In the speaker's experience with type D ECMO patients receiving fundoplication, no subsequent surgery for reflux has been needed, representing definitive repair of both CDH and fundoplication
Prolonged operative time required for thoracoscopic repair in babies requiring inotropes or special ventilation (increasing CO2, decreasing pH) is not good for the patient
quoteWe don't have fetal treatment for this patient right now.↗
▶Ep 24 · 3:02
clinicalNot all centers in the European FETO trials used ECMO, which may affect the apparent benefit of FETO↗
▶Ep 24 · 3:02
epidemiologicalCenters with high CDH volume doing ECMO achieve survival of almost 50% or more in severe CDH↗
▶Ep 24 · 3:02
quoteI am not agree with that since you review the number of the center with a great number of babies with CDH that are doing ECMO, the survival of this patient is almost 50 or more%. So I don't know if when you read the total trial, not all the centers in Europe use ECMO.↗
▶Ep 24 · 4:11
clinicalIn Europe, some maternal-fetal medicine centers perform FETO but then transfer patients to other centers for delivery and neonatal care↗
▶Ep 24 · 5:18
clinicalA protocol of very early repair (8-10 hours after ECMO cannulation at 6-8 hours of life) has been implemented, though the speaker's feeling is it may not be doing better↗
▶Ep 24 · 7:04
clinicalAt least 4 reports confirm the data favoring early on-ECMO repair, representing a practice change↗
▶Ep 24 · 7:49
clinicalMost commonly open approach is used; thoracoscopy is reserved for babies who don't need oxygen in the NICU, and conversion to open occurs if a patch is needed↗
▶Ep 24 · 9:04
opinionProlonged operative time required for thoracoscopic repair in babies requiring inotropes or special ventilation (increasing CO2, decreasing pH) is not good for the patient↗
▶Ep 24 · 10:43
clinicalChoice between muscle flap and mesh depends on the defect characteristics; mesh is usually used, but flap is chosen if there is good lift of diaphragm posteriorly↗
▶Ep 24 · 14:32
clinicalSkeletal deformity is part of the CDH disease itself, making it unclear whether chest deformity is due to the patch or the underlying condition↗
▶Ep 24 · 14:32
clinicalSynthetic patches pulling on ribs causing chest deformity makes sense in type A-D defects, but these defects are very rare↗
▶Ep 24 · 15:19
clinicalFundoplication is performed in type D defect patients who are on ECMO↗
▶Ep 24 · 16:21
clinicalIn the speaker's experience with type D ECMO patients receiving fundoplication, no subsequent surgery for reflux has been needed, representing definitive repair of both CDH and fundoplication↗
▶Ep 24 · 16:21
quoteI got the result different what what the studies say in those babies that I have done the fund duplication. I haven't done another surgery for that. So, it's been a definitive repair both from the CDH and the fund obligation.↗
