Heart Center
At Children's Medical CenterNews Archive
Dr. Hisashi Nikaidoh receives international recognition for landmark cardiac procedure
Dr. Hisashi Nikaidoh has received international recognition for the landmark procedure that bears his name following 20 years of successful surgeries. Dr. Nikaidoh was recognized at the Fourth World Congress of Pediatric Cardiology and Cardiac Surgery that took place Sept. 18-22 in Buenos Aires.
Children diagnosed with the rare triad of transposition of the great arteries, ventricular septal defect and pulmonary stenosis have a significantly improved prognosis after undergoing aortic translocation with reconstruction of the right ventricular outflow tract, commonly called the Nikaidoh procedure.
“The aortic translocation, or the Nikaidoh procedure as it is appropriately known, is a truly innovative approach to the surgical repair of many patients with transposition of the great arteries,” said Dr. Joseph M. Forbess, chief of cardiothoracic surgery at Children’s. “Perhaps equally important, moreover, is the fact that the long-term follow-up for patients receiving this procedure appears to be superior to other surgical strategies. With the introduction of this procedure, Dr. Nikaidoh has left a mark on congenital heart surgery that will last forever.”
Dr. Nikaidoh has been involved directly in 18 of his procedures since 1984 when he proposed his alternative to the Rastelli procedure, the classical treatment option for this combination of heart defects. “My version of the repair avoids the conduit of the Rastelli operation while providing a more direct route from the left ventricle to the aorta,” Dr. Nikaidoh said. “To me, this is the main advantage of the operation over the Rastelli repair. The long-term survival is clearly better than Rastelli.”
Dr. Thomas Yeh Jr., cardiothoracic surgeon at Children’s, presented a report at the Fourth World Congress showing his remarkable findings after following up with 17 patients who underwent the Nikaidoh procedure. “We were frankly a bit stunned at how well the left side of the heart was doing,” Dr. Yeh said. “Dr. Nikaidoh's daring was to move the whole valve over rather than just patching within the ventricle.”
Many doctors from across the world also championed the Nikaidoh procedure at the Fourth World Congress. Dr. Mark Hazekamp from Leiden , The Netherlands, presented “Nikaidoh Procedure for TGA, VSD and Left Ventricular Outflow Tract Obstruction.” Dr. Victor O. Morell, chief of the Division of Pediatric Cardiothoracic Surgery at Children’s Hospital of Pittsburgh , presented a video of himself performing the Nikaidoh procedure.
Children's physician quoted in The Washington Post
Dr. Sarah Blumenschein, director of preventive cardiology at Children's, was quoted in a Sept. 21 Associated Press article that ran in The Washington Post. The article discussed a study that addresses the link between excess body fat in teens, even those who are not overweight, and less elastic blood vessels, a condition that can mean future cardiovascular disease.
The findings underscore the dangers of the obesity epidemic, even in youngsters. An estimated 30 percent of schoolchildren are believed to be overweight.
"What you want is a very pliable blood vessel that has a lot of give and take," said Dr. Sarah Blumenschein, director of preventive cardiology at Children's Medical Center-University of Texas Southwestern. "Obesity itself appears to be an independent factor for decreased flexibility."
Reconstituted blood is better for infants' heart surgery than fresh blood
DALLAS – Oct. 14, 2004 – Using reconstituted blood – packed red cells and fresh-frozen plasma that are mixed in the operating room just before use – for heart bypass surgery in infants works better than using fresh whole blood, researchers at UT Southwestern Medical Center at Dallas and Children’s Medical Center Dallas have found.
Babies who received the reconstituted blood during surgery to repair congenital heart defects on average had shorter stays in the intensive care unit and spent less time on mechanical ventilation after surgery than babies who received fresh whole blood – blood that is less than 48 hours old and whose red cells and plasma have not been separated.
The findings, which appear in today’s New England Journal of Medicine, put to rest a decades-long debate in the medical community, said Dr. Daniel Stromberg, assistant professor of pediatrics at UT Southwestern and the study’s senior author. “The results demonstrate that the current national opinion regarding the benefits of fresh whole blood is incorrect,” said Dr. Stromberg, who is also a cardiologist at Children’s. “Fresh whole blood priming of the cardiopulmonary bypass circuit is actually worse in terms of clinical outcomes. This is important for patients and for blood banks – potentially saving lots of money and preserving component inventory.”
During heart surgery, babies must be placed on a cardiopulmonary bypass machine, which does the work of the heart and lungs while surgeons make repairs. The machine must be primed with donor blood because babies do not have enough of their own blood to supply both the machine and their tiny bodies. Blood priming of the cardiopulmonary bypass machine is not necessary for adults, whose blood volume is larger.
Traditionally, surgeons have insisted on using fresh whole blood to prime the bypass machine and would even cancel procedures when it wasn’t available. Using reconstituted blood would ease blood centers’ burden of meeting the demand for whole blood, researchers said. Physicians estimate that 19,000 operations for congenital heart disease are performed annually in the United States, with the majority requiring cardiopulmonary bypass.
One benefit of using fresh whole blood in the cardiopulmonary bypass machine was that the patient’s donor exposure was decreased: one donor as compared to two donors with the reconstituted blood. That risk could be easily minimized by using both components of reconstituted blood from the same donor, Dr. Stromberg said.
Reconstituted blood also costs slightly more initially than fresh blood. but the overall savings from reconstituted blood use during recovery could be thousands of dollars. During the study, babies who received the reconstituted blood for heart surgery left the cardiac ICU roughly 25 percent quicker than those getting fresh blood (70.5 hours to 97 hours) and spent 31 percent less time on mechanical ventilation following surgery (36.3 hours to 53 hours). The reconstituted blood group also demonstrated less accumulation of fluid 48 hours after surgery (-6.9 milliliter per kilogram of body weight to 28.8 ml/per kg).
Researchers studied 200 patients during a four-year period at Children’s; participants were younger than 1 year old with congenital heart defects that required open heart surgery to repair. Patients were randomly assigned to receive fresh whole blood or reconstituted blood during surgery. All blood products used were acquired from a standard donor pool and underwent routine screening for infectious agents, as required by the Food and Drug Administration. All care providers, except for the operating room perfusionist and circulating nurse – who monitor and operate equipment that oxygenates the blood during open heart surgery, were blinded to the patient’s group assignment.
Other UT Southwestern researchers who participated in the study were Dr. Steven Mou, a fellow in the pediatric intensive care unit; Dr. Brett Giroir, professor of pediatrics; Dr. Erica Molitor-Kirsch, assistant professor of pediatrics; Dr. Steven R. Leonard, professor of cardiovascular and thoracic surgery; Dr. Hisashi Nikaidoh, professor of cardiovascular and thoracic surgery; and Dr. William Scott, professor of pediatrics. Deborah Town, a nurse and clinical research coordinator at Children’s; Dr. Lonnie Roy, biostatistician and senior planning analyst in Children’s market research department; and Dr. Frank Nizzi of Carter BloodCare in Dallas were also involved in the study.
J.D. and Hallie Young and the Morrison Trust of San Antonio funded the study.
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