JULY - 20238In My OpinionPediatric cardiac surgery (PCS) is one of the most specialized domains in the cardiovascular field and has benefited from numerous biotechnological innovations since its emergence in the 1950's. Most PCS programs were founded decades ago, but our experience shows there is still a need for the creation of new programs in selected areas, even in Western countries. A PCS program was not present at our institution until October 2020, despite being the leading university hospital in a region of 6 million inhabitants.Founding the PCS program was an exciting and incredibly challenging task, the priority being to build a dedicated multidisciplinary team of specialists working towards the same goal. The technical aspect, ensuring availability of the right precision equipment such as cardiopulmonary bypass machines, surgical instruments and implantable medical devices, was also crucial to the success of the program.Specificities of the discipline include the need for multiple reoperations in some children born with congenital heart diseases (e.g. single ventricles and tetralogy of Fallot). Furthermore, reoperations are almost systematic after the implantation of prosthetic valves as a result of patient growth. PCS is also characterized by a broad variety of practice and the persistent lack of strong evidence in favor of one device versus another in a determined category. Therefore, the choice of implantable medical device remains at the discretion of the surgeon.Alongside the usual set of sutures, clips, cannulas and drains, a PCS unit needs to be equipped with specific implantable devices:Patches: These devices are widely used given the frequency of conditions such as ventricular septal defect and tetralogy of Fallot, and the subsequent need for intracardiac defect closure. Bovine pericardium, treated with glutaraldehyde (e.g. Edwards bovine pericardial patch, Edwards Lifesciences) or not (e.g. PhotoFix®, CryoLife), represents a popular material. Alternatives consist of synthetic devices which include expanded polytetrafluoroethylene (e.g. Gore® Acuseal, W.L. Gore & Associates) and knitted polyester (e.g. Hemapatch, Getinge). Polytetrafluoroethylene felts (e.g. Bard® PTFE, Becton Dickinson) are used as pledgets to reinforce suture lines when necessary. Last but not least, PEDIATRIC CARDIAC SURGERY: HOW TO EQUIP A PROGRAM WITH IMPLANTABLE MEDICAL DEVICES IN THE CURRENT ERAJerome Soquet, MD, Associate Professor, Consultant Cardiac Surgeon, Founding Director of Pediatric Cardiac Surgery, Lille University Hospital (France)Jerome SoquetBy
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