ABSTRACT Introduction: The coronavirus disease 2019 (COVID-19) pandemic has required changes in the management of pediatric cardiac surgery. We would like to share the patient treatment and surgical management strategies employed in our Pediatric Cardiovascular Surgery Clinic during the COVID-19 pandemic. Methods: A total of 112 patients were followed up in our clinic between 11.03.2020 and 02.07.2020. Their mean age was 1,118 (4-5,740) days. Management and treatment were performed by our pediatric heart team (pediatric cardiac anesthetists, general pediatricians, pediatric cardiologists, pediatric cardiac surgeons, and an infectious diseases specialist). We prepared new protocols and a surveillance system specific to the pandemic to prevent in-hospital transmission and reduce postoperative mortality and morbidity; our operations were performed according to these protocols. All decisions pertaining to the operation timing and treatment strategy of our COVID-19-positive patients were made by the same team. Results: During the study period, a total of 112 patients, 69 boys and 43 girls, were hospitalized in our clinic. A total of 333 COVID-19 real-time polymerase chain reaction tests were performed on patients and accompanying persons; positive results were found in three patients and two accompanying individuals. Conclusion: By employing new protocols and a surveillance system throughout the healthcare system, we think that early diagnosis and treatment of the pediatric congenital heart disease population, which is susceptible to infections, can continue unperturbed. This and similar approaches can increase postoperative success and prevent transmission in the pediatric population - which are frequently COVID-19 asymptomatic. Introduction 201 COVID19 COVID 19 (COVID-19 surgery COVID-1 Methods 11 11032020 03 2020 11.03.202 02072020 02 07 02.07.2020 1118 1 118 1,11 45,740 45740 4 5,740 5 740 (4-5,740 days anesthetists pediatricians cardiologists surgeons specialist. specialist . specialist) inhospital hospital morbidity COVID19positive COVIDpositive Results period 6 girls 33 realtime real time persons individuals Conclusion infections unperturbed asymptomatic 20 COVID1 (COVID-1 COVID- 1103202 0 202 11.03.20 0207202 02.07.202 111 1,1 45 45,74 4574 5740 5,74 74 (4-5,74 3 2 (COVID- 110320 11.03.2 020720 02.07.20 1, 45,7 457 574 5,7 7 (4-5,7 (COVID 11032 11.03. 02072 02.07.2 45, 57 5, (4-5, 1103 11.03 0207 02.07. (4-5 110 11.0 020 02.07 (4- 11. 02.0 (4 02. (

Resumen Objetivo: Las prácticas multidisciplinarias de manejo de la sangre del paciente reducen los costos de los productos sanguíneos y las complicaciones relacionadas con las transfusiones en los hospitales. Los costos hospitalarios son altos en pacientes pediátricos de cirugía cardíaca porque generalmente se necesitan niveles altos de hematocrito; la necesidad de hemoderivados es alta debido a los procedimientos quirúrgicos largos y complejos; la estancia en la unidad de cuidados intensivos (UCI) es larga y el uso de modalidades de tratamiento como la diálisis y la ECMO es común en esta población de pacientes. Métodos: En este estudio retrospectivo; Investigamos los efectos del uso de los protocolos multidisciplinarios de manejo sanguíneo del paciente sobre el uso de hemoderivados y los costos asociados comparando los resultados del protocolo implementado en el año 2019 con el uso de hemoderivados y los costos del año anterior. En nuestra clínica se operaron 414 pacientes en 2019; 230 de ellos eran varones y 184 mujeres. Resultados: Las transfusiones realizadas en cumplimiento de dichos protocolos han reducido las tasas de mortalidad junto con una disminución de los costos hospitalarios. Conclusiones: Nosotros también logramos una reducción del 10% en los costos de los productos sanguíneos por paciente después de la implementación del protocolo multidisciplinario de manejo de sangre del paciente.

Abstract Objective: Multidisciplinary patient blood management practices reduce costs of blood products and transfusion-related complications in hospitals. Hospital costs are high in pediatric cardiac surgery patients because high hematocrit levels are usually needed; the need for blood products is high due to complex and long surgical procedures; the length of stay in the intensive care unit (ICU) is long, and the use of treatment modalities such as dialysis and ECMO is common in this patient population. Methods: In this retrospective study, we investigated the effects of the use of the multidisciplinary patient blood management protocols on the use of blood products and associated costs by comparing the outcomes of the protocol implemented in the year 2019 to the blood product use and costs of the previous year. In our clinic, 414 patients were operated on in 2019; 230 of them were males and 184 of them were females. Results: Transfusions carried out in adherence to such protocols have reduced mortality rates along with a decline in hospital costs. Conclusions: We, too, achieved a 10% reduction in blood product costs per patient after the implementation of the multidisciplinary patient blood management protocol.

Abstract Arteriovenous fistula due to coronary angiography intervention is rarely seen. Arteriovenous fistulas may be asymptomatic according to the size of the shunt, as well as to the heart failure. In this case report, we aimed to share gradual transition from endovascular methods to surgery and why surgical treatment is required for a patient who developed arteriovenous fistula after coronary angiography.