Since 1962, thousands
of infants and childrens have undergone palliative or corrective
operations at Children's Hospital and Research Center at Oakland.
In 1997, Dr. Frank Hanley, one of the worlds' most renowned pediatric
cardiovascular
surgeons, assumed the role of director of the cardiac surgery
program at Children's Hospital and Research Center at Oakland.
Dr. Hanley and his associates, Olaf Reinhartz and V. Mohan Reddy, are all members of the full time faculty at Stanford
University. These dedicated pediatric cardiovascular surgeons
provide our center with a breadth and depth of experience unrivaled
in the Western United States. Our surgeons are well known for
their work in the repair of the most complex defects in the smallest
infants. In addition, our surgical team has pioneered research
in fetal surgery. Our surgeons have assumed a leadership role
in the staged management of patients born with functional singlel
ventricle. Our surgeons also have special expertise in the surgical
treatment of valvular heart disease in children including an
aggresive commitment to repair abnormal heart valves when possible.
The multidisciplinary cardiac surgery
team that will care for your child is composed
of board certified pediatric cardiothoracic
surgeons, pediatric anesthesiologists, pediatric cardiac intensivists,
and pediatric critical care doctors. Our team also includes
pediatric cardiac perfusionists, cardiac nurse specialists,
cardiac ICU nurses and ICU respiratory therapists. The
surgical team is composed of Drs. Frank L. Hanley, Olaf Reinhartz and V. Mohan Reddy, each of whom is recognized by their
peers as
leaders and innovators in the world of pediatric cardiothoracic
surgery.
Novel to the care of post-operative
cardiac surgical patients at Children’s Hospital are three dedicated pediatric
cardiac intensivists who share the responsibility of supervising
the care of your child in the Pediatric ICU. The combined approach
of early corrective cardiac surgery and dedicated pediatric cardiac
intensivists managing the post operative care has resulted in 0.0%
mortality for surgeries of mild complexity, 1.2% for moderate complexity, and 2.0% for all cardiac surgery patients presenting
to Children’s Hospital and Research Center at Oakland. These
results represent one of the lowest mortality rates for pediatric
cardiac surgery in the United States and we are proud of our aggressive,
multidisciplinary approach to the management of congenital heart
disease.
While Children’s Hospital and Research Center
at Oakland is a teaching hospital training pediatric cardiac surgical
fellows,
critical care fellows and pediatric residents, your child’s
care will be directly supervised by your child’s primary
cardiologist. In addition, during your child’s hospital stay,
you will interact with the cardiac intensivists, the pediatric
cardiology nurse specialist and the cardiothoracic surgeon, as
well as other qualified and dedicated professionals. The repair
of many lesions requires an inpatient stay of 3-4 days; however,
your child’s actual length of stay will depend on diagnosis,
patient age and other factors, which will be discussed in detail
with you prior to surgery and during your child's hospitalization.
Your child’s pediatrician will remain actively
involved during the hospital admission as well as before and after
surgery.
The cardiothoracic surgeon will provide a detailed summary of the
operation and upon discharge, your child’s cardiologist will
provide your pediatrician with a complete summary of the hospital
course as well as subsequent outpatient evaluations.
About Cardiac Surgery
The majority of children who
require heart surgery have been diagnosed with a form of congenital
heart disease. A smaller number have acquired heart disease,
usually associated with an infection (such as rheumatic fever)
or Kawasaki disease. Our team works closely with the referring
cardiologists to determine the necessity and timing of surgery.
We also manage a range of non-cardiac conditions including vascular
rings and tracheal abnormalities. Therefore, many referrals come
from pediatricians, family physicians and other specialists.
Patients and their families
are encouraged to meet with the surgeons to review proposed treatments.
The decision to perform surgery is always made in conjunction
with the child's primary care physician. The surgeons work closely
with their colleagues in cardiology and other specialties to
determine pre- and post-surgical plans of care.
Types of Cardiac Surgery Surgery for congenital heart
defects usually falls into one of three categories: "closed"
corrective surgery, open-heart corrective surgery, or palliative
surgery.
Closed corrective surgery does
not require the use of cardiopulmonary bypass (CPB) because there
is no need to open the heart to repair the defect. Typical procedures
include ligation and division of patent ductus arteriosus, repair
of coarctation of the aorta, and repair fo vascular rings.
Open-heart corrective surgery
is used to correct defect sinside the heart. During these procedures,
CPB is used to supply oxygen to the blood an dpump blood through
thte body, bypassing the heart and lungs. Some children require
hypothermia, which lowers the body temperature and allows the
surgeon to decrease circulation while safely repairing the heart.
Palliative surgery is used
almost exclusively in the treatment of complex defects that are
not suited to early or complete correction. In these cases, a
staged approach to treatment is more effective. Palliative surgery
provides a bridge of time to prepare the heart for the possibility
of eventual complete repair.
The type of surgery required to repair your child's
heart lesion will be discussed with you prior to your child's admission.
In addition to the type of surgery, you should also ask the cardiac
surgeon about the different types of incisions (midline, thoracotomy
or transverse) that might be appropriate for your child. Drs. Hanley, Reinhartz and Reddy have extensive operative experience and will
recommend the type of surgery and incision they feel is best for
your child.
Approaches and Incisions
Congenital heart defects can
be repaired through a variety of incisions in the chest. Some
operations require a lateral thoracotomy. Direct surgery within
the heart usually requires a midline sternotomy incision. Our
surgical team has considerable experience with all of the different
approaches to the heart. The surgical incision and the approach
to the chest cavity for each child is tailored to provide the
optimal cosmetic result while maintaining the hightest standards
for the quality of the outcome and minimizing the risks to the
patient.
Each patient and their family
participate in a preoperative conference with members of the
surgical team. At that conference, the anatomy and physiology
of the congenital heart defect will be discussed in detail. The
surgical approach to the congenital heart defect will also be
discussed within the context of the appropriate type of incision
for the safest repair.
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