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  1. Article: Prolonged Pediatric Extracorporeal Membrane Oxygenation Support with Cardiopulmonary Failure in Juvenile Myelomonocytic Leukemia.

    Bartkevics, Maris / Hennig, Bert / Gungor, Tayfun / Ammann, Roland / Kadner, Alexander

    Case reports in hematology

    2020  Volume 2020, Page(s) 5696380

    Abstract: We report a case of a child survival after extracorporeal membrane oxygenation (ECMO) support of 25 days for cardiopulmonary failure and septic shock in the context of juvenile myelomonocytic leukemia (JMML). ECMO support is still a matter of debate for ... ...

    Abstract We report a case of a child survival after extracorporeal membrane oxygenation (ECMO) support of 25 days for cardiopulmonary failure and septic shock in the context of juvenile myelomonocytic leukemia (JMML). ECMO support is still a matter of debate for the management of septic patients with malignancy. However, these patients are at increased risk for early death secondary to pulmonary complications due to leukostasis, direct pulmonary infiltration with WBC, and systemic inflammatory response syndrome following malignant cell lysis. Despite the high risk of complications, ECMO support must be discussed as part of management, providing better outcome in this group of patients.
    Language English
    Publishing date 2020-01-13
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2627639-2
    ISSN 2090-6579 ; 2090-6560
    ISSN (online) 2090-6579
    ISSN 2090-6560
    DOI 10.1155/2020/5696380
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  2. Article ; Online: Early Experience With a Novel Suture Device for Sternal Closure in Pediatric Cardiac Surgery.

    Heinisch, Paul Philipp / Nucera, Maria / Bartkevics, Maris / Erdoes, Gabor / Hutter, Damian / Gloeckler, Martin / Kadner, Alexander

    The Annals of thoracic surgery

    2021  Volume 114, Issue 5, Page(s) 1804–1809

    Abstract: Background: Sternal closure by absorbable suture material is an established method for chest closure in pediatric cardiac surgical procedures. However, the formation of granuloma around knotted suture material is frequently observed and has potential ... ...

    Abstract Background: Sternal closure by absorbable suture material is an established method for chest closure in pediatric cardiac surgical procedures. However, the formation of granuloma around knotted suture material is frequently observed and has potential for prolonged wound healing and infection, particularly in newborns and infants. This retrospective study analyzed the suitability and reliability of a novel absorbable, self-locking, multianchor knotless suture with antibacterial technology for sternal closure in pediatric cardiac surgical procedures.
    Methods: The applied material (STRATAFIX Symmetric PDS Plus, Ethicon) presents a polydioxanon (PD) suture with a self-locking, multianchor design that enables a sternal closure in a continuous knotless suture technique. All children undergoing knotless closure after standard median sternotomy were examined for the occurrence of sternal wound infection or sternal instability by applying the screening criteria of the Centers for Disease Control and Prevention at hospital discharge and at 30 and 60 days.
    Results: The new knotless sternal closure was used in 130 patients. Patients were a mean age of 19.0 ± 31.9 months (range, 0-142 months), and mean bodyweight was 7.8 ± 6.6 kg (range, 2.4-35 kg). Delayed sternal closure occurred in 23 patients, with a mean closure time after 2.9 ± 2.6 days. One superficial incisional sternal site infection occurred, but no cases of deep sternal site infection or sternal instability were observed.
    Conclusions: The application of the absorbable, knotless suture technique provides excellent results regarding the rate of sternal wound infection and improved healing after median sternotomy in pediatric patients.
    MeSH term(s) Infant ; Humans ; Infant, Newborn ; Child ; Child, Preschool ; Retrospective Studies ; Reproducibility of Results ; Sternum/surgery ; Sternotomy/adverse effects ; Cardiac Surgical Procedures/methods ; Sutures ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/prevention & control ; Surgical Wound Infection/surgery ; Suture Techniques ; Anti-Bacterial Agents ; Treatment Outcome
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2021-10-02
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 211007-6
    ISSN 1552-6259 ; 0003-4975
    ISSN (online) 1552-6259
    ISSN 0003-4975
    DOI 10.1016/j.athoracsur.2021.08.066
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    Zs.A 252: Show issues Location:
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  3. Article ; Online: A Near Miss and Salvage Management of Aortoesophageal Fistula Secondary to Cell Battery Ingestion.

    Bartkevics, Maris / Stankovic, Zoran / Schibli, Susanne / Fluri, Simon / Berger, Steffen / Schmidli, Juerg / Kadner, Alexander

    World journal for pediatric & congenital heart surgery

    2019  Volume 11, Issue 1, Page(s) 120–122

    Abstract: We report a case of an infant surviving aortoesophageal fistula secondary to lithium cell battery ingestion. In the setting of a delayed vascular complication, computed tomography and magnetic resonance imaging are essential to establishing the correct ... ...

    Abstract We report a case of an infant surviving aortoesophageal fistula secondary to lithium cell battery ingestion. In the setting of a delayed vascular complication, computed tomography and magnetic resonance imaging are essential to establishing the correct diagnosis and surgical management. Management of children after battery ingestion must be guided by a high index of clinical suspicion.
    MeSH term(s) Aortic Diseases/diagnosis ; Aortic Diseases/diagnostic imaging ; Aortic Diseases/surgery ; Diagnosis, Differential ; Esophageal Fistula/diagnosis ; Esophageal Fistula/diagnostic imaging ; Esophageal Fistula/surgery ; Female ; Foreign Bodies ; Humans ; Infant ; Magnetic Resonance Imaging ; Near Miss, Healthcare ; Tomography, X-Ray Computed ; Vascular Fistula/diagnosis ; Vascular Fistula/diagnostic imaging ; Vascular Fistula/surgery
    Language English
    Publishing date 2019-11-22
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2550261-X
    ISSN 2150-136X ; 2150-1351
    ISSN (online) 2150-136X
    ISSN 2150-1351
    DOI 10.1177/2150135119880549
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  4. Article ; Online: Right Axillary Thoracotomy in Congenital Cardiac Surgery: Analysis of Percutaneous Cannulation.

    Heinisch, Paul Philipp / Bartkevics, Maris / Beck, Maria Julia / Erdoes, Gabor / Glöckler, Martin / Humpl, Tilman / Carrel, Thierry / Kadner, Alexander

    The Annals of thoracic surgery

    2020  Volume 112, Issue 6, Page(s) 2047–2053

    Abstract: Background: Vertical right axillary minithoracotomy (VRAMT) represents a minimally invasive and cosmetically attractive alternative for selected congenital heart defects. We report our institutional experience with VRAMT, especially regarding the ... ...

    Abstract Background: Vertical right axillary minithoracotomy (VRAMT) represents a minimally invasive and cosmetically attractive alternative for selected congenital heart defects. We report our institutional experience with VRAMT, especially regarding the performance of percutaneous femoral venous access to establish extracorporeal circulation in this pediatric population.
    Methods: A retrospective single-center analysis was made of children to 16 years of age who underwent corrective cardiac surgery using VRAMT over a period of 5 years. VRAMT involved a 4 cm to 5 cm vertical incision parallel to the anterior axillary fold and aortic/bicaval cannulation. Since 2016, the technique has been modified and the inferior vena cava was cannulated using femoral percutaneous venous access. The primary endpoints were all-cause mortality, with additional secondary endpoints of major adverse cardiac and cerebrovascular events and conversion to median sternotomy.
    Results: A total of 110 patients with biventricular congenital malformations were included. Age was 2.3 years (range, 0.2 to 16), and body weight was 11 kg (range, 3 to 47). Extracorporeal circulation time was 66 minutes (range, 24 to 167), cross-clamp time was 41 minutes (range, 9 to 95). Fast-track-management with on-table extubation was achieved in 34.5% (n = 38). For patients with percutaneous femoral venous cannulation (n = 38, 34.5%), thrombosis at the cannulation site was recorded in 5 cases (13.5%). There was no early or late mortality during the follow-up of 14.4 months (range, 0.8 to 47.19). No wound infection or thoracic deformities were observed.
    Conclusions: VRAMT can be considered as an alternative, minimally invasive, and cosmetically attractive access for the repair of frequent congenital heart defects in newborns and young children. Percutaneous femoral venous cannulation provides sufficient extracorporeal circulation flow and can be used even in infants with early postoperative heparin prophylaxis.
    MeSH term(s) Adolescent ; Axilla ; Cardiac Surgical Procedures/methods ; Catheterization/methods ; Child ; Child, Preschool ; Female ; Femoral Artery ; Follow-Up Studies ; Heart Defects, Congenital/surgery ; Humans ; Infant ; Male ; Minimally Invasive Surgical Procedures/methods ; Retrospective Studies ; Thoracotomy/methods ; Vena Cava, Inferior
    Language English
    Publishing date 2020-11-04
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 211007-6
    ISSN 1552-6259 ; 0003-4975
    ISSN (online) 1552-6259
    ISSN 0003-4975
    DOI 10.1016/j.athoracsur.2020.10.011
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 252: Show issues Location:
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  5. Article: Initial experiences with a centrifugal-pump based minimal invasive extracorporeal circulation system in pediatric congenital cardiac surgery.

    Kadner, Alexander / Heinisch, Paul Philipp / Bartkevics, Maris / Wyss, Serena / Jenni, Hans-Joerg / Erdoes, Gabor / Eberle, Balthasar / Carrel, Thierry

    Journal of thoracic disease

    2019  Volume 11, Issue Suppl 10, Page(s) S1446–S1452

    Abstract: Background: Minimal invasive extracorporeal circulation (MiECC) circuits are an established alternative to conventional extracorporeal circulation (CECC). Based on the positive effects and improved perioperative outcomes of MiECC in adult cardiac ... ...

    Abstract Background: Minimal invasive extracorporeal circulation (MiECC) circuits are an established alternative to conventional extracorporeal circulation (CECC). Based on the positive effects and improved perioperative outcomes of MiECC in adult cardiac surgery, this perfusion concept appears particularly attractive to pediatric cardiac surgery. So far, there are no reports on the clinical application of a MiECC system for corrective surgery in neonates and children. We report our initial experiences by using a MiECC system in pediatric cardiac surgery.
    Methods: A total of 38 pediatric patients underwent surgical interventions for a variety of congenital heart disease from March 2017 until August 2018 with a MiECC. Following the classification of MiECC circuits by the Minimal invasive Extra-Corporeal Technologies International Society (MiECTIS), type I and type III perfusion circuits were assembled depending on the planned intervention: type I for closed heart interventions and type III for open heart procedures. Primary outcome was conversion to CECC, secondary endpoints included major adverse cardiac or cerebrovascular events (MACCE).
    Results: MiECC perfusion was successfully performed in all patients (100%). Median patient age was 9.5 months (range, 0.2-176 months) with a median weight of 8.1 kg (range, 2.3-49 kg). For both MiECC types no system related technical complications were encountered. Beating heart procedures were performed in 23 cases (60%) at normothermia, while in 15 (40%) interventions cardioplegic cardiac arrest was induced at mild hypothermia. All patients had an uneventful perioperative course with no in-hospital mortality. MACCE did not occur during the hospitalization period.
    Conclusions: MiECC can be performed by using standard techniques for closed and open cardiac procedures for the correction of a variety of malformations in neonates and children with good results and uneventful postoperative course.
    Language English
    Publishing date 2019-06-24
    Publishing country China
    Document type Journal Article
    ZDB-ID 2573571-8
    ISSN 2077-6624 ; 2072-1439
    ISSN (online) 2077-6624
    ISSN 2072-1439
    DOI 10.21037/jtd.2019.01.95
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  6. Article ; Online: Late correction of tetralogy of Fallot in children.

    Heinisch, Paul P / Guarino, Laetitia / Hutter, Damian / Bartkevics, Maris / Erdoes, Gabor / Eberle, Balthasar / Royo, Carlos / Rhissass, Jaafar / Pfammatter, Jean-Pierre / Carrel, Thierry / Kadner, Alexander

    Swiss medical weekly

    2019  Volume 149, Page(s) w20096

    Abstract: Aim of study: To report our experience of late correction after infancy in patients with tetralogy of Fallot (ToF).: Methods: Observational single-centre retrospective analysis of the surgical techniques and perioperative development of patients from ...

    Abstract Aim of study: To report our experience of late correction after infancy in patients with tetralogy of Fallot (ToF).
    Methods: Observational single-centre retrospective analysis of the surgical techniques and perioperative development of patients from developing countries undergoing total surgical correction of ToF after infancy, between 1 November 2011 and 30 November 2016. Variables are presented as numbers with percentages or as mean ± standard deviation. Due to the setting of the humanitarian programme, clinical and echocardiographic follow-up procedures could be conducted for only one month postoperatively.
    Results: Twenty-five children (mean age: 70.8 ± 42 months, range 23-163; 44% female) underwent total surgical correction of ToF. Two patients (0.8%) initially received a Blalock-Taussig shunt and underwent subsequent correction 24 and 108 months later, respectively. Preoperative mean right ventricular/pulmonary artery (RV/PA) gradient was 84 ± 32 mm Hg, with a Nakata index of 164 ± 71 mm2/m2. Major aortopulmonary collateral arteries (MAPCAs) were observed in eight children (32%), six (26%) of whom underwent transcatheter closure before surgery. 24 children (96%) underwent a valve-sparing pulmonary valve repair and one patient received a transannular patch (TAP). There were no cases which saw major adverse cardiac and cerebrovascular events (MACCE). Mean duration of mechanical ventilation was 28 ± 19.6 hours (range 7-76). Pre-discharge echocardiography demonstrated a mean RV/PA gradient of 25 ± 5.7 mm Hg, with left ventricular ejection fraction >60% in all cases. Overall length of hospital stay was 11.7 ± 4.5 days. There were no in-hospital mortality cases.
    Conclusions: Late surgical correction of ToF can be safely performed and produce highly satisfying early postoperative results comparable to those of classical “timely” correction. A valve-sparing technique can be applied in the majority of children.
    MeSH term(s) Cardiac Surgical Procedures ; Child, Preschool ; Echocardiography ; Female ; Humans ; Male ; Pulmonary Artery/physiopathology ; Reoperation/statistics & numerical data ; Retrospective Studies ; Tetralogy of Fallot/surgery
    Language English
    Publishing date 2019-07-03
    Publishing country Switzerland
    Document type Journal Article ; Observational Study
    ZDB-ID 2036179-8
    ISSN 1424-3997 ; 1424-7860
    ISSN (online) 1424-3997
    ISSN 1424-7860
    DOI 10.4414/smw.2019.20096
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    Ua VI Zs.152: Show issues Location:
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  7. Article ; Online: Vertical Right Axillary Mini-Thoracotomy for Correction of Ventricular Septal Defects and Complete Atrioventricular Septal Defects.

    Heinisch, Paul Philipp / Wildbolz, Marc / Beck, Maria Julia / Bartkevics, Maris / Gahl, Brigitta / Eberle, Balthasar / Erdoes, Gabor / Jenni, Hans-Joerg / Schoenhoff, Florian / Pfammatter, Jean-Pierre / Carrel, Thierry / Kadner, Alexander

    The Annals of thoracic surgery

    2018  Volume 106, Issue 4, Page(s) 1220–1227

    Abstract: Background: Vertical right axillary mini-thoracotomy (VRAMT) is the standard approach for correction of atrial septal defect and partial atrioventricular septal defect at our institution. This observational single-center study compares our initial ... ...

    Abstract Background: Vertical right axillary mini-thoracotomy (VRAMT) is the standard approach for correction of atrial septal defect and partial atrioventricular septal defect at our institution. This observational single-center study compares our initial results with the VRAMT approach for the repair of ventricular septal defect (VSD) and complete atrioventricular septal defect (CAVSD) in infants and children to an approach using standard median sternotomy (MS).
    Methods: The perioperative courses of patients undergoing VSD and CAVSD correction through either a VRAMT or an MS were analyzed retrospectively. The surgical technique for the VRAMT involved a 4- to 5-cm vertical incision in the right axillary fold.
    Results: Of 84 patients, 25 (VSD, n = 15; CAVSD, n = 10) underwent correction through a VRAMT approach, whereas 59 (VSD, n = 35; CAVSD, n = 24) had repair through MS. VSD and CAVSD groups were comparable with respect to age and weight. No significant differences were observed for aortic cross-clamp duration, intensive care unit stay, hospital stay, and echocardiographic follow-up. There was no need for any conversion from VRAMT to MS in any case. Neither wound infections nor thoracic deformities were observed in both groups.
    Conclusions: VRAMT can be considered as a safe and effective approach for the repair of VSD and CAVSD in selected patient groups, and the outcome data appear comparable to those of MS.
    MeSH term(s) Academic Medical Centers ; Age Factors ; Axilla/surgery ; Chi-Square Distribution ; Child ; Child, Preschool ; Cohort Studies ; Confidence Intervals ; Echocardiography/methods ; Female ; Follow-Up Studies ; Heart Septal Defects/diagnostic imaging ; Heart Septal Defects/mortality ; Heart Septal Defects/surgery ; Heart Septal Defects, Ventricular/diagnostic imaging ; Heart Septal Defects, Ventricular/mortality ; Heart Septal Defects, Ventricular/surgery ; Humans ; Infant ; Male ; Minimally Invasive Surgical Procedures/adverse effects ; Minimally Invasive Surgical Procedures/methods ; Patient Positioning ; Patient Safety ; Patient Selection ; Retrospective Studies ; Risk Assessment ; Sternotomy/adverse effects ; Sternotomy/methods ; Switzerland ; Thoracotomy/adverse effects ; Thoracotomy/methods ; Treatment Outcome
    Language English
    Publishing date 2018-05-30
    Publishing country Netherlands
    Document type Comparative Study ; Journal Article ; Observational Study
    ZDB-ID 211007-6
    ISSN 1552-6259 ; 0003-4975
    ISSN (online) 1552-6259
    ISSN 0003-4975
    DOI 10.1016/j.athoracsur.2018.05.003
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  8. Article ; Online: Efficacy of mechanical postconditioning following warm, global ischaemia depends on circulating fatty acid levels in an isolated, working rat heart model†.

    Bartkevics, Maris / Huber, Simon / Mathys, Veronika / Sourdon, Joevin / Dornbierer, Monika / Carmona Mendez, Natalia / Gahl, Brigitta / Carrel, Thierry P / Tevaearai Stahel, Hendrik T / Longnus, Sarah L

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

    2016  Volume 49, Issue 1, Page(s) 32–39

    Abstract: Objectives: The number of heart transplantations is limited by donor organ availability. Donation after circulatory determination of death (DCDD) could significantly improve graft availability; however, organs undergo warm ischaemia followed by ... ...

    Abstract Objectives: The number of heart transplantations is limited by donor organ availability. Donation after circulatory determination of death (DCDD) could significantly improve graft availability; however, organs undergo warm ischaemia followed by reperfusion, leading to tissue damage. Laboratory studies suggest that mechanical postconditioning [(MPC); brief, intermittent periods of ischaemia at the onset of reperfusion] can limit reperfusion injury; however, clinical translation has been disappointing. We hypothesized that MPC-induced cardioprotection depends on fatty acid levels at reperfusion.
    Methods: Experiments were performed with an isolated rat heart model of DCDD. Hearts of male Wistar rats (n = 42) underwent working-mode perfusion for 20 min (baseline), 27 min of global ischaemia and 60 min reperfusion with or without MPC (two cycles of 30 s reperfusion/30 s ischaemia) in the presence or absence of high fat [(HF); 1.2 mM palmitate]. Haemodynamic parameters, necrosis factors and oxygen consumption (O2C) were assessed. Recovery rate was calculated as the value at 60 min reperfusion expressed as a percentage of the mean baseline value. The Kruskal-Wallis test was used to provide an overview of differences between experimental groups, and pairwise comparisons were performed to compare specific time points of interest for parameters with significant overall results.
    Results: Percent recovery of left ventricular (LV) work [developed pressure (DP)-heart rate product] at 60 min reperfusion was higher in hearts reperfused without fat versus with fat (58 ± 8 vs 23 ± 26%, P < 0.01) in the absence of MPC. In the absence of fat, MPC did not affect post-ischaemic haemodynamic recovery. Among the hearts reperfused with HF, two significantly different subgroups emerged according to recovery of LV work: low recovery (LoR) and high recovery (HiR) subgroups. At 60 min reperfusion, recovery was increased with MPC versus no MPC for LV work (79 ± 6 vs 55 ± 7, respectively; P < 0.05) in HiR subgroups and for DP (40 ± 27 vs 4 ± 2%), dP/dtmax (37 ± 24 vs 5 ± 3%) and dP/dtmin (33 ± 21 vs 5 ± 4%; P < 0.01 for all) in LoR subgroups.
    Conclusions: Effects of MPC depend on energy substrate availability; MPC increased recovery of LV work in the presence, but not in the absence, of HF. Controlled reperfusion may be useful for therapeutic strategies aimed at improving post-ischaemic recovery of cardiac DCDD grafts, and ultimately in increasing donor heart availability.
    MeSH term(s) Animals ; Disease Models, Animal ; Fatty Acids/blood ; Graft Rejection ; Graft Survival ; Heart Transplantation/methods ; Heart Transplantation/mortality ; Male ; Myocardial Reperfusion/adverse effects ; Myocardial Reperfusion/methods ; Myocardial Reperfusion Injury/prevention & control ; Organ Preservation/methods ; Random Allocation ; Rats ; Rats, Wistar ; Risk Assessment ; Sensitivity and Specificity ; Survival Rate ; Tissue Donors ; Warm Ischemia/adverse effects ; Warm Ischemia/methods
    Chemical Substances Fatty Acids
    Language English
    Publishing date 2016-01
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639293-3
    ISSN 1873-734X ; 1010-7940 ; 1567-4258
    ISSN (online) 1873-734X
    ISSN 1010-7940 ; 1567-4258
    DOI 10.1093/ejcts/ezv008
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