2012 annual meeting & cardiothoracic forum - Society for ...

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ACTA-SCTS JOINT MEETING • Manchester Central Conference Centre 088 New Rib-Specific Fixation Systems: Time to Consider More Aggressive Operative Management of Traumatic Rib Fractures? Authors: A.R. Kendal; U. Abah; N. D’Souza; P.E. Belcher; E.A. Black John Radcliffe Hospital, United Kingdom Objectives: The optimal management of traumatic ribs fractures remains controversial. Although recent NICE guidelines (IPG361) recommend internal rib fixation to stabilise a flail chest wall, there is little reported on the role of early rib fracture fixation in preventing complications. It is also not clear whether rib fixation of non-flail segments is beneficial. We report our experience of early surgical intervention in both flail and non-flail chest wall injuries using a variety of different metal fixation systems. Methods: A retrospective analysis was conducted of all patients that underwent open reduction and internal fixation of multiple rib fractures, irrespective of flail or non flail segment, between May 2009 and August 2011. Results: 21 patients with traumatic rib fractures underwent open reduction and internal fixation, of which 16 were emergency cases. 76% of patients had a flail chest segment. A mean of 3 (SD 1.3) ribs were fixed per patient using Synthes MatrixRib, intramedullary splints, StraCos clips or StraTos bars. VATS was performed in 16 patients in order to help assess associated thoracic injuries and to assist in open reduction of the fractures. The peri-operative mortality rate was zero. The median length of post-operative stay was 7 days and only one patient required ventilation. Conclusions: In accordance with NICE findings, open reduction and internal fixation of multiple traumatic rib fractures proved a safe and effective management of flail chest segments. Based on our experience, we would recommend the use of specifically contoured rib fixation plates. Moreover, our successful management of non-flail segments with early rib fixation should prompt thoracic surgeons to explore the potential benefits of extending operative management beyond current NICE guidelines. 152
JOINT ANNUAL MEETING 2012 ABSTRACTS 089 Outcome of Aortic Valve Repair in Paediatric Cardiothoracic Surgery Authors: Natasha Prior 1 A. Hatem 1 P. Reddy 1 R. Dhannapuneni 1 A. Corno 2 P. Venugopal 1 N. Alphonso 1 1 Alder Hey Children’s Hospital, United Kingdom; 2 Prince Salman Heart Center, Saudi Arabia, Saudi Arabia Objectives: Aortic valve disease occurs in approximately 4 per thousand births. Management options include medical treatment, balloon valvuloplasty, mechanical valve replacement, bioprosthesis, homograft, Ross procedure, or aortic valve repair. In this study, we retrospectively evaluated our clinical experience with aortic valve repair in children over a 5 year time period. Methods: From February 2006 until November 2011, 39 aortic valve repairs were performed. In this retrospective study, the outcomes in terms of early and late mortality, ICU and hospital stay, and failed procedure requiring re-operation, or cardiological interventional procedure were reviewed. Results: The mean age at time of surgery was 7.3+/-6.0 years, mean weight was 26.5+/-21.3 Kg and body surface area was 0.88+/-0.52 m2. Surgical indication included aortic regurgitation in 35.9 % of cases (n = 14), aortic stenosis in 33.3 % (n = 13) and mixed aortic valve disease in 30.8 % (n = 12). 11 solitary aortic valve repairs were performed. The remaining 28 cases were aortic valve repairs combined with additional cardiac surgical procedures. Surgical technique of aortic valve repair included:- Commisurotomy (n = 25); valvuloplasty (n = 20) and leaflet reconstruction using pericardium (n = 14) (13 autologous & one bovine). In 36.8 % of cases (n=14), a combination of techniques was employed to effect repair. Mean cardiopulmonary bypass time was 146+/-91 minutes with mean cross-clamp time of 103+/-60 minutes. The mean follow-up period was for 289.4+/-343.6 days and accumulative follow up was a total of 30.9 years. There were no early deaths and three (7.7%) late deaths. All late deaths occurred in children receiving combined complex congenital heart surgery. Post-operative complications occurred in 23.1 % (n = 9) of patients. The mean ICU stay was 7.8+/-17.8 days and mean postoperative hospital stay was 11.6+/-18.4 days. None of the patients proceeded to a post-operative cardiological interventional procedure but two (5.1 %) patients required surgical revision after aortic valve repair (one at 24 hours and one at 21 days post-op). Conclusions: After 5 years of experience with aortic valve repair, we demonstrate the acceptability of this procedure as a management option in paediatric aortic valve disease 153
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