New clinical trial to improve recovery in children undergoing heart surgery


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3D illustration of the human heart and circulatory system. Credit: Bryan Brandenburg/ Wikimedia Commons, CC BY-SA 3.0

A new clinical trial led by the University of Birmingham and funded by the British Heart Foundation could help improve the recovery of children who have life-saving heart surgery.

The £ 570,000 study will compare two ways to protect the heart when children need open heart surgery to repair congenital heart defects, to find the most effective one.

Congenital heart disease is a heart defect that develops in the womb before a baby is born. Every day in the UK around 13 babies are diagnosed with congenital heart disease, with more diagnosed later in life.

In severe cases, and often at a young age, open heart surgery is needed to repair the defect to help improve the child’s survival and quality of life. Some children need multiple surgeries, and recovery from open heart surgery can take weeks or even months.

During open heart surgery, a fluid called cardioplegia is commonly used to stop the heartbeat so that the surgeon can safely repair it. Although the technique is safe, cardioplegia stops blood flow to the heart and can damage the heart muscle when blood flow is restored, which can affect a child’s recovery.

There are many types of cardioplegia solutions available, which work slightly differently, and it is currently unclear which fluid works best in children of different ages.

In the US, the most commonly used solution is called del Nido cardioplegia, which was designed specifically for use in cardiac surgery in children but was not previously available in the UK.

The new trial will compare del Nido cardioplegia with St Thomas’ cardioplegia, which has been used for many years in adults and children and is currently the standard of care in the UK.

It will involve 220 children undergoing open heart surgery at four UK hospitals: Birmingham Children’s Hospital, Bristol Royal Hospital for Children, Great Ormond Street Hospital and Leeds Children’s Hospital.

Half of the patients will be assigned to receive del Nido, the other half receiving St Thomas’ cardioplegia. Researchers will then compare the two groups by assessing how well the children are recovering from surgery and determining the extent of any heart damage.

The study will reveal whether one solution is potentially more effective than the other for children during surgery.

The research will be led by Nigel Drury, consultant in pediatric cardiac surgery at Birmingham Children’s Hospital and Hunterian Professor at the Institute of Cardiovascular Sciences at the University of Birmingham.

Mr Drury, who is also an intermediate member of the British Heart Foundation (BHF), said: ‘By improving the way we protect the heart during surgery, we expect children to recover from surgery faster. and with fewer complications.

These early benefits can also lead to better long-term results, with less heart muscle injury and scarring. As children with severe heart defects often need multiple surgeries, they will have the most to gain from improving health. how we protect the heart during each surgery.

“If our trial is successful, it will support the need for a larger and definitive study, which may have the potential to change the way children are treated around the world.”

Dr Shannon Amoils, Senior Research Advisor at the British Heart Foundation, said: ‘Heart defects are the most common birth defect in babies born in the UK, so it is important that we continue to refine treatments. of these conditions to help improve the lives of young patients.

“This multi-center trial, held in four major UK children’s hospitals, will compare how well these two solutions can protect the hearts of children undergoing open heart surgery. If the study reveals significant differences between the two solutions, a larger clinical trial would ultimately be this important research could make heart surgery even safer for children.

“The BHF can only fund vital research like this with the generous support of the public, advancing our mission to beat grief forever.”

Nine-year-old Alfie Donnelly from Erdington was born with various complex congenital heart conditions and had to undergo three open heart operations at Birmingham Children’s Hospital.

Mum Claire Donnelly, 43, said: “When Alfie was a newborn baby we noticed he didn’t feed well, was cold all the time and didn’t cry. We had a hard time waking him up a morning and he was making a groan when he breathed, so I called the hospital who told us to bring him.

“Alfie got so ill he was put on life support. After several tests and scans, we were told that Alfie’s heart disease was rare and complex and that he needed open heart surgery. . We were also told that if a procedure took place in advance, it was unlikely that he would survive past his first birthday. The whole situation seemed so bizarre to me, I remember feeling frozen in place.

“Alfie was only a week old when he had his first surgery, and he was a bit of a fighter. Since then, he has had two more open heart surgeries, including replacing the damaged valve in his heart with one. donor.

“Alfie’s recovery from the surgery was slow and he had other complications. After his first and second surgery, Alfie had a build-up of fluid in his lungs, which required several chest drains. made him spend more time in the hospital.

“With what Alfie went through, it made us a strong family and we all enjoy life even more. For us as a family, the research that BHF funds gives us hope that children and babies with congenital heart disease, like Alfie, are not forgotten. It takes a lot more to educate children about heart defects. ”

Children with heart disease abandoned by lack of clinical trials, study finds

Provided by the University of Birmingham

Quote: New clinical trial to improve recovery in children undergoing heart surgery (2021, December 13) retrieved December 14, 2021 from heart.html

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