Congenital heart disease (CHD) refers to a series of birth defects that aff ect the heart and
thoracic vessels, aff ecting 6 to 8 out of 1,000 babies being born. In 40% of these children
no treatment is indicated because of minimal eff ect on hemodynamics and outcome.
In 60% treatment will be required; about half of them will require urgent surgery after
birth, while the other half will probably require surgery or medication at some point
during childhood. Due to advances in heart surgery, 85% of children with congenital
heart disease will 

Scohy, T.V. (Thierry)

Scohy, TV

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Peri-operative anesthetic innovations during pediatric cardiac surgery

Congenital heart disease (CHD) refers to a series of birth defects that aff ect the heart and
thoracic vessels, aff ecting 6 to 8 out of 1,000 babies being born. In 40% of these children
no treatment is indicated because of minimal eff ect on hemodynamics and outcome.
In 60% treatment will be required; about half of them will require urgent surgery after
birth, while the other half will probably require surgery or medication at some point
during childhood. Due to advances in heart surgery, 85% of children with congenital
heart disease will survive into adulthood.
Although CHD has been recognized for centuries, therapeutic options were not available
until the 20th century. Until the late 1930s little advances were made in cardiac
surgery due to a lack of refi nement in anesthesia and problems related to now routine
perioperative support techniques, such as blood transfusion and mechanical ventilation. After the fi rst successful ligation of a patent ductus arteriosus in 1938, a lot of
new operations found their origin. In 1949 perioperative mortality, approached 14.5%. In the 1950s extracorporeal circulation made its entry. The introduction of new anesthetic
drugs and the use of prostaglandins to maintain ductal patency and pulmonary
blood fl ow was one of the most important advances of the 1970s. In the late 1970s
cardioplegia solutions were introduced. During the 1980s sufentanil and midazolam
off ered alternatives to potent volatile anesthetics, although hospital mortality was
still 6%. From the 1990s miniaturizing components of the cardiopulmonary bypass
circuit reduced priming volumes, producing less coagulation factor dilution and further
improvement in patient outcome.
During the past two decades, mortality after surgery for congenital cardiac disease has
decreased dramatically and is now reported to be 4% in the European Association for
Cardio-thoracic Surgery and the Society of Thoracic Surgeons Congenital Heart Surgery
Database, the focus of clinical research and eff orts to improve quality has now shifted
to that of the minimization of morbidity

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Stellingen behorend bij het proefschrift Peri-operative Anesthetic Innovations During Pediatric Cardiac Surgery. Thierry Scohy 1. The Oldelft micromultiplane TEE phased array probe, with 48 elements, a center frequency of 7.5 Mhz, a tube diameter of 5.2 mm and head size of only 8.2-7 mm, provides good image quality (this thesis). 2. Intraoperative multiplane TEE is clearly beneficial for the simultaneous visualisation of the complex interaction of the right- and left ventricular function during left ven-tricular assist device (LVAD) implantation in children with end-stage cardiac failure (this thesis). 3. Intraoperative 30 echography permits comprehensive 30 viewing and measuring of cross sectional area of coarctation of the aorta providing useful additional informa-tion to support intraoperative decision-making (this thesis). 4. Alveolar Recruitment Strategy with PEEP of 8 em H20 significantly decreases ventila-tion perfusion mismatch, shunting or both and improves the dynamic compliance of the respiratory system (Crs), oxygenation and End-Expiratory Lung Volume in neonates after cardiac surgery for congenital heart disease (this thesis). 5. Conventional intraoperative high dose opioids (sufentanil 1 Omcg/kg) and with-holding glucose in intravenous fluids permits a save and moderate glucose control during pediatric cardiac surgery for congenital heart disease (this thesis). 6. Intraoperative TEE monitoring is recommended in all cases of pediatric cardiac surgery. 7. The delivery of high quality medical care is the core business of the medical profession. 8. Inadequate teamwork increases the risk of peri-operative complications and mortal-ity with a factor of 4.8. (Mazzocco et al. Am J Surg 2009; 197:678-685) 9. If physicians would read two articles per day out of the six million medical articles published annually, in one year, they would fall 82 centuries behind in their reading (MiserWF, JAm Board Fam Pract 1999; 21:315-33). 10. Clinical research also is quality management. 11. The difference between clinical investigation and the application of a new treatment is the controlled nature of research. 

Peri-operative Anesthetic Innovations During Pediatric Cardiac Surgery

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Peri-operative Anesthetic Innovations During Pediatric Cardiac Surgery

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