|
| | Clinical Outcomes***The Congenital Heart Institute of Florida (CHIF) specializes in the care of Pediatric and Adult patients with congenital Cardiac, Thoracic, and Vascular disease.The Congenital Heart Institute of Florida (CHIF) is the largest congenital and pediatric practice in Florida and provides cardiovascular and thoracic surgery and cardiac transplantation.In 2002, CHIF performed 811 pediatric and congenital cardiothoracic surgical operations including 404 open heart procedures, with an overall mortality of 3.08%. In 2003, CHIF performed 827 pediatric and congenital cardiothoracic surgical operations including 402 open heart procedures, with an overall mortality of 2.78%. The graph below compares the CHIF mortality to the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database mortality for all cardiac patients, neonates, and infants.
CHIF performs all forms of pediatric and congenital cardiothoracic surgical operations. Our outstanding results with the following procedures provide a representative sampling of our clinical outcomes: ***All mortality figures represent 30 day mortality. Outcomes are reported through January 1, 2004. A registry and database (a component of the CardioAccess International Clinical Outcomes Database: Comprehensive Cardiovascular and Thoracic Module, CardioAccess Inc., Saint Petersburg, Florida and Fort Lauderdale, Florida: http://www.cardioaccess.com) has been prospectively maintained on all patients and has been utilized for data collection and analysis.
The Congenital Heart Institute of Florida (CHIF) has performed 415 ventricular septal defect repairs with an overall mortality of 0.72%. Since 1999, CHIF has performed 187 ventricular septal defect repairs with an overall mortality of 0. The Congenital Heart Institute of Florida (CHIF) has performed 336 tetralogy of Fallot repairs with an overall mortality of 2.08%. Since 1999, CHIF has performed 141 tetralogy of Fallot repairs with an overall mortality of 1.42%. The Congenital Heart Institute of Florida (CHIF) has performed more arterial switch procedures than any other program in Florida.CHIF performed 159 primary arterial switch between 1991 and 2003, inclusive, with an overall mortality of 3.14%.Since 1996, CHIF has performed 89 primary arterial switch procedures with an overall mortality of 1.12%.The Congenital Heart Institute of Florida (CHIF) is ranked among the best programs in the country for the arterial switch procedures by the Pediatric Cardiac Care Consortium. The Congenital Heart Institute of Florida (CHIF) has performed more Ross procedures than any other program in Florida.By 2004, CHIF had performed 111 Ross procedures with zero mortality. At The Congenital Heart Institute of Florida (CHIF), the majority of our neonates with hypoplastic left heart syndrome are now treated with Norwood Staged Palliation. Our operative strategy for Norwood Stage 1 has evolved over the last several years. Circulatory arrest is avoided and typically only used during the atrial septectomy. The majority of our cases are performed with continuous antegrade cerebral perfusion either through the aortopulmonary shunt in neonates with a small aorta or through direct aortic cannulation with the arterial cannula (typically 6 French in size) advanced into the innominate artery in neonates with a larger ascending aorta. The source of pulmonary blood flow is most commonly a systemic to pulmonary artery shunt, but we selectively utilize the Sano right ventricle to pulmonary artery conduit in smaller neonates weighing less than 2500 grams at the time of Norwood Stage 1 Palliation. As of 2004, our total Stage 1 Norwood volume is 130 cases with a 30 day survival of 81.54%. During the current era since January 1, 2001, we have performed 55 Norwood Stage 1 procedures with a 30 day survival of 87.27%.In the second half of the 1990’s, our program utilized primary cardiac transplantation and Norwood Staged Palliation on equal basis. We have now evolved to the more selective utilization of cardiac transplantation. Although the majority of our patients are now treated with a primary strategy of Staged Palliation, we employ cardiac transplantation as treatment for hypoplastic left heart syndrome in the setting of family preference, significant ventricular dysfunction, severe atrio-ventricular or ventriculo-arterial valve regurgitation, and in patients with failing staged palliation at any point in the process of staged palliation.At The Congenital Heart Institute of Florida (CHIF), biventricular repair for hypoplastic left heart syndrome is employed in a smaller select subgroup of patients. We remain quite selective in choosing patients with hypoplastic left heart syndrome to undergo biventricular repair. Eight children with hypoplastic left heart syndrome have undergone biventricular repair with a survival of 6 out of 8 (75%. Three children with hypoplastic left heart complex underwent biventricular repair consisting of arch reconstruction and closure of septal defects. All three of these patients had small non-apex forming left ventricles and ductal dependent blood flow to the descending thoracic aorta with hypoplastic aortic and mitral valves. Two of these 3 patients with hypoplastic left heart complex are currently alive and well with 2 ventricles, but 1 of these 3 neonates diagnosed with hypoplastic left heart complex was found at surgery to have intrinsic mitral valve stenosis (therefore not truly hypoplastic left heart complex) and died after attempted biventricular repair. The remaining 4 surviving patients undergoing biventricular repair include 2 children undergoing a single stage Norwood (Stage 1) plus Rastelli procedure (Yasui procedure), 1 child undergoing a single stage Norwood (Stage 1) plus REV procedure, and 1 child undergoing a 2 stage Norwood (Stage 1) and then Rastelli procedure. One child died after a neonatal aortic homograft insertion and Konno procedure followed by a replacement of the leaking aortic homograft followed by cardiac transplantation. The Congenital Heart Institute of Florida (CHIF) has performed more heart transplants than any other program in Florida and is one of the largest pediatric cardiac transplantation programs in the United States.The United States Department of Health and Human Services studied 128 heart transplant centers. Our program ranks first in patients receiving a transplant within 1 year on the waiting list and fourth in survival after transplantation.At the Congenital Heart Institute of Florida (CHIF), our pediatric cardiac transplantation program performed our first heart transplant on May 21, 1995 and we have now had sixty-four consecutive children undergo heart transplantation. Diagnoses include 31 hypoplastic left heart syndrome, 21 cardiomyopathy, and 12 post-operative complex congenital heart disease. Nine (9/64 = 14.06%) were neonates. Forty-two (42/64 = 65.62%) were infants. The overall 30-day survival after cardiac transplantation is 58/64 (90.63%).The Congenital Heart Institute of Florida (CHIF) recently reported that with aggressive immunosuppression, children with elevated panel reactive antibody (PRA) are reasonable candidates for cardiac transplantation. We have also begun a program of listing infants for ABO incompatible donor hearts following the Toronto Hospital for Sick Children Protocol. We recently successfully performed our first and only ABO incompatible transplant to date in a recipient of blood type O (the universal donor with limited conventional recipient options) who intentionally received a heart from a donor with blood type AB (the universal recipient with limited conventional donor options). The immunosuppression protocol used in this patient is quite similar to our protocol for patients with high PRA. Both of these strategies of aggressive immunosuppressive regimens may help combat some problems associated with the shortage of donor organs. The Congenital Heart Institute of Florida (CHIF) is a world leader in Minimally Invasive Pediatric Cardiothoracic Surgical Procedures. CHIF has an active surgical robotics program and was the first program in Florida to perform robotically assisted pediatric cardiac surgical procedures. CHIF has also performed 58 Minimally Invasive Endoscopic Patent Ductus Arteriosus Procedures and 62 Minimally Invasive repairs of Pectus Excavatum. |
