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Microvascular surgery in the congenital cardiac patient: A case series exploring feasibility and practical applications. J Plast Reconstr Aesthet Surg 2017 May;70(5):639-645 PMID: 28325567

Pubmed ID

28325567

DOI

10.1016/j.bjps.2017.02.002

Abstract

BACKGROUND: Pediatric congenital heart disease patients are at risk for vascular injuries during surgical procedures or when the arterial system is accessed for monitoring or diagnostic studies. Our treatment of emergent situations in this patient population using microvascular techniques shows the feasibility of such techniques.

METHODS: A retrospective chart review of patients aged 0-18 years with congenital heart disease identified six patients who underwent microvascular surgery by the senior surgeon from June 2007 to May 2015. We studied this series, highlighting technical aspects of surgery and perioperative care to determine their effect on outcome.

RESULTS: Six patients with congenital cardiac defects requiring cardiothoracic surgery were studied, body weight ranging from 3.2 to 19.1 kg at the time of surgery. Five suffered iatrogenic arterial injury to the heart or vessels used for access or diagnostic studies, including coronary artery laceration, brachial artery thrombosis, and external iliac artery avulsion. Interventions included direct end-to-end repair and vein grafting. Vessel diameter averaged 1 mm. Patients received vasopressors intraoperatively and were on vasopressors and antihypertensives postoperatively. One patient died because of disseminated intravascular coagulation on postoperative day 17, but bypass graft was patent prior to death. The rest survived with clinical evidence of patency of the repaired vessel for a long-term.

CONCLUSIONS: Microsurgical intervention may be life-saving as a revascularization procedure to the heart by direct coronary repair or bypass grafting. Iatrogenic injuries to the limb may cause critical ischemia; limbs can be salvaged by microsurgical repair. Despite technical and physiological challenges, microsurgery is feasible and sometimes crucial in this patient population.

Author List

LoGiudice JA, Adamson K, Ghanayem N, Woods RK, Mitchell ME

Authors

Karri A. Adamson MD Assistant Professor in the Plastic Surgery department at Medical College of Wisconsin
John A. LoGiudice MD Associate Professor in the Plastic Surgery department at Medical College of Wisconsin
Michael Edward Mitchell MD Professor in the Surgery department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-85015294699

MESH terms used to index this publication - Major topics in bold

Child, Preschool
Fatal Outcome
Feasibility Studies
Female
Heart Defects, Congenital
Humans
Infant
Infant, Newborn
Intraoperative Complications
Male
Microsurgery
Patient Safety
Vascular System Injuries
jenkins-FCD Prod-353 9ccd8489072cb19f5b9f808bb23ed672c582f41e