Heart Surgery For Children: A Delicate Balance
Nick Evanson underwent three heart surgeries for a congenital heart defect, performed by David Overman, MD, pediatric cardiac surgeon at Children's of Minnesota. Now 8 years old, Nick is doing fine.
Helping children who are born with heart defects is a major strength of Children's Hospitals and Clinics of Minnesota. Significant heart problems are the most common birth defect, affecting nearly 1 percent of infants.
David Overman, MD, and Frank Moga, MD, are the pediatric heart surgeons who practice at Children's of Minnesota. Working with their colleagues at Children's Heart Clinic and the hospital, Overman and Moga perform delicate and complex surgeries that save lives and improve quality of life for children.
"Children's is considered a high volume center, based on numbers of surgeries, by the Society of Thoracic Surgeons," Overman explains. In 2006, 429 cardiac surgeries were performed at Children's. "On balance, high volume translates into better results, because experience is a major factor in quality of care."
Among hospitals in the metropolitan area, Children's cares for nearly two-thirds of pediatric patients hospitalized for cardiac surgery.
Forty percent of cardiac surgeries at Children's are performed on patients from the neonatal intensive care unit. "Many repairs for congenital heart problems are done early in life," Overman says. "Because congenital heart defects are rare and there is a wide range of them, surgeries on such patients are inherently high-intensity undertakings."
Congenital heart problems in children are entirely different from adults' heart problems, emphasizing the importance of Children's focus on pediatrics. Pediatric cardiologists at Children's Heart Clinic see patients with a wide range of congenital heart problems. Specialized testing to assess a problem may involve a pediatric cardiologist who specializes in using CT technology at Children's to obtain finely tuned studies of the moving heart. Hundreds of children each year undergo testing and treatment in Children's cardiac catheterization laboratory. Information that pediatric cardiologists gain in the cath lab often forms the basis for surgeons to plan their work.
During open-heart surgery on children, Moga and Overman work as a team, drawing on a total of 19 years of surgical experience. Likewise, other operating room staff at Children's – Minneapolis also work solely with children. Pediatric anesthesiologists and pediatric certified registered nurse anesthetists are skilled at supporting patients during complex and sometimes- lengthy surgeries. Dedicated surgical technologists and registered nurses in the operating room also specialize in pediatric cardiac surgeries.
After surgery patients go to Children's pediatric intensive care unit (PICU). The medical team treating patients includes not only the cardiac surgeon and pediatric cardiologist, but physicians who specialize in pediatric critical care medicine. PICU physician specialists are on-site 24/7. Registered nurses and respiratory therapists with specialized pediatric critical care knowledge and skills care for these patients after surgery. Supporting them are a number of professionals, including pharmacists and social workers, who also are experienced in caring for these patients and families.
"Our superior results are truly a team effort, involving care providers from birthing and diagnosis, to the surgical intervention itself, on through to recovery and discharge home," Overman says.
Children's Delivers Excellent Results for Cardiac Surgery
Patients who undergo heart surgery at Children's do very well, as measured against national benchmarks of care reported by the Pediatric Health Information System. Compared with the top pediatric hospitals treating cardiac patients, Children's patients undergoing cardiac surgery in 2006 had:
A length of stay in the hospital lower than expected, given the severity of patients' illnesses.
Fewer deaths than expected, given the severity of the patients' cardiac conditions.