Biography:

In the past Michael C. Mongé has collaborated on articles with Paul J. Devlin and Carl L. Backer. One of their most recent publications is Original articleCongenital heart surgeryRepair of Partial Atrioventricular Septal Defect: Age and Outcomes. Which was published in journal The Annals of Thoracic Surgery.

More information about Michael C. Mongé research including statistics on their citations can be found on their Copernicus Academic profile page.

Michael C. Mongé's Articles: (4)

Original articleCongenital heart surgeryRepair of Partial Atrioventricular Septal Defect: Age and Outcomes

BackgroundWe evaluated the outcomes of patients undergoing surgical repair of partial atrioventricular septal defect (AVSD) and analyzed the effect of age on outcome.MethodsIn this single-center retrospective study, we included all children who underwent repair of partial AVSD between 1990 and 2014. We divided the patients into 4 age quartiles (first quartile: 0–0.75 years, n = 22; second quartile: 0.75–1.5 years, n = 21; third quartile: 1.5–3.75 years, n = 22; and fourth quartile: >3.75 years, n = 21). These quartiles were evaluated for their association with the time-to-event outcomes of survival, freedom from left atrioventricular valve regurgitation (LAVVR), and freedom from reoperation using log-rank analysis.ResultsDuring the study period, 86 patients underwent partial AVSD repair at a median age of 1.5 years. There were no operative deaths and 2 late deaths (unknown cause and trauma). There were 13 reoperations. The most common cause of reoperation was left ventricular outflow tract obstruction (LVOTO) (5 patients [first quartile, 2 cases; second quartile, 1 case; third quartile, 2 cases, and fourth quartile, 0 cases]). LAVV reoperation for insufficiency or stenosis was performed in 4 patients (first quartile, 1 case; second quartile, 1 case; third quartile, 1 case; and fourth quartile, 1 case). Two patients underwent pacemaker placement (second quartile, 1 case and fourth quartile, 1 case). There were no statistically significant differences in the most common complications—LVOTO, LAVVR, and AV heart block—between the 4 age quartiles. Median follow-up was 7.1 years (interquartile range [IQR], 0.8–11.4 years). On echocardiography, 72 patients (84%) had less than or equal to mild LAVVR, 8 (9%) patients had mild to moderate LAVVR, 5 (6%) patients had moderate LAVVR, and 1 (1%) patient had severe LAVVR. Age at repair had no significant association with degree of late AV valve insufficiency.ConclusionsResults of partial AVSD repair at a median age of 1.5 years are excellent. Operating at this age is not associated with increased mortality, reoperation, or LAVVR.

Original articleCongenital heart surgeryNovel Modifications of a Ventricular Assist Device for Infants and Children

BackgroundA continuous-flow “adult” ventricular assist device (VAD) was modified to support infants and children waiting for heart transplantation.MethodsA centrifugal VAD, designed to flow at 1.5 to 8 L/min, was used as a bridge to transplantation in pediatric patients. In smaller children and infants, a modified recirculation shunt permitted lower flow ranges. In hypoxic patients, an oxygenator was spliced into the circuit.ResultsFrom 2010 to 2015, the VAD was placed in 13 consecutive patients. Age ranged from 0.9 to 16 years (median, 7 years). Body surface area (BSA) ranged from 0.4 to 2.1 m2 (median, 0.8 m2). Ten patients had a BSA less than 1.0 m2. Four patients were receiving extracorporeal membrane oxygenation (ECMO) before VAD. Three patients had single-ventricle physiology. Five patients had a recirculation shunt and 3 underwent insertion of an oxygenator. Median time on the VAD was 20 days (range, 2–140 days). In patients with a recirculation shunt, mean patient flow was 1.5 L/min (mean flow/BSA, 2.7 L/min/m2), with mean total VAD flow of 3.4 L/min. Twelve patients underwent transplantation, and 1 patient underwent VAD explantation. All patients survived and were discharged at a median of 26 days (range, 17–83 days) after transplantation. Three patients experienced major bleeding events. There were 2 cerebrovascular accidents. VAD mortality dropped from 33% (3 of 9) during 2007 to 2010 to 0% (0 of 13) between 2011 and 2015 (p = 0.05). Wait-list mortality dropped from 10% (5 of 52) to 4% (4 of 91) for these periods (p = 0.29).ConclusionsThe centrifugal VAD successfully supported pediatric patients awaiting heart transplantation. The modified recirculation shunt facilitated the successful support of patients in whom optimal flows were substantially lower than those recommended by the manufacturer. The design allows placement of an in-line oxygenator. Compared with pulsatile devices, use of this VAD was associated with a trend toward decreased mortality associated with VAD use.

Original articleCongenital heart surgeryDouble Aortic Arch With Kommerell Diverticulum

BackgroundVascular rings with a Kommerell diverticulum (KD) most commonly occur in patients with a right aortic arch. We report on a less commonly seen subset of vascular ring patients—those with a double aortic arch and a KD.MethodsBetween 2002 and 2017, 66 patients underwent an operation for a double aortic arch. Ten of those patients also had excision of a KD. We performed a retrospective medical record review of these patients to characterize their demographics and outcomes.ResultsAll 10 patients (7 male, 3 female) had a double aortic arch that was right dominant and also had a KD. The patients were a mean age of 4.9 ± 4.3 years (range, 6 months to 29 years), and median age was 4 years. All patients had preoperative computed tomographic angiography or magnetic resonance imaging and mean compression of the distal trachea of 63% ± 12% (range, 40% to 80%). The distal left arch was atretic in all patients. All patients underwent division of their left aortic arch, division of the ligamentum, and resection of the KD. The left subclavian artery was transferred to the left carotid artery in 2 patients. The mean size of the diverticulum was 9 × 10 mm. There were no major postoperative complications or readmissions. The postoperative length of stay was 3.1 ± 0.8 days. Five of the patients reported no related persisting symptoms. The remaining 5 patients reported substantial symptomatic relief with only minor respiratory symptoms.ConclusionsVascular ring patients with a double aortic arch can also have a KD. In addition to dividing the smaller aortic arch and the ligamentum, we recommend excision of the KD.

No Ventricular Septal Defect Patch Atrioventricular Septal Defect Repair

For the past 10 years, our center has used the no ventricular septal defect patch atrioventricular septal defect repair proposed independently by Wilcox and Nicholson. The technique emphasizes direct closure of the ventricular element of the defect and a pericardial patch for the atrial component. A particular advantage of the operation is that it lends itself to repair in the smaller infant, which allows operative repair at 3-4 months of age, decreasing the risk of perioperative problems with pulmonary hypertension. The result of this strategy at multiple centers is a very low operative mortality, a low incidence of left atrioventricular valve reoperation, and an extremely low incidence of need for a pacemaker.

Advertisement
Join Copernicus Academic and get access to over 12 million papers authored by 7+ million academics.
Join for free!

Contact us