Pediatric Cardiac Surgery: Renal Failure, Heart Failure, and Monetary Failure
Friday, May 13, 2016
4:00 PM-5:30 PM
BIOMED Seminar
Title:
Pediatric Cardiac Surgery: Renal Failure, Heart Failure, and Monetary Failure
Speaker:
Randy Stevens, MD
Pediatric Cardiothoracic Surgeon, St. Christopher's Hospital for Children
Assistant Professor of Pediatrics, Drexel University College of Medicine
Details:
In the United States, approximately 1 million babies are born with a heart defect in need of corrective treatment. Of this cohort, 40,000 live births each year with congenital heart disease require surgical intervention. In severe cases, babies are born with multiple malformations such that they have a single ventricle physiology. The incidence of children born with a single ventricle heart is about 2-4 in 10,000 live births. Without surgical intervention this set of lesions is lethal. As a treatment, the concept of a total right ventricular bypass, first introduced by Fontan and Baudet in 1968, is a palliative surgery aimed at separating the systemic and pulmonary circulations, eliminating venous blood mixing. This procedure creates the total cavopulmonary connection (TCPC).
To compensate for the underdeveloped pulmonary circulation the TCPC or Fontan, completion is implemented in 3 stages, progressively separating the systemic and pulmonary circulations and gradually increasing blood flow to the lungs. This Fontan completion produces a configuration in which a single functional ventricle pumps blood through the systemic circulation and then further through the pulmonary vascular beds. The single ventricle experiences a lower preload pressure and an increase in venous pressure to compensate for the lack of a pressure boost typically provided by a right ventricle. The absence of this right ventricle in high-risk Fontan patients places significant limitations on the amount of energy available to drive blood through the pulmonary vascular beds.
Modifications to the Fontan procedure, coupled with better management, have improved surgical outcomes reducing post-operative mortality to the level of simpler congenital heart repairs. However, patients are subjected to long-term complications, such as thrombosis, atrial arrhythmias, ventricular dysfunction, and protein losing enteropathy. Over their lifespan, these high-risk patients utilize healthcare resources disproportionate to their numbers. Collectively, their hospitalization costs exceed $1.5 billion/year, constituting an emerging public health concern. This seminar talk will discuss this growing health concern in pediatric cardiac surgery, renal failure as a consequence, new solutions, and the need for financial investment to develop new therapeutics.
For more info, please visit drexel.edu/biomed.
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Biosketch:
Dr. Randy Stevens, MD, is an Attending Pediatric Cardiothoracic Surgeon at the St. Christopher's Hospital for Children in Philadelphia and is Assistant Clinical Professor of Pediatrics in the Drexel University College of Medicine. He received his medical degree from the Ross University School of Medicine, completed his internship and residency in general surgery at Yale University's New Haven Hospital, and completed his residency and postdoctoral research fellowship in Cardiothoracic Surgery at the University of Kentucky. Dr. Stevens was awarded a prestigious National Research Service Award (F32) from the National Heart, Lung, and Blood Institute during his fellowship at the University of Kentucky. At the conclusion of his research fellowship, he completed a surgical fellowship in Pediatric Cardiac Surgery at the University of Toronto's Hospital for Sick Children.
Dr. Stevens has been in practice for over 18 years, and he routinely performs cardiac surgery on pediatric patients requiring surgical intervention because of cardiovascular decompensation secondary to congenital heart disease. He treats pediatric patients with cardiomyopathy, myocarditis, and several forms of congenital heart defects. His research includes developing new surgical techniques for palliation of hypoplastic left heart syndrome and new technology to treat single ventricle patients.
Contact Information
Ken Barbee
215-895-1335
barbee@drexel.edu