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Information for Patients
Outpatient Services and Inpatient Units: (302) 651-6660
After 5 p.m. and Weekends:
Cardiac Intensive Care Unit: (302) 651-6644
General Inpatient Unit, 2B: (302) 651-6690
+1 (302) 651-4993
Excellence in Pediatric Heart Surgery
At the Nemours Cardiac Center we understand how overwhelming it may be to find out your child needs heart surgery. You can rest assured that our heart surgery team is one of the best in the country. At the Nemours Cardiac Center in the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del. (named among the best children’s hospitals in the country by U.S. News & World Report for pediatric cardiology and pediatric heart surgery), our heart surgeons are at the forefront of pediatric heart surgery, contributing to ongoing advances in the field.
As national leaders in pediatric heart care, the pediatric heart surgeons at the Nemours Cardiac Center have the experience, skills and advanced technology required to provide swift diagnosis and repair in children of all ages with heart disease. Specializing in complex congenital (present at birth) heart disease (often called “congenital heart defects”), we offer first-class pediatric heart surgery as well as minimally invasive surgical approaches and hybrid techniques (combining traditional surgery with interventional catheterization techniques).
Reconstructive pediatric heart surgery is often the best option for most forms of congenital heart disease and many heart problems that develop later in childhood (called “acquired heart disease”). We perform pediatric heart surgery in our Nemours Cardiac Center’s state-of-the-art surgical suite (used exclusively for children with heart problems) to repair and reorganize abnormal structures in the heart so that the heart muscle isn’t overburdened.
At the Nemours Cardiac Center, our outcomes and quality measures are among the best in the nation, giving babies and children with heart conditions the very best chance at life.
It’s often the tiniest hearts that need the most help from the start. That’s why our Nemours Cardiac Center experts specialize in early detection and repair of congenital heart defects, from the most straightforward to the most complicated. In fact, most of our surgical patients are newborns or infants — 2 out of 3 of the children we treat are less than a year old. We can correct many heart problems with a single operation in early infancy. More complex abnormalities may require a series of two or three operations.
Early repair of structural heart defect avoids years of often-damaging abnormal circulation and allows the heart to function normally again as quickly as possible. Whenever possible, our pediatric heart surgeons repair heart abnormalities in children when they’re very young, which allows the newly constructed regions of the heart and blood vessels to grow as the child grows. This approach, along with combined catheter and surgical procedures, allows us to minimize the number of pediatric heart surgeries — and gives young children the very best chance of leading a long, fulfilling life.
Fetal Diagnosis & Repair After Birth
In coordination with the Nemours Partners for Perinatal Management, the Nemours Cardiac Center’s fetal cardiology team works with expectant parents to diagnose heart conditions in babies before they’re even born.
If you’re pregnant and your obstetrician and/or perinatologist (a doctor who specializes in high-risk pregnancies) suspects your baby may have a heart defect, we’ll perform a fetal echocardiogram (or fetal “echo”). This in-depth cardiac ultrasound study allows us to view the structure, function and rhythm of your baby’s heart while still in the womb — as early as the 18th week of pregnancy.
If we detect a defect, we’ll then help you understand your baby’s condition and refer you to our pediatric cardiologists and pediatric heart surgeons, who can start making plans for how to treat the problem once your baby’s born. That way, you’ll be prepared and know what to expect if your baby needs pediatric heart surgery after the birth.
The Nemours Cardiac Center features its own operating room (OR), used exclusively for pediatric heart surgery and staffed with a highly skilled team that specializes in the care of children with heart problems.
To provide top-rate pediatric heart surgery for children and their families before, during and after any heart operation, our board-certified pediatric cardiologists, cardiothoracic surgeons (who specialize in operating on children’s hearts and chests), cardiac anesthesiologists and critical care physicians lead a comprehensive team of:
- advanced practice nurses (APNs)
- physician assistants (PAs)
- nurses (operating room, cardiac intensive care unit and inpatient unit nurses)
- respiratory therapists (who evaluate and treat breathing problems associated with pediatric heart disease)
- sonographers (who performs echocardiograms — ultrasounds of the heart)
- dietitians (nutritionists)
- physical and occupational therapists
- social workers
- Child Life specialists and more
Our pediatric heart surgery care team is comprehensive (and large), so it might feel a little overwhelming trying to figure out who’s who and who does what.
The Nemours Cardiac Center is designed so that all inpatient care areas — including cardiac operating suites — are in close proximity and used exclusively for cardiac patients.
This arrangement allows for:
- smooth transfers of patients from one care area to another
- instantaneous communication between care teams
- rapid coordination and collaboration of care
- easy navigation by families who are rooming in (staying overnight)
The layout of the Cardiac Center is key to providing family-centered care. The space allows our caregivers and families to have constant access to each other and to easily communicate with each other throughout children’s care. Family members and caregivers spend a lot of time together in the Cardiac Center, and our patients and families often tell us how our nurses, doctors and other staff quickly became like family to them.
Our board-certified surgeons have expertise and experience in all aspects of pediatric heart surgery (particularly related to complex congenital heart disease) including:
- neonatal surgery (operations on newborns)
- single-ventricle palliation (treatment of the heart in babies born with one working ventricle instead of two; includes defects like hypoplastic left heart syndrome — when the left side of the heart is underdeveloped)
- surgical treatment of heart failure including heart transplantation, mechanical circulatory support (artificial pumps to replace the function of a failing heart) and extracorporeal life support (“ECMO”)
- heart valve repair and replacement
- aortic surgery (of the large blood vessel coming from the heart)
- thoracic surgery (chest surgery)
The procedures we have particular expertise with include:
- stage 1 Norwood procedure
- pulmonary artery banding
- systemic-pulmonary shunt (modified Blalock-Taussig shunt)
- bidirectional Glenn and hemi-Fontan procedures (superior cavopulmonary connection)
- Fontan procedure
- arterial switch operation
- hybrid Norwood procedure
- ventricular septal defect (VSD) closure
- atrial septal defect (ASD) closure
- atrioventricular (AV) canal (also called “AV septal defect”) repair
- tetralogy of Fallot repair
- pulmonary valve repair and replacement (See Pulmonary Regurgitation and Pulmonary Stenosis)
- patent ductus arteriosus (PDA) ligation
- Ross procedure and aortic valve repair or replacement
- valve-sparing aortic root replacement (also called the “David procedure”)
- aortic coarctation repair
The Nemours Cardiac Center was designed, from the beginning, to focus on the care of children with heart disease. That singular focus by everyone within the Cardiac Center is evident in both our outcomes and in the satisfaction of our patients and their families. We take great pride in our results and the comprehensive, dedicated cardiac care we offer.
The Nemours Cardiac Center has been an active participant in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (CHSD) since 2005, and ranks among the best institutions for risk-adjusted outcomes (where the results account for the complexity of the child’s condition, the operative procedure, and other complicating factors).
Some of what makes our pediatric heart surgery care the best it can be is our:
- dedicated team of pediatric cardiac specialists (surgeons, cardiologists, anesthesiologists, intensive care doctors, nurses, etc.) — all focused on and specializing in taking care of children with heart disease. This specialization results in excellent outcomes across the spectrum of pediatric cardiac disease.
- expertise and specialization in the repair of complex heart defects. We take on more medium- to high-risk patients than the national average (40 percent here versus the STS national average of 34 percent).
- high survival rate (and low mortality, or death rate) in common but complex procedures. In most risk categories (including the highest), our operative mortality is equivalent to or lower (better) than the STS benchmark.
- higher survival rate (lower mortality) for heart surgery in newborns — 95.2 percent survival (or 4.8 percent mortality) at the Nemours Cardiac Center, versus 94.1 percent (or 5.9 percent mortality) for the national expected rate based on risk-adjustment from the STS Congenital Heart Surgery Database (that is, looking at a baby’s age and birth weight).
- cardiac anesthesiologists, who provide all of the anesthesia care and work only in the Nemours Cardiac Center, which limits anesthesia-related complications — we have 1.5 percent here at the Cardiac Center, versus 2.5 percent nationwide.
Our Nemours Cardiac Center team provides first-class open-heart surgery, as well as advanced nonsurgical approaches like cardiac catheterization (when a thin plastic, flexible tube, called a “catheter,” is inserted into a blood vessel in the leg that leads to the heart). In some complex cases, members of our team work together to perform both heart surgery and interventional catheterization procedures in the same setting. This kind of combined treatment option is typically called a “hybrid procedure.”
Whenever possible, surgeons at the Nemours Cardiac Center use alternative approaches to minimize the invasiveness of procedures. For example, we may close atrial septal defects (ASDs) through a limited incision dividing only the lower half of the sternum (or breastbone). Or we may perform surgery on the lungs or other structures in the chest with a camera through incisions only a few millimeters long. Through these techniques, we’re improving the outlook for scores of children with less discomfort, faster recovery time and shorter hospital stays.
Appropriate anesthesia care is critical for infants and children undergoing pediatric heart surgery. The Nemours Cardiac Center has its own team of anesthesiologists with the experience and skills required to care for children with heart problems, from the minor to the very complex.
Because the anesthesiologists at the Nemours Cardiac Center work only with heart patients in the Cardiac Center and often care for patients more than once, we get to know your child and your family — and we’re able to determine which medications and strategies work best for your child’s individual needs. We find that parents are often reassured to see a trusted familiar face as their child makes a trip to the operating room or catheterization and electrophysiology suite.
What You Can Expect
Anesthesia care begins prior to the procedure when you meet your child’s anesthesiologist, who will prescribe an oral medication to relax your child and ease his or her separation from you into the operating room. Most children receive anesthesia by a mask rather than an IV (a small tube inserted in a vein), so needles can be avoided until your child is under anesthesia. Soon after reaching the operating room, your child will then get further sedation or general anesthesia, which makes for an anxiety- and pain-free experience during the procedure.
In the operating room, we give modern anesthetic medications that provide a safe and smooth transition to pain control after the procedure. When it’s appropriate, we use epidural medications (given as an injection in the lower back) to ease pain after pediatric heart surgery.
Children with heart abnormalities are, after all, regular kids who may need regular kid procedures such as ear tubes and tonsillectomies, hernia repairs, eye surgery, treatment for broken bones, MRI tests, etc. The Nemours Cardiac Center anesthesiologists are available to provide anesthesia or sedation for these procedures, using their knowledge and experience to provide the special care that children with heart conditions need. Our “surgical home” program allows the child’s parent, surgeon or other specialist doctor to contact our cardiac anesthesia scheduler who will take it from there, coordinating:
- the day and time of surgery
- preprocedure testing
- admission for the day of the procedure
- a plan for recovery and discharge
All of the before- and after-procedure care takes place within the Nemours Cardiac Center by the cardiac center nurses, therapists, nurse practitioners and physician assistants who are experts with cardiac patients and, in many cases, are familiar faces to the child and family.
Infants and children who undergo pediatric heart surgery usually spend their first night after the operation in the cardiac intensive care unit (or the “CICU”). There may also be other times when the function of the heart, lungs or kidneys are significantly impaired and your child will need to stay in the CICU. Children with complicated problems may stay there for extended periods of time.
In the CICU, we’ll closely and continuously watch your child and give medication for pain and sedation. Our doctors, nurses, respiratory therapists, pharmacists and other health professionals are equipped with sophisticated technology to monitor your child and adjust treatment on a moment-to-moment basis.
Our Nemours Cardiac Center team works together to provide expert, comprehensive care for children with heart failure. While initial management of children with heart failure focuses on diagnosis and medications, some patients may require surgical therapy. At the Nemours Cardiac Center, we have a comprehensive heart failure program.
This program includes a team of experts and range of treatment options, including mechanical circulatory support (providing assistive devices for newborns, babies and children who require “artificial” heart support while waiting for a heart transplant or for their own heart problems to improve). Available devices include extracorporeal membrane oxygenation (or “ECMO”) and ventricular assist devices (or “VADs”). The Nemours Cardiac Center team identifies the best treatment strategy for each patient.
When children can’t be treated successfully with medication or surgical repair, a heart transplant may be the best option. This requires a long-term commitment from the family and the medical care team. At the Nemours Cardiac Center, we have the resources to support transplant recipients in the short- and long-term. In fact, we were the very first to perform a heart transplant in the state of Delaware.
Our kid-friendly outpatient office at duPont Hospital for Children will serve as your home base for your child’s heart care needs. In our heart center’s Outpatient Services area, we see babies, kids, teens and expectant mothers (of unborn babies with possible congenital heart defects) for:
- diagnosis and testing
- preoperative (before surgery) appointments
- postoperative (after surgery) follow-ups
Care in Your Community
In addition to our outpatient clinic at duPont Hospital for Children, our pediatric cardiologists from the Nemours Cardiac Center go to Nemours duPont Pediatrics offices throughout Delaware, Pennsylvania and New Jersey. All of our satellite locations offer follow-ups for children with known pediatric heart problems and for kids who’ve had pediatric heart surgery or heart catheterization at the Nemours Cardiac Center.
Cardiac evaluations and outpatient care from our Cardiac Center experts also are available at offices throughout the Delaware Valley — offering heart center care that’s convenient for you. We also collaborate with many of the region’s hospitals and health systems to take our pediatric heart center skills and expertise to a greater number of children throughout our community — making it easier for families who need our help to get the top-notch pediatric cardiology care they need.
Whether your child needs to stay a short time or longer after pediatric heart surgery, families often appreciate our convenient location and beautiful grounds. We’re located in a serene, park-like setting of huge oaks and inviting green lawns.
You’ll also find:
- free parking
- little red wagons (available for escorting young children)
- kid-friendly waiting areas
- café and cafeteria
- on-site pharmacy
- Child Life Activity Center
- Family Resource Center (with private sleeping rooms, a library, showers, kitchenette, laundry room and business center)
Building a Healthier Future for Children
Our newly expanded hospital — opened in November 2014 — creates an environment to promote physical, emotional and spiritual healing. The Nemours Cardiac Center’s inpatient and outpatient facilities will remain in the existing hospital building, but you can visit the Expansion for the brand new Sodexo Dining Area, Abessinio Gift Shop and to enjoy our impressive, colorful, state-of-the art space, with offerings such as the five-story Anthony N. Fusco Sr. Atrium, interactive Discovery Zone Presented by DuPont and rooftop Healing Garden.
Throughout your family’s pediatric heart surgery experience, know that at the Nemours Cardiac Center we do whatever it takes to give your child the very best, most comprehensive and compassionate care possible. We’ll be there to help your family every step of the way, treating your child as we would our own.
Prepare Your Child for Heart Surgery and Anesthesia
If your child needs heart surgery, you probably have lots of questions. Get detailed information about your preoperative appointment and what will happen in the operating room at the Nemours Cardiac Center. Find Out What to Expect »
Also, check out these articles from Nemours’ experts at KidsHealth.org to help ease some of your concerns and answer some of your questions:
- Anesthesia Basics
- Anesthesia: Preparing Your Child
- Anesthesia Types
- Anesthesia: What to Expect
- Preparing Your Child for Surgery
- What Happens in the Operating Room? (an article for kids)
- What Is Minimally Invasive Surgery?
- When Your Child Needs a Heart Transplant
Get a Peek at the Nemours Cardiac Center
Catch a glimpse at the outpatient and inpatient spaces at Nemours Cardiac Center — and see some of the physicians and care team members you’ll meet along the way. Watch Video »
Have Questions About Anesthesia?
Dr. Ellen Spurrier, a pediatric anesthesiologist who works exclusively with heart patients at the Nemours Cardiac Center, talks about anesthesia during heart surgery. Watch Video »