[New approaches in cardiac surgery for the therapy of congenital heart disease].
Recent developments in the field of pediatric cardiac surgery and pediatric cardiology have led to significant changes in the surgical approach to the various cardiac malformations. There is a clear trend towards surgical treatment at a younger age of the patient, towards complete correction of malformations instead of staged procedures with initial palliation and delayed correction. Perioperative cardioprotection has improved significantly as has postoperative management in specialized pediatric cardiac intensive care units. As a result of this, mortality and morbidity of pediatric cardiac surgery have been in steady decline, although complexity of cardiac surgery in even smaller children has increased. Preoperative diagnostic work-up of the cardiac malformation can nowadays be achieved in an always increasing number of patients without invasive cardiac catheterization and based exclusively on ultrasound findings alone. A new element comes from the possibilities of therapeutic cardiac catheterization, which now allows for a combined therapeutic approach using therapeutic catheter procedures either to perform preparatory interventions prior to surgery or to treat surgical complications in the postoperative course. Refinements in the use of surgical implants have led to new possibilities of correction of complex malformations early in life, especially with regard to the use of biological prosthesis for valvar or outflow tract replacement.
Abteilung Pädiatrische Kardiologie, Inselspital Bern. Jean.Pierre.Pfammatter@insel.ch
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Pfammatter
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Berdat
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Carrel
D000367:Age Factors; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000639:trends; D006348:Cardiac Surgical Procedures / Q000639:trends*; D002309:Cardiology / Q000379:methods / Q000639:trends*; D002648:Child; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000639:trends; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000639:trends; D010372:Pediatrics / Q000639:trends*; D019990:Perioperative Care / Q000639:trends; D014463:Ultrasonography