Browsing by Author "Brooks, Andre"

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    Common Arterial Trunk Repair at the Red Cross War Memorial Hospital, Cape Town: A 20-year review of surgical practice and outcomes
    (2023) Moodley, Allen; Brooks, Andre
    BACKGROUND: A description of the post-operative outcomes following Common Arterial Trunk (CAT) repair over 20 years before and following the transition to nonconduit repair. Primary outcomes were 30-day and overall, in-hospital mortality for paediatric patients who underwent CAT repair at Red Cross War Memorial Children's Hospital (RCWMCH). Secondary outcomes encompassed (a) Incidence of postoperative complications and (b) medium-term outcomes, including reinterventions, late deaths, and loss to follow-up. METHOD: A single-centre retrospective study of all consecutive patients who undertook the repair of CAT from January 1999 to December 2018 at RCWMH. Patients with an interrupted aortic arch or previous pulmonary artery banding were excluded. RESULTS: Fifty-four patients had CAT repair during the study period. Thirty-four (63.0%) patients had a conduit repair, and 20 (37.0%) patients had a non-conduit repair. There were 2 intraoperative deaths. Thirty-day in-hospital mortality was 22.2%. Overall, in-hospital mortality was 29.6%. Twenty-nine (55.8%) of fifty-two patients suffered a postoperative complication. A total of 38 patients were followed up post-hospital discharge with 11 patients (28.9%) lost to follow-up and 8 (21.1%) late mortalities observed. The actuarial survival for the conduit group was 77.5%, 53.4% and 44.5% at 6, 12 and 27 months respectively and non-conduit group was 58.6% at 6 months. The overall freedom from revision surgery between the conduit group and non-conduit group was 5 66.2% vs 86.5%, 66.2% vs 76.9% and 29.8% vs 64.1% at 1, 2 and 8 years respectively. CONCLUSIONS: No difference in postoperative mortality between the conduit and non-conduit repair. Reintervention rates were lower in the non-conduit group.
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    Mid-Term Outcome Of A Decade Of Delayed Total Cavopulmonary Connection Completion Strategy At Red Cross War Memorial Children's Hospital.
    (2023) Swai, Noel; Brooks, Andre; Zühlke Liesl
    Background: Total cavo-pulmonary connection (TCPC) is currently the definitive palliative operation for single ventricle congenital anomalies. It is the last stage in the single ventricle pathway and can be completed following a bidirectional Glenn shunt (BGS), if a set of strict criteria are met. The TCPC is inherently an ineffective circulation, and long-term complications are inevitable. In an attempt to delay TCPC circulation-related complications, we have followed a delayed TCPC completion strategy and maintenance of forward flow at the time of bidirectional Glenn shunt circulation whenever possible. In this study, we will describe the results over the last decade. Materials and Methods. Single-centre, retrospective study from January 1, 2009, to December 31, 2018. A total of 42 patients underwent extracardiac TCPC procedures on cardiopulmonary bypass. The most common indication for TCPC was Tricuspid atresia (56%). The median age at the time of operation was 9 [Interquartile range: 7 – 11] years. The median time interval between the bidirectional Glenn shunt and TCPC procedure was 6 [IQR: 4 - 9] years. The median followup was 24 [Interquartile range: 12 – 43] months. Results: Most common postoperative morbidities were prolonged pleural effusion 22 (58%) and infection 16 (38%) which were independently risk factors for prolonged hospital or intensive care unit (ICU) stay respectively. There was no 30-day mortality, and the 1-year and 5-year survival rates were 98% and 88%, respectively. The preservation of forward flow at the time of BGS did not prolong the time interval between the two procedures. Conclusion: Delayed TCPC strategy with or without retention of forward flow at the time of bidirectional Glenn circulation has shown acceptable outcomes. In this series, we did not show any benefit in the retention of forward flow. This strategy may be ideal in a resource-limited environment. We recommend the implementation of infection and pleural drainage control management protocols to avoid prolonged ICU and hospital stays.
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    Outcomes following neonatal cardiac surgery in a South African tertiary centre
    (2023) Du Toit, Derrik; Zühlke, Liesl; Brooks, Andre
    Background: Neonatal Cardiac Surgery has developed significantly since its advent, with improved outcomes, survival, and physiological repair. Limited programs offer neonatal cardiac surgery in emerging economies. We report our experience with neonates undergoing cardiac surgery in our cardiac surgery program. Methods: We performed a secondary data analysis on all neonates aged < 30 days undergoing congenital cardiac surgery from 1 April 2017 to 31 March 2020, including outcomes up to 30-days post-surgery. Results: A total of 859 patients underwent cardiac surgery at our center, of these 81 (9.4%) were neonates. The proportion of neonates increased annually (8.7%, 9.6% and 10.2%). There were 49 (60%) males, and 32 (40%) had surgery in the second week of life. Fourteen (17%) were premature, four (5%) had a major chromosomal abnormality, five (6%) a major medical illness and eight (10%) a major non-cardiac structural anomaly. The RACHS categorization of surgery was predominantly RACHS 3; n = 28 (35%) and 4; n = 23 (29%). Hours in ICU were extensive; median 189 [IQR 114-286] as were hours of ventilation; median 95 [IQR 45-163]. Almost 60% (n=48) of procedures were complicated by sepsis, as defined in our database. The in-hospital mortality rate was 13% (n=13); the 30-day mortality rate was 19.8% (n=16). Conclusion: The proportion of neonates in our service increased over the period. Focused strategies to shorten prolonged ICU stay and decrease rates of bacterial sepsis in neonates are needed. A multi-disciplinary, collaborative heart-team approach is crucial for best outcomes.