Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

In infant heart surgery, newer technique yields better survival in first year of life

27.05.2010
Was largest clinical trial to compare surgical treatments for congenital heart disease

Pediatric researchers report that a recently introduced surgical procedure offers infants with severely underdeveloped hearts a better chance at surviving during their first year of life, in comparison to the standard surgery.

Heart surgeons from 15 centers in the federally sponsored Pediatric Heart Network studied the outcomes in 549 newborns who received a complex series of surgeries for hypoplastic left heart syndrome (HLHS).

"This landmark study is the largest clinical trial ever performed in congenital heart surgery, and the first randomized trial comparing two surgical procedures for congenital heart defects," said senior author J. William Gaynor, M.D., a pediatric cardiothoracic surgeon at The Children's Hospital of Philadelphia, and co-principal investigator of the study. As one of the nation's leading programs in pediatric cardiology, the Cardiac Center at Children's Hospital enrolled 101 subjects in this study.

The study results appear in the May 27 issue of the New England Journal of Medicine, published today.

The lead author and principal investigator of this study, called the Single Ventricle Reconstruction (SVR) Trial, was Richard G. Ohye, M.D., head of the Pediatric Cardiovascular Surgery Division of the University of Michigan.

Occurring about once in every 100 live births, congenital heart disease is the most common birth defect. It includes a broad variety of structural abnormalities, but HLHS is among the most severe forms. In HLHS, affecting 1 in 5,000 live births, the left ventricle, one of the heart's two pumping chambers, is small and unable to function. Without treatment, HLHS is fatal in the first few days of life.

Starting in the 1980s, surgeons developed surgical procedures for HLHS that have allowed increasingly more children born with a single functioning ventricle to survive. The intervention involves three planned surgeries, beginning in the newborn period and extending to 18 to 36 months of age.

The SVR trial reported in the current study compares two techniques used in the initial, riskiest stage of surgery, called the Norwood procedure. As part of the Norwood procedure, surgeons implant a shunt to reroute blood from the malformed heart to the pulmonary artery, which supplies the lungs.

The traditional surgical approach is to use a modified Blalock-Taussig (MBT) shunt, which carries blood from an artery branching off the aorta to the pulmonary artery. The newer technique, sometimes known as the Sano procedure or the right ventricle-pulmonary artery (RVPA) shunt, links the right ventricle to the pulmonary artery. If either technique fails, the only alternative is a heart transplant.

In the current trial, researchers randomized infants who required the Norwood procedure to two groups, 275 for the MBT shunt and 274 for the RVPA shunt. Twelve months after the surgery, 74 percent of infants with the RVPA shunt survived and didn't require a heart transplant, compared to 64 percent of infants with the MBT shunt. The RVPA group did, however, undergo a higher rate of complications requiring unintended interventions, such as needing stents or balloons to keep the shunt open. After the first year, rates for transplantation-free survival were the same for both groups.

The researchers will continue to follow the children in the study over a longer period to further analyze patient outcomes for the two types of shunts.

Beyond survival, patient outcomes include quality-of-life issues. As medical and surgical advances have improved survival rates for children born with heart defects, caregivers have been able to focus on long-term effects of their disease and its treatment. In particular, children with complex congenital heart disease (CHD) are at greater risk of neurodevelopmental problems. As these children reach school age, they tend to have higher rates of academic, behavioral and coordination difficulties compared to peers.

The Children's Hospital of Philadelphia is one of several centers that now have formalized programs to provide ongoing neurodevelopmental care for children with congenital heart disease. As a member of such a program and a leader in ongoing research on neurodevelopmental outcomes in CHD patients, Gaynor concluded, "It will be important to monitor these children as they grow and to not only make sure they are physically doing well but also hitting developmental milestones."

The National Heart, Lung and Blood Institute, part of the National Institutes of Health, provided funding support for this study through its sponsorship of the Pediatric Heart Network.

About the Cardiac Center at Children's Hospital: The Cardiac Center at The Children's Hospital of Philadelphia is a world leader in reconstructive heart surgery, heart catheterization, specialized anesthesia and nursing for children and young adults with heart disease. Children and adolescents are cared for by a multidisciplinary team that is one of the most experienced in the world. As one of the largest and most comprehensive programs in the nation, our pediatric cardiologists provide a complete range of services to more than 24,000 outpatients each year in eight locations in Philadelphia and the region. Our success rates are among the best in the U.S.

About The Children's Hospital of Philadelphia: The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking third in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 460-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.

Joey McCool Ryan | EurekAlert!
Further information:
http://www.chop.edu

More articles from Medical Engineering:

nachricht Novel breast tomosynthesis technique reduces screening recall rate
21.02.2017 | Radiological Society of North America

nachricht Biocompatible 3-D tracking system has potential to improve robot-assisted surgery
17.02.2017 | Children's National Health System

All articles from Medical Engineering >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

Im Focus: Three Magnetic States for Each Hole

Nanometer-scale magnetic perforated grids could create new possibilities for computing. Together with international colleagues, scientists from the Helmholtz Zentrum Dresden-Rossendorf (HZDR) have shown how a cobalt grid can be reliably programmed at room temperature. In addition they discovered that for every hole ("antidot") three magnetic states can be configured. The results have been published in the journal "Scientific Reports".

Physicist Dr. Rantej Bali from the HZDR, together with scientists from Singapore and Australia, designed a special grid structure in a thin layer of cobalt in...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

Viruses support photosynthesis in bacteria – an evolutionary advantage?

23.02.2017 | Life Sciences

Researchers pave the way for ionotronic nanodevices

23.02.2017 | Power and Electrical Engineering

Microhotplates for a smart gas sensor

22.02.2017 | Power and Electrical Engineering

VideoLinks
B2B-VideoLinks
More VideoLinks >>>