cardioversion in 2, overdrive pacing in 1 and radiofrequency ablation in 2 patients. A coronary sinus lead fracture was identified in 1 patient followed by successful replacement. Conclusions: RM enables early detection of tachyarrhythmia followed by optimization of medical treatment and potentially life-saving anti-tachycardic intervention in adults after atrial repair of TGA.


Schindler E.,German Pediatric Heart Center | Photiadis J.,German Pediatric Heart Center | Sinzobahamvya N.,German Pediatric Heart Center | Dores A.,German Pediatric Heart Center | And 2 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2011

Objective: There has been concern about the usage of aprotinin, an antifibrinolytic drug that was often used in pediatric cardiac surgery until 2006. At our center, these concerns led to the replacement of aprotinin with tranexamic acid for antifibrinolytic treatment. Methods: In this retrospective observational study, two groups of pediatric patients were studied during two different periods, receiving either aprotinin (n= 70) or tranexamic acid (n= 70) upon cardiac surgery. Data were collected from children with cyanotic heart defects, children who weighed less than 10. kg, and children who underwent re-operation. Results: There was no difference in terms of blood loss or amount of erythrocyte concentrates and fresh frozen plasma transfused. Only the intraoperative amount of platelet concentrate received by children in the tranexamic acid group was 29. ml (p= 0.013) higher. There was no significant difference in the length of stay at the intensive care unit, in renal function values, or in the rate of rethoracotomy. Conclusions: The results of this study suggest that tranexamic acid represents an adequate alternative to aprotinin in congenital cardiac surgery. © 2010 European Association for Cardio-Thoracic Surgery.


Yamamoto T.,German Pediatric Heart Center | Schmidt-Niemann M.,German Pediatric Heart Center | Schindler E.,German Pediatric Heart Center
Annals of Emergency Medicine | Year: 2016

We report a rare case of acute upper airway obstruction caused by spontaneous retropharyngeal hemorrhage as a result of hemophilia A in a 16-year-old pediatric patient who routinely received factor VIII replacement. Initial diagnosis was delayed because the patient presented with symptoms, such as throat pain and odynophagia, similar to those of common benign upper airway infections. Within 2 days of the initial presentation of symptoms, the patient went into respiratory failure as a result of retropharyngeal hemorrhage. The possibility of spontaneous retropharyngeal or epiglottic hemorrhage or hematoma should be considered as a cause of rapidly progressing odynophagia and dyspnea by hemophilia patients. © 2015 American College of Emergency Physicians.


Hraska V.,German Pediatric Heart Center | Mattes A.,German Pediatric Heart Center | Haun C.,German Pediatric Heart Center | Blaschczok H.C.,German Pediatric Heart Center | And 4 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2011

Objective: Anatomic correction of corrected transposition of the great arteries, utilizing the morphologic left ventricle as a systemic pumping chamber, is considered the preferred method. The purpose of the study was to analyze the intermediate functional outcome following anatomical correction. Methods: Between 1997 and 6/2010, 23 patients with corrected transposition of the great arteries and associated lesions underwent anatomical correction. Seventeen (74%) and six patients (26%) had situs solitus {S,L,L} and situs invs {I,D,D}, respectively. Fifteen patients (65%) had undergone 18 palliations before the corrective operation. The median age at palliation was 0.23 years, with a range of 0.016-8.4 years. A corrective, modified Senning-arterial switch procedure was performed in nine patients, 13 patients underwent a modified Senning-Rastelli procedure, and in one patient a combination of modified Senning and aortic translocation (Bex/Nikaidoh) was used. The median age at the corrective operation was 2 years (from 0.3 to 15.7 years). Results: There was no mortality or heart transplant within the mean follow-up of 3.4 years. Freedom from reintervention was 77% at 5 years. There were no signs of obstruction of the systemic and pulmonary venous tunnels. The function of both ventricles was normal in all patients, even in the four patients who required retraining of the left ventricle. Mild aortic regurgitation was noticed in three patients. Preoperatively detected significant tricuspid regurgitation either disappeared or became trivial after the operation in all the six patients. All patients except two are in sinus rhythm; one patient is pacemaker-dependent preoperatively and one is pacemaker-dependent postoperatively. There were no clinically apparent neurological problems. All patients, but one, are in the New York Heart Association (NYHA) class I. Conclusions: Anatomic correction of corrected transposition of the great arteries can be performed in selected patients without mortality and with acceptable morbidity. The mid-term functional outcome is excellent, resulting in normal ventricular function, even in retrained left ventricles, and minimal incidence of complete heart block. The long-term function of the aortic valve, intraventricular tunnels, conduits, and ventricles requires close surveillance. © 2011 European Association for Cardio-Thoracic Surgery.


Sata S.,German Pediatric Heart Center | Murin P.,German Pediatric Heart Center | Hraska V.,German Pediatric Heart Center
Annals of Thoracic Surgery | Year: 2012

Neonatal repair of Ebstein's anomaly is challenging and should be considered only if medical measures to stabilize the circulation and provide antegrade pulmonary blood flow fail. Anatomic repair, based on the cone reconstruction technique, has demonstrated promising survival benefits in older patients; however, there are no data regarding neonatal repair. This is a report on a successful salvage operation using cone reconstruction of Ebstein's anomaly in a neonate who had required extracorporeal membrane oxygenation support before surgery and who had failed to wean. © 2012 The Society of Thoracic Surgeons.


Hraska V.,German Pediatric Heart Center
Annals of Thoracic Surgery | Year: 2013

In failing Fontan circulation, the elevated central venous pressure increases lymphatic production and simultaneously retards lymphatic return to the central venous system, thus unbalancing lymphatic homoeostasis. To improve lymphatic drainage, a new concept based on decompression of the thoracic duct to the lower pressure levels of the common atrium, with concomitant increase of preload, has been developed. The thoracic duct, which in the majority of patients enters the circulation at the left subclavia-jugular junction, is decompressed by diverting the innominate vein directly to the common atrium. © 2013 The Society of Thoracic Surgeons.


PubMed | German Pediatric Heart Center
Type: Journal Article | Journal: Annals of emergency medicine | Year: 2016

We report a rare case of acute upper airway obstruction caused by spontaneous retropharyngeal hemorrhage as a result of hemophilia A in a 16-year-old pediatric patient who routinely received factor VIII replacement. Initial diagnosis was delayed because the patient presented with symptoms, such as throat pain and odynophagia, similar to those of common benign upper airway infections. Within 2 days of the initial presentation of symptoms, the patient went into respiratory failure as a result of retropharyngeal hemorrhage. The possibility of spontaneous retropharyngeal or epiglottic hemorrhage or hematoma should be considered as a cause of rapidly progressing odynophagia and dyspnea by hemophilia patients.


Schneider M.,German Pediatric Heart Center | Wiebe W.,German Pediatric Heart Center | Hraska V.,German Pediatric Heart Center | Zartner P.,German Pediatric Heart Center
Journal of Interventional Cardiology | Year: 2013

Background The small vessel size of infants and children makes interventional treatment of impaired coronary perfusion, such as stenoses, complete occlusions, and fistulae, demanding. Materials and techniques appropriate for this young age group have to demonstrate their ability to effectively treat these lesions. Methods and Results Between 2004 and 2011, 14 patients with an age of 9 days to 25 years (median 4.6 years) and a bodyweight of 1.7-65 kg (median 14 kg) underwent coronary intervention. In 3 cases, emergency revascularization of the left coronary artery (CA) was performed successfully, followed by stent implantation in 1 patient. Embolization of coronary arterial fistulae with coils and vascular plugs was effective in 10 patients. An antegrade, retrograde or combined approach to achieve the most distal device placement preserved all side branches. One infant with pulmonary atresia and an intact ventricular septum was prepared for biventricular repair by step-by-step closure of the right ventricular to the CA connections. No procedure-related deaths occurred. Conclusion Congenital and post-procedural coronary obstructive lesions can be considered for effective treatment with balloon dilation at any age as a salvage procedure. In coronaries impaired by external compression, stent implantation can restore perfusion, but long-term results are missing. Interventional closure of coronary fistulae has shown improvement of coronary arterial perfusion. The latter techniques can be used to close right ventricular to CA connections in patients with pulmonary atresia to prepare for biventricular repair, but bail-out strategies should be planned in all coronary interventions. (J Interven Cardiol 2013;26:287-294) © 2013, Wiley Periodicals, Inc.

Loading German Pediatric Heart Center collaborators
Loading German Pediatric Heart Center collaborators