Abstract
We analyzed and assessed the influence of preoperative management and transport organization for neonates with critical congenital heart defects on surgical repair results and early postoperative course. Between 2006 and 2008 34 neonates with critical CHD were admitted to neonates emergency surgery department of A.N. Bakoulev Scientific Center for Cardiovascular Surgery, RAMS. TMA (main arteries transposition) was the most common CHD observed in patients, followed by different PAA (pulmonary artery atresia) forms, then came patients with aorta coarctation and some other forms of hypoplastic left heart syndrome. We assessed factors prolonging neonates stay in hospital after CHD repair, conducted complex analysis of treatment outcomes and gave recommendations for transport organization optimization. We concluded that wrong patients transportability assessment, failure to follow transport rules, accompanying severe patients by doctors not significantly experienced in intensive pediatric cardiology and absence of constant contact with hospital on the way worsen significantly outcomes of cardiosurgery in neonates with critical CHD and prolong the period of postoperative care.
References
1. Бокерия, Л. А. Сердечно-сосудистая хирургия, болезни и врожденные аномалии системы кровообращения / Л. А. Бокерия, Р. Г. Гудкова. - М.: НЦССХ им. А. Н. Бакулева РАМН, 1996-2007 гг.
2. Гришина, М. В. Научно-методическое обоснование оптимизации доступности населения к кардиохирургическим видам помощи: автореф. дис.
3. Лобачева, Г. В. Факторы риска развития ранних осложнений и их коррекция у больных после операций на открытом сердце: автореф. дис.
4. Сердечно-сосудистая хирургия / Под ред. В. И. Бураковского, Л. А. Бокерия. - М.:Медицина, 1996. - С. 221-225.
5. Харькин, А. В. Комплексная интенсивная терапия у новорожденных после кардиохирургических вмешательств: дис.
6. Аkinturk, H. Hybrid Transcatheter-Surgical Palliation. Base for Univentricular or Biventricular Repair: The Gessen Experience / H. Аkinturk, I. Michel-Behnke, K. Valeske et al. // Pediatr. Cardiol. - 2007. - Vol. 28. - P. 79-87.
7. Annibale, D. J. Preparation of the critically ill neonate for transport / D. J. Annibale, J. B. Cahill, D. S. Tuttle et al. // J. S. C. Med. Assoc. - 2002. - Vol. 98, № 3. - P. 129-136.
8. Bacha, E. A. Single-ventricle palliation for high-risk neonates: The emergence of an alternative hybrid stage I strategy / E. A. Bacha, Suanne Daves et al. // J. Thorac. Cardiovasc. Surg. - 2006. - Vol. 131, № 1. - P. 163-171.
9. Bacha, E. A. Surgery for coarctation of ajrta in infants less than 2 kg / E. A. Bacha, M. Almodovar, D. L. Wessel et al. // Ann. Thorac. Surg. - 2001. - Vol. 71. - P. 1260-1264.
10. Bojar, M. Perioperative care in cardiac and thoracic surgery / M. Bojar // Blackwell Science: manual. - Malden, Mass, 1985. - Р. 516.
11. Castaneda, A. R. Current trends in the management of infants with critical congenital heart defects / A. R. Castaneda // Prec. Am. Acad. Cardiovasc. Perfusion. - 1990. - Vol. 11. - P. 64-66.
12. Flabouris, A. Incidents during out-of-hospital patient transportation / A. Flabouris, W. B. Runciman, B. Levings // Anaesth. Intensive Care. - 2006. - Vol. 34, № 2. - P. 228-236.
13. Freishtat, R. J. Admission predictor modeling in pediatric interhospital transport / R. J. Freishtat, B. L. Klein, S. J. Teach // Pediatr. Emerg. Care. - 2004. - Vol. 20, № 7. - P. 443-447.
14. Galantowicz, М. Hybrid Approach for Hypoplastic Left Heart Syndrome: Intermediate Results After the Learning / М. Galantowicz, J. P. Cheatham, A. Phillips et al. // Curve. An. Thorac. Surg. - 2008. - Vol. 85. - P. 2063-2071.
15. Galantowicz, M. Lessons learned from the development of a new hybrid strategy for the management of hypoplastic left heart syndrome / M. Galantowicz, J. P. Cheatham // Pediatr. Cardiol. - 2005. - Vol. 26. - P. 190-199.
16. Glatz, J. A. Impact of Mitral Stenosis and Aortic Atresia on Survival in Hypoplastic Left Heart Syndrome / A. Glatz, R. T. Fedderly, N. S. Ghanayen et al. // Ann. Thorac. Surg. - 2008. - Vol. 85. - P. 2057-2062.
17. Heffner, J. E. Airway management in the critically ill patient / J. E. Heffner // Crit. Care Clinics. - 1990. - Vol. 6. - P. 533-550.
18. Kirklin, J. W. Cardiac Surgery / J. W. Kirklin, B. G. Barratt- Boyes. - Ed. 2nd. - New York, 1993. - Р. 942-973.
19. Mainali, E. S. Safety and efficacy of high-frequency jet ventilation in neonatal transport / E. S. Mainali, C. Greene, H. J. Rozycki, G. R. Gutcher // J. Perinatol. - 2007. - Vol. 27, № 10. - P. 609-613.
20. Markakis, C. Evaluation of a risk score for interhospital transport of critically ill patients / C. Markakis, M. Dalezios, C. Chatzicostas // J. Emerg. Med. J. - 2006. - Vol. 23, № 4. - P. 313-317.
21. Moss, S. J. Towards safer neonatal transfer: the importance of critical incident review / S. J. Moss, N. D. Embleton, A. C. Fenton // Arch. Dis. Child. - 2005. - Vol. 90, № 7. - P. 729-732.
22. Mullane, D. Neonatal transportation: the effects of a national neonatal transportation programme / D. Mullane, H. Byrne, T. A. Clarke et al. // Ir. J. Med. Sci. - 2004. - Vol. 173, № 2. - P. 105-108.
23. Wheeler, D. S. Development of a pediatric critical care transport team: experience at a military medical center / D. S. Wheeler, J. L. Sperring, K. K. Vaux, W. B. Poss // Mil. Med. - 1999. - Vol. 164, № 3. - P. 188-193.
