Pediatric Cardiothoracic Surgery State-of-the-Art Surgical Care

Thirty-day Operative Survival for the Pediatric Cardiac Surgery Program
Cumulative Numbers for the years 2002-2007

Patients receive both preoperative and postoperative care in a dedicated Pediatric Cardiac Intensive Care Unit (PCICU). The 12-bed PCICU, completed in 2005, is a state-of-the-art facility, designed specifically for the critical care of all pediatric cardiac defects. Capabilities include complete postoperative monitoring with intracardiac lines and cerebral oximetry (NIRS), 24-hour ECMO availability, and ventricular assist device support with the Berlin Heart device. Care is delivered by a team which includes pediatric cardiology intensivists, pediatric cardiac surgeons, dedicated pediatric cardiac care nurses, respiratory therapists, and pharmacologists.

The pediatric cardiac program is located in theMUSC Children's Hospital. Built in 1987, Children's Hospital is South Carolina's largest and most comprehensive pediatric healthcare center. It is dedicated to enhancing the health of children throughout South Carolina, and to providing an environment that supports excellence in pediatric patient care, teaching and research. Child magazine consistently ranks MUSC Children's Hospital as one of the top pediatric facilities in the country.

Our pediatric cardiac program functions within the Children’s Heart Program of South Carolina. Since the earliest days of congenital heart surgery, all of the specialists caring for children with heart disease in the state of South Carolina have worked together to coordinate care and provide the best possible outcomes for our patients. Pediatric cardiology groups are based in 4 locations – Charleston, Columbia, Greenville and Florence – with outreach clinics in a variety of other statewide cities. To optimize the care of the most critical patients, all surgical and catheterization procedures are performed in the MUSC Children’s Hospital. This system allows for the highest level of care by the specialized teams, while still assuring that the majority of the patient’s care is delivered close to home. This coordinated approach is unique to our state and we are proud to work so closely with our statewide colleagues to provide it.

Our cardiac program is one of 7 centers in the Pediatric Heart Network of the National Heart Lung and Blood Institute at the NIH. Funded since 2001, this network conducts prospective, multi-institutional trials on children with heart disease.

Highlights of our pediatric cardiac program include:

• 99 percent 30-day operative survival rate for all operations from 2002-2007
• 92 percent 30-day survival rate for the Norwood procedure for hypoplastic left heart syndrome from 2002-2007
• Emphasis on, and excellence in early complete cardiac repair in neonates and infants
• Surgical management of patients with congenital heart disease from premature neonates to adults
• Staged repair of hypoplastic left heart syndrome through a customized approach (Norwood/Sano, Glenn/hemi-Fontan, and lateral-     tunnel/extracardiac conduit Fontan procedures).
• Tetralogy of Fallot repair with pulmonary valve preservation
• Aortic and mitral valve repair.
• Ross procedure for aortic valve replacement
• Valve-sparing aortic root replacement for Marfan Syndrome
• Innovative surgical techniques, including minimally invasive surgery, blood conservation, and low-prime cardiopulmonary bypass
• Avoidance of circulatory arrest by the use of selective brain perfusion during aortic arch surgery
• Mechanical cardiac support program including extracorporeal membrane oxygenation (ECMO), and ventricular assist devices (VAD’s)
• The first implantation of the Berlin Heart Ventricular Assist Device in the Southeast

Biventricular pacemaker and automatic implantable cardioverter defibrillator (AICD) implantation

Pediatric heart transplant cardiac program:

Our program is a pioneer in the treatment of end-stage heart failure in children, and offers the only heart transplant program in the state. For over two decades, the pediatric heart transplant program has made this lifesaving surgery an option for patients who no longer respond to medical treatment. Our multidisciplinary team of transplant specialists includes surgeons, cardiologists, anesthesiologists, perfusionists, psychologists, advanced nurse practitioners, and social workers delivering comprehensive patient care with the highest survival rate in the Southeast. Our pediatric heart transplant program provides:

• 100 percent 30-day survival rate following heart transplant
• Proven and new agents for heart failure in children, such as milrinone, carvedilol and nesiritide
• Pulmonary vasodilator therapy for pulmonary hypertension, including newer agents such as bosentan (Tracleer) and sildenafil (Viagra)
• Aggressive anti-inflammatory treatment for myocarditis, including immunoglobulin therapy
• Comprehensive screening, diagnosis and management of all forms of heart muscle failure or cardiomyopathy
• Use of extracorporeal membrane oxygenation (ECMO) and ventricular assist device (VAD), as bridges to transplant