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Microvascular surgery in the congenital cardiac patient: A case series exploring feasibility and practical
John A LoGiudice1, Karri Adamson1, Nancy Ghanayem2
1Department of Plastic Surgery, Medical College of Wisconsin, 1155 N. Mayfair Road, Milwaukee, WI 53226, USA.
Insights
Pediatric congenital heart disease patients undergoing surgery can experience vascular injuries. Microsurgery offers a feasible and potentially life-saving solution for repairing these critical iatrogenic arterial injuries in children.
Area of Science:
- Pediatric Cardiovascular Surgery
- Vascular Microsurgery
- Congenital Heart Disease Management
Background:
- Pediatric patients with congenital heart disease (CHD) face risks of vascular injury during surgical procedures or arterial access.
- Emergent vascular complications require specialized treatment approaches.
Observation:
- A retrospective review identified six pediatric CHD patients (0-18 years) who underwent microvascular surgery.
- Five patients sustained iatrogenic arterial injuries, including coronary artery laceration, brachial artery thrombosis, and external iliac artery avulsion.
- Vessel repair involved direct end-to-end anastomosis and vein grafting for vessels averaging 1 mm in diameter.
Findings:
- Microsurgical repair was performed on iatrogenic arterial injuries in pediatric CHD patients.
- Postoperative management included vasopressors and antihypertensives.
- One patient expired due to disseminated intravascular coagulation; the remaining five showed long-term patency of repaired vessels.
Implications:
- Microsurgical intervention can be life-saving for revascularization in pediatric CHD patients.
- Limb salvage is possible through microsurgical repair of critical ischemia caused by iatrogenic injuries.
- Microsurgery is a feasible and crucial option for managing complex vascular challenges in this vulnerable population.
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.
