DEPARTMENT OF EMERGENCY SURGERY IN PREMATURE NEWBORNS AND INFANTS (UP TO 1 Y.O.) WITH CHD (ESN)

Department of emergency surgery in premature newborns and infants (up to 1 y.o.) with CHD (ESN) was founded in December 1980 at the initiative and direct participation of Academician V.I. Burakovsky. It was the first and for many years, the only one in the country specialized medical department delivering emergency care to newborns with CHD. Since its foundation, department’s staff have mastered and constantly improved methods of repair of all currently known CHD.

The main direction of department’s clinical work remains the development of diagnostic patterns and improvement of surgical methods of CHD repair in early neonatal period aiming at better repair outcomes, better postoperative nursing care and better quality of life in the long-term postoperative period.

Unique operations and large series of repair interventions were performed in the ESN department under cardiopulmonary bypass, including in newborns for the first time in the country (for more information, see the section "More details about the department").
In recent years, there has been a sharp increase in the number of open valve-sparing operations in children of all ages, both in isolation and in combination with various comorbidities. There has also been observed an extension in indications for primary total interventions in a number of CHD, which were previously treated in a multi-stage manner. Particular attention is paid to the treatment of extremely complex CHD, when indicated hemodynamic correction with Norwood operations and Damus-Kay-Stensel techniques. At the same time, significant progress has been made in performing interventions, including those under cardiopulmonary bypass, in children with initially low body weight. Classical methods of surgical treatment of other, more common CHD, are also being improved in order to reduce trauma, avoid unnecessary surgical impact on the myocardium of the heart, and increase freedom from the risk of future reoperations. With some “reference” interventions, the risk of serious complications has been reduced to almost zero. Under standard situations, it can be stated that there is no risk of fatal complications. The observed results of surgical treatment, based on an integrated approach of various specialists, show a steady positive trend.
Cardiovascular surgeons of the department developed and performed the following types of operations:

• the first in the clinic Ozaki procedure in a child (together with the Department of surgery of older children with CHD, head- Acad. V.P. Podzolkov), А.Е. Chernogrivov, 2021
• three-patch repair of supravalvular aortic stenosis with the use of Brom’s technique in an infant, А.Е. Chernogrivov, 2021
• operation of elimination of the aorto-pulmonary septum defect in combination with agenesis of the pulmonary valve with the pulmonary valve cusps replacement, А.Е. Chernogrivov, 2022
• the first in the clinic Nikaidoh procedure in the modification of Ross-Konno-Jatene with the creation of an outlet to the pulmonary artery with a homograft, А.Е.Chernogrivov, 2022
• the first operation to eliminate an extended interrupted aortic arch with the pulmonary artery trunk self-tissues, А.Е. Chernogrivov, 2022
• the first operation to eliminate an extended interrupted aortic arch in a combined way (using the pulmonary artery trunk self-tissues and a homograft), А.Е. Chernogrivov, 2022, first in the world
• complete reconstruction of the pulmonary valve with neo-tricuspidization by self-tissues during the primary total correction of tetralogy of Fallot in infancy, А.Е. Chernogrivov, 2022
• the first procedure of one-stage total plasty of mitral and tricuspid insufficiency with the elimination of severe subaortic obstruction and the expansion of a restrictive non-committed ventricular septal defect in case of double outlet right ventricle, А.Е. Chernogrivov, 2022
• simultaneous total repair of the common arterial trunk and interrupted aortic arch after the hybrid stage, performed using two conduits in an infant, А.Е. Chernogrivov, 2022
• the first in the clinic, reconstruction of the aortic arch with homograft tissues under cardiopulmonary bypass in case of its critical obstruction in a newborn with a right-side arch in combination with a vascular ring and Kommerell diverticulum, А.Е. Chernogrivov, 2022
• the first in the clinic, mitral valve replacement with a specially made homograft in an infant, А.Е. Chernogrivov, 2022
• the first operation of simultaneous plasty with extended posterior leaflet augmentation in case of total mitral insufficiency with open aortic valve valvuloplasty for critical stenosis in a newborn infant, А.Е. Chernogrivov, 2023
• total repair of multiple ventricular septal defects of the "Swiss cheese" type in an infant, А.Е.Chernogrivov, 2023
• the first operation of simultaneous plasty for total mitral insufficiency with aortic root expansion and aortic valve leaflet replacement for critical stenosis in an infant, А.Е.Chernogrivov, 2023
• the first modified Norwood operation using a Necker homograft after a hybrid stage with heart and visceral inversion, А.Е. Chernogrivov, 2023

During the reporting year, 360 operations were performed in the department. More than 60% of interventions out of this number were performed in the neonatal period, mainly in patients of 3-5 risk groups according to STAT (out of five possible, where the fifth group is the most difficult with the highest risk of adverse outcome). At the same time, mortality in the department does not exceed the average world statistics.

The department consists of 11 wards with 15 neonatal and pediatric beds.
Patients are admitted 24/7. You can get to the department for treatment from any region of Russia as well as neighboring countries and beyond. The department has created all the conditions for the joint stay of children and parents (subject to the availability of all necessary tests from the parents).