Clinician-to-Clinician Update Clinician-to-Clinician Update

New Surgical Approaches Improve Congenital Heart Disease Outcomes

March 2016

In its moderate to severe forms, congenital heart disease (CHD) occurs in about 6 in 1,000 live births in the United States. When mild forms of CHD are included, the incidence increases to 75 per 1,000 live births.1 CHD is a major cause of serious morbidity and mortality. About one-quarter of infant deaths in the United States attributable to congenital anomalies are caused by CHD.2 Even children with mild CHD have over a fivefold greater risk of critical cardiac morbidity during childhood and adolescence when compared with the general population.3

Recent advances in technology, surgical procedures, and support have improved outcomes for these young patients. Significant improvements in microsurgical and off-pump techniques, myocardial protection, and perioperative care now allow many complex CHDs to be corrected in one complete procedure. Patients who have access to this high-level surgical expertise have been shown to have improved outcomes in terms of both short-term morbidity and mortality4 and long-term functional outcomes.5 The use of current technology has also been demonstrated to reduce the risk of adverse events in pediatric cardiopulmonary bypass procedures.6

Specialists at the University of Minnesota Masonic Children’s Hospital Heart Center have helped advance innovative care for patients with CHD. Surgeons at the Heart Center were the first team in Minnesota to repair tetralogy of Fallot, the first to repair a ventricular-septal defect, and the first to implant a Berlin Heart EXCOR® pediatric ventricular-assist device. Today the Heart Center offers new minimally invasive procedures as well as traditional open-chest surgeries and medical-management treatment options. To minimize risk of the deleterious effects associated with cardiopulmonary bypass, procedures are performed “off pump” whenever possible. University of Minnesota Masonic Children’s Hospital surgeons also have access to the most current technology to help further reduce these risks, including specialized pediatric oxygenators, miniature ultrafiltration devices, and a normothermic environment.

The Heart Center’s new senior cardiac surgeon and co-director, Anthony Azakie, MD, brings to the program 15 years of experience with complete CHD repair in newborns. With the arrival of Dr. Azakie and new providers, the program offers an even greater level of expertise to our youngest and most fragile CHD patients.

References

  1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890-1900.
  2. Centers for Disease Control and Prevention (CDC). Racial differences by gestational age in neonatal deaths attributable to congenital heart defects—United States, 2003–2006. MMWR. 2010;59:1208-1211.
  3. Videbæk J, et al. A long-term nationwide follow-up study of simple congenital heart disease diagnosed in otherwise healthy children. Circulation. 2015 Dec 18. pii: CIRCULATIONAHA.115.017226.
  4. Panni RZ, et al. Earlier surgical intervention in congenital heart disease results in better outcome and resource utilization. BMC Health Serv Res. 2011;11:353.
  5. Majnemer A, et al. Long-term neuromotor outcome at school entry of infants with congenital heart defects requiring open-heart surgery. J Pediatr. 2006;148:72-77.
  6. McRobb CM, et al. Recent Advances in Pediatric Cardiopulmonary Bypass. Semin Cardiothorac Vasc Anesth. 2014;18:153-160.

When to refer

University of Minnesota Masonic Children’s Hospital Heart Center is a state-of-the-art facility that includes a cardiovascular intensive care unit and outpatient clinic spaces. The Heart Center offers a full range of treatments—including ablation, placement of ventricular assist devices, catheterization, surgery, and transplant—for patients with the following conditions:

  • All congenital heart defects in neonates and children
  • Young adult congenital heart disease
  • Acquired heart disease
  • Congestive heart failure/cardiac transplantation
  • Cardiac arrhythmias, irregular heartbeat
  • Chest pain
  • Syncope
  • Hyperlipidemia/hypercholesterolemia
  • Heart murmurs

Physicians can request consultations with our specialists or admit a patient 24 hours a day, 7 days a week through the University of Minnesota Masonic Children’s Hospital’s physician referral service: 888-KIDS-UMN (888-543-7866).

Collaborative Care

Clinicians at the University of Minnesota Masonic Children’s Hospital Heart Center provide coordinated care for the complex medical challenges facing pediatric patients with congenital heart disease. Our multidisciplinary team includes experienced congenital heart surgeons, adult and pediatric cardiologists, electrophysiologists, cardiac imaging specialists, cardiovascular geneticists, pediatric critical care physicians, nurse practitioners, nutritionists, and genetic counselors, all of whom work seamlessly with other medical or surgical specialists as needed. We are happy to provide a consultative visit for your patient and then collaborate with you to outline and establish a followup plan, or we can transition the patient’s primary cardiology care to our clinics. We are committed to ongoing communication with you about your patient and will consult directly with you after your patient has been seen.

Related Articles

March 2016

Complete Repair of Congenital Heart Lesions in a High-Risk Infant

A low-weight newborn with multiple heart anomalies diagnosed as Taussig-Bing heart underwent a successful primary, complete surgical repair. He continues to do well at 2-years’ follow-up.

Continue reading

March 2016

Pediatric Specialty Updates

Senior cardiac surgeon named co-director of pediatric Heart Center. Dr. Anthony Azakie joins new pediatric cardiologists on the Heart Center team.

Continue reading