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Opotowsky AR, Khairy P, Diller G, Kasparian NA, Brophy J, Jenkins K, Lopez KN, McCoy A, Moons P, Ollberding NJ, Rathod RH, Rychik J, Thanassoulis G, Vasan RS, Marelli A. Clinical Risk Assessment and Prediction in Congenital Heart Disease Across the Lifespan: JACC Scientific Statement. J Am Coll Cardiol 2024; 83:2092-2111. [PMID: 38777512 DOI: 10.1016/j.jacc.2024.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/12/2024] [Accepted: 02/22/2024] [Indexed: 05/25/2024]
Abstract
Congenital heart disease (CHD) comprises a range of structural anomalies, each with a unique natural history, evolving treatment strategies, and distinct long-term consequences. Current prediction models are challenged by generalizability, limited validation, and questionable application to extended follow-up periods. In this JACC Scientific Statement, we tackle the difficulty of risk measurement across the lifespan. We appraise current and future risk measurement frameworks and describe domains of risk specific to CHD. Risk of adverse outcomes varies with age, sex, genetics, era, socioeconomic status, behavior, and comorbidities as they evolve through the lifespan and across care settings. Emerging technologies and approaches promise to improve risk assessment, but there is also need for large, longitudinal, representative, prospective CHD cohorts with multidimensional data and consensus-driven methodologies to provide insight into time-varying risk. Communication of risk, particularly with patients and their families, poses a separate and equally important challenge, and best practices are reviewed.
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Affiliation(s)
- Alexander R Opotowsky
- Adult Congenital Heart Disease Program, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | - Paul Khairy
- Adult Congenital Heart Centre, Montreal Heart Institute, Montréal, Quebec, Canada
| | - Gerhard Diller
- Department of Cardiology III, University Hospital Münster, Münster, Germany
| | - Nadine A Kasparian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Heart and Mind Wellbeing Center, Cincinnati, Ohio, USA; Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - James Brophy
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Kathy Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Keila N Lopez
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital & Baylor College of Medicine, Houston, Texas, USA
| | - Alison McCoy
- Vanderbilt Clinical Informatics Core, Department of Biomedical Informatics, Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jack Rychik
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - George Thanassoulis
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | - Ramachandran S Vasan
- School of Public Health, University of Texas, San Antonio, Texas, USA; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University, Montreal, Quebec, Canada.
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2
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Dawes TJW, Woodham V, Sharkey E, McEwan A, Derrick G, Muthurangu V, Moledina S, Hepburn L. Predicting Peri-Operative Cardiorespiratory Adverse Events in Children with Idiopathic Pulmonary Arterial Hypertension Undergoing Cardiac Catheterization Using Echocardiography: A Cohort Study. Pediatr Cardiol 2024:10.1007/s00246-024-03447-3. [PMID: 38512488 DOI: 10.1007/s00246-024-03447-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/07/2024] [Indexed: 03/23/2024]
Abstract
General anesthesia in children with idiopathic pulmonary arterial hypertension (PAH) carries an increased risk of peri-operative cardiorespiratory complications though risk stratifying individual children pre-operatively remains difficult. We report the incidence and echocardiographic risk factors for adverse events in children with PAH undergoing general anesthesia for cardiac catheterization. Echocardiographic, hemodynamic, and adverse event data from consecutive PAH patients are reported. A multivariable predictive model was developed from echocardiographic variables identified by Bayesian univariable logistic regression. Model performance was reported by area under the curve for receiver operating characteristics (AUCroc) and precision/recall (AUCpr) and a pre-operative scoring system derived (0-100). Ninety-three children underwent 158 cardiac catheterizations with mean age 8.8 ± 4.6 years. Adverse events (n = 42) occurred in 15 patients (16%) during 16 catheterizations (10%) including cardiopulmonary resuscitation (n = 5, 3%), electrocardiographic changes (n = 3, 2%), significant hypotension (n = 2, 1%), stridor (n = 1, 1%), and death (n = 2, 1%). A multivariable model (age, right ventricular dysfunction, and dilatation, pulmonary and tricuspid regurgitation severity, and maximal velocity) was highly predictive of adverse events (AUCroc 0.86, 95% CI 0.75 to 1.00; AUCpr 0.68, 95% CI 0.50 to 0.91; baseline AUCpr 0.10). Pre-operative risk scores were higher in those who had a subsequent adverse event (median 47, IQR 43 to 53) than in those who did not (median 23, IQR 15 to 33). Pre-operative echocardiography informs the risk of peri-operative adverse events and may therefore be useful both for consent and multi-disciplinary care planning.
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Affiliation(s)
- Timothy J W Dawes
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK.
- UCL Institute of Cardiovascular Science, University College London, London, UK.
| | - Valentine Woodham
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK
| | - Emma Sharkey
- Department of Anaesthesia, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Angus McEwan
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK
| | - Graham Derrick
- UCL Institute of Cardiovascular Science, University College London, London, UK
- Department of Paediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Vivek Muthurangu
- UCL Institute of Cardiovascular Science, University College London, London, UK
| | - Shahin Moledina
- UCL Institute of Cardiovascular Science, University College London, London, UK
- National Paediatric Pulmonary Hypertension Service UK, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lucy Hepburn
- Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 1LE, UK
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3
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Quinn BP, Gunnelson LC, Kotin SG, Gauvreau K, Yeh MJ, Hasan B, Lozier J, Barry OM, Shahanavaz S, Batlivala SP, Salavitabar A, Foerster S, Goldstein B, Divekar A, Holzer R, Nicholson GT, O'Byrne ML, Whiteside W, Bergersen L. Catheterization for Congenital Heart Disease Adjustment for Risk Method II. Circ Cardiovasc Interv 2024; 17:e012834. [PMID: 38258562 DOI: 10.1161/circinterventions.123.012834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Current metrics used to adjust for case mix complexity in congenital cardiac catheterization are becoming outdated due to the introduction of novel procedures, innovative technologies, and expanding patient subgroups. This study aims to develop a risk adjustment methodology introducing a novel, clinically meaningful adverse event outcome and incorporating a modern understanding of risk. METHODS Data from diagnostic only and interventional cases with defined case types were collected for patients ≤18 years of age and ≥2.5 kg at all Congenital Cardiac Catheterization Project on Outcomes participating centers. The derivation data set consisted of cases performed from 2014 to 2017, and the validation data set consisted of cases performed from 2019 to 2020. Severity level 3 adverse events were stratified into 3 tiers by clinical impact (3a/b/c); the study outcome was clinically meaningful adverse events, severity level ≥3b (3bc/4/5). RESULTS The derivation data set contained 15 224 cases, and the validation data set included 9462 cases. Clinically meaningful adverse event rates were 4.5% and 4.2% in the derivation and validation cohorts, respectively. The final risk adjustment model included age <30 days, Procedural Risk in Congenital Cardiac Catheterization risk category, and hemodynamic vulnerability score (C statistic, 0.70; Hosmer-Lemeshow P value, 0.83; Brier score, 0.042). CONCLUSIONS CHARM II (Congenital Heart Disease Adjustment for Risk Method II) risk adjustment methodology allows for equitable comparison of clinically meaningful adverse events among institutions and operators with varying patient populations and case mix complexity performing pediatric cardiac catheterization.
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Affiliation(s)
- Brian P Quinn
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| | - Lauren C Gunnelson
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| | - Sarah G Kotin
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| | - Mary J Yeh
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| | - Babar Hasan
- Division of Cardio-Thoracic Sciences, Sindh Institute of Urology and Transplantation, Pakistan (B.H.)
| | - John Lozier
- Division of Pediatric Cardiology, UH Rainbow Babies and Children's Hospital, Cleveland, OH (J.L.)
| | - Oliver M Barry
- Division of Pediatric Cardiology, Columbia University Medical Center, New York Presbyterian/Morgan Stanley Children's Hospital (O.M.B.)
| | - Shabana Shahanavaz
- Cincinnati Children's Hospital-Heart Institute and Department of Pediatrics, University of Cincinnati College of Medicine, OH (S.S., S.P.B.)
| | - Sarosh P Batlivala
- Cincinnati Children's Hospital-Heart Institute and Department of Pediatrics, University of Cincinnati College of Medicine, OH (S.S., S.P.B.)
| | - Arash Salavitabar
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S.)
| | - Susan Foerster
- Division of Pediatric Cardiology, Children's Wisconsin, Milwaukee (S.F.)
| | - Bryan Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh School of Medicine, PA (B.G.)
| | - Abhay Divekar
- Division of Pediatric Cardiology, UT Southwestern Medical Center, Children's Medical Center Dallas, TX (A.D.)
| | - Ralf Holzer
- Division of Pediatric Cardiology, Department of Pediatrics, University of California Davis, Sacramento (R.H.)
| | - George T Nicholson
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville, TN (G.T.N.)
| | - Michael L O'Byrne
- Division of Cardiology, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (M.L.O.)
| | - Wendy Whiteside
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor (W.W.)
| | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
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4
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JACC Cardiovasc Interv 2024; 17:115-216. [PMID: 38099915 DOI: 10.1016/j.jcin.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California.
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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5
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Holzer RJ, Bergersen L, Thomson J, Aboulhosn J, Aggarwal V, Akagi T, Alwi M, Armstrong AK, Bacha E, Benson L, Bökenkamp R, Carminati M, Dalvi B, DiNardo J, Fagan T, Fetterly K, Ing FF, Kenny D, Kim D, Kish E, O'Byrne M, O'Donnell C, Pan X, Paolillo J, Pedra C, Peirone A, Singh HS, Søndergaard L, Hijazi ZM. PICS/AEPC/APPCS/CSANZ/SCAI/SOLACI: Expert Consensus Statement on Cardiac Catheterization for Pediatric Patients and Adults With Congenital Heart Disease. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101181. [PMID: 39131968 PMCID: PMC11307799 DOI: 10.1016/j.jscai.2023.101181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Affiliation(s)
- Ralf J Holzer
- UC Davis Children's Hospital, Sacramento, California
| | | | - John Thomson
- Johns Hopkins Children's Center, Baltimore, Maryland
| | - Jamil Aboulhosn
- UCLA Adult Congenital Heart Disease Center, Los Angeles, California
| | - Varun Aggarwal
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | | | - Mazeni Alwi
- Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Emile Bacha
- NewYork-Presbyterian Hospital, New York, New York
| | - Lee Benson
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Thomas Fagan
- Children's Hospital of Michigan, Detroit, Michigan
| | | | - Frank F Ing
- UC Davis Children's Hospital, Sacramento, California
| | | | - Dennis Kim
- Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Emily Kish
- Rainbow Babies Children's Hospital, Cleveland, Ohio
| | - Michael O'Byrne
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Xiangbin Pan
- Cardiovascular Institute, Fu Wai, Beijing, China
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6
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Hofbeck M, Arenz C, Bauer UMM, Horke A, Kerst G, Meyer R, Tengler A, Beckmann A. German Registry for Cardiac Operations and Interventions in Congenital Heart Disease: Annual Report 2022. Thorac Cardiovasc Surg 2024; 72:e16-e29. [PMID: 38914128 DOI: 10.1055/a-2350-7374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND The German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease is a voluntary registry initiated by the German Society for Thoracic and Cardiovascular Surgery and the German Society for Pediatric Cardiology and Congenital Heart Defects. Since 2012, the registry collects data for the assessment of treatment and outcomes of surgical and interventional procedures in patients with congenital heart disease (CHD) of all age groups. METHODS This real-world, prospective all-comers registry collects clinical and procedural characteristics, adverse events (AEs), mortality, and medium-term outcomes (up to 90 days) of patients undergoing surgical and interventional. A unique pseudonymous personal identifier (PID) allows longitudinal data acquisition in case of further invasive treatment in any participating German heart center. Prior to evaluation, all data sets are monitored for data completeness and integrity. Evaluation includes risk stratification of interventional and surgical procedures and classification of AEs. Each year's data are summarized in annual reports containing detailed information on the entire cohort, all subgroups, and 15 index procedures. In addition, each participating center receives an institutional benchmark report for comparison with the national results. This paper presents a comprehensive summary of the annual report 2021. RESULTS In 2021, a total of 5,439 patients were included by 22 participating centers. In total, 3,721 surgical, 3,413 interventional, and 34 hybrid procedures were performed during 6,122 hospital stays. 2,220 cases (36.3%) could be allocated to the 15 index procedures. The mean unadjusted in-hospital mortality ranged from 0.4% among interventional and 2% among surgical cases up to 6.2 % in cases with multiple procedures. In-hospital mortality among index procedures accounted for 2.3% in total cavopulmonary connection, 20.3% in Norwood procedures, and 0.4% following interventional closure of patent ductus arteriosus. For the remaining seven surgical and five interventional index procedures, no in-hospital deaths were recorded. The 10-year longitudinal evaluation of 1,795 patients after tetralogy of Fallot repair revealed repeat interventional or surgical procedures in 21% of the patients. Over the same period, 31.1% of 2,037 patients, following initial treatment of native coarctation, required at least one additional hospital admission, 39.4% after initial interventional, and 21.3% after initial surgical therapy. CONCLUSION The annual report 2021 of the German Registry for Cardiac Operations and Interventions in CHD shows continuously good results in accordance with previous data of the registry. Compared to international registries on CHD, it can be ascertained that in Germany invasive treatment of CHD is offered on a high medical level with excellent quality. The proven fact that patients with various malformations like tetralogy of Fallot and coarctation of the aorta require repeat procedures during follow-up confirms the urgent requirement for longitudinal assessment of all patients presenting with complex lesions.
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Affiliation(s)
- Michael Hofbeck
- Department of Pediatric Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Claudia Arenz
- German Pediatric Heart Center, University of Bonn, Bonn, Germany
| | | | - Alexander Horke
- Division of Surgery for Congenital Heart Defects, Department of Cardiac Surgery, University of Hannover, Hannover, Germany
| | - Gunter Kerst
- Clinic for Pediatric Cardiology and Congenital Heart Disease, Stuttgart, Germany
| | - Renate Meyer
- BQS Institute for Quality and Patient Safety, Hamburg, Germany
| | - Anja Tengler
- Division of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian University of Munich, Munich, Germany
| | - Andreas Beckmann
- Clinic for Cardiac Surgery and Pediatric Cardiac Surgery Heart Center Duisburg, Duisburg, Germany
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7
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Backer CL, Overman DM, Dearani JA, Romano JC, Tweddell JS, Kumar SR, Marino BS, Bacha EA, Jaquiss RDB, Zaidi AN, Gurvitz M, Costello JM, Pierick TA, Ravekes WJ, Reagor JA, St Louis JD, Spaeth J, Mahle WT, Shin AY, Lopez KN, Karamlou T, Welke KF, Bryant R, Husain SA, Chen JM, Kaza A, Wells WJ, Glatz AC, Cohen MI, McElhinney DB, Parra DA, Pasquali SK. Recommendations for centers performing pediatric heart surgery in the United States. J Thorac Cardiovasc Surg 2023; 166:1782-1820. [PMID: 37777958 DOI: 10.1016/j.jtcvs.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
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Affiliation(s)
- Carl L Backer
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - David M Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minn
| | | | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Mich
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - S Ram Kumar
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Emile A Bacha
- Department of Surgery, Columbia University/New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | | | - Ali N Zaidi
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, Mass
| | - John M Costello
- Department of Pediatrics, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, SC
| | - Trudy A Pierick
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - William J Ravekes
- Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Md
| | - James A Reagor
- Department of Cardiovascular Perfusion, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - James Spaeth
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - William T Mahle
- Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Andrew Y Shin
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, Calif
| | - Keila N Lopez
- Department of Pediatrics, Texas Children's Hospital, Houston, Tex
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Karl F Welke
- Department of Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC
| | - Roosevelt Bryant
- Department of Surgery, Phoenix Children's Hospital, Phoenix, Ariz
| | - S Adil Husain
- Department of Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Jonathan M Chen
- Department of Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Aditya Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Mass
| | - Winfield J Wells
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Andrew C Glatz
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Mo
| | - Mitchell I Cohen
- Department of Pediatrics, Inova Children's Hospital, Fairfax, Va
| | - Doff B McElhinney
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, Calif
| | - David A Parra
- Department of Pediatrics, Vanderbilt Children's Hospital, Nashville, Tenn
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Mich
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8
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Hasan BS, Barry OM, Ali F, Armstrong AK, Batlivala SP, Crystal MA, Divekar A, Gudausky T, Holzer R, Kreutzer J, Nicholson G, O’Byrne ML, Quinn BP, Boe BA. Evaluating Procedural Performance: A Composite Outcome for Aortic and Pulmonary Valvuloplasty in Congenital Cardiac Catheterization. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101119. [PMID: 39129900 PMCID: PMC11308845 DOI: 10.1016/j.jscai.2023.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2024]
Abstract
Background Safety events and technical success (TS) have been previously reported for aortic and pulmonary valvuloplasty, but a composite performance measure as a novel, patient-centered strategy has neither been developed nor been studied. This study aims to refine a procedural performance (PP) variable, a composite of TS and procedural safety, for isolated, standard-risk aortic and pulmonary valvuloplasty. Methods A multicenter review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes registry. Data were collected for all cases of isolated balloon aortic and pulmonary valvuloplasty from 2014 through 2017. Patients were excluded if they were aged <1 month, were inpatient at the time of the procedure, or had significant comorbidities, such as Williams or Noonan syndrome. Criteria for TS were developed and categorized (optimal, satisfactory, and unsatisfactory) by expert consensus based on previous outcome research. Adverse events (AE) were categorized by severity (level 1-5) using established criteria. Level 4 and 5 severity AE were considered high-severity AE. Using criteria of TS and AE severity, PP was divided into 3 composite outcome classes. Factors correlating with class III (suboptimal) PP were analyzed. Results There were 169 cases of aortic and 270 cases of pulmonary valvuloplasty in the cohorts. In the aortic valvuloplasty cohort, a suboptimal PP (class III) occurred in 14% of cases, mostly due to high-severity AE (7%). No significant correlation between patient or case characteristics and PP was demonstrated. In the pulmonary valvuloplasty cohort, class III PP occurred in 9% of cases, predominantly due to residual valve gradient, which correlated with lower weight (P = .02). Conclusions We designed a composite variable of PP consisting of TS and safety as a comprehensive measure of outcome. Incorporating both TS and AE may better reflect patient outcome than each metric measured separately. PP indices may identify areas for further investigation and quality improvement.
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Affiliation(s)
- Babar S. Hasan
- Division of Cardio-thoracic Sciences, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Oliver M. Barry
- Division of Cardiology, Morgan Stanley Children’s Hospital of New York and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Aimee K. Armstrong
- The Heart Center, Nationwide Children’s Hospital and Department of Pediatrics Ohio State University School of Medicine, Columbus, Ohio
| | - Sarosh P. Batlivala
- Department of Pediatrics, University of Cincinnati College of Medicine and Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Matthew A. Crystal
- Division of Cardiology, Morgan Stanley Children’s Hospital of New York and Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Abhay Divekar
- Division of Pediatric Cardiology, UT Southwestern Medical Center, Dallas Children’s Hospital, Dallas, Texas
| | - Todd Gudausky
- Division of Pediatric Cardiology, Children's Wisconsin and Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ralf Holzer
- Department of Pediatrics, UC Davis Medical Center, UC Davis Children’s Hospital, Sacramento, California
| | - Jacqueline Kreutzer
- Division of Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - George Nicholson
- Division of Cardiology, Monroe Carell Jr. Children’s Hospital and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael L. O’Byrne
- Division of Cardiology and Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian P. Quinn
- Department of Cardiology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Brian A. Boe
- Department of Cardiology, Joe DiMaggio Children’s Hospital, Hollywood, Florida
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9
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Leclair G, Dingankar A, Robertson CMT, Bond GY, Mohammadian P, Dinu I, Averin K, Guerra GG, Atallah J. Neurodevelopmental Outcomes of Infants after Neonatal Surgical Intervention for Tetralogy of Fallot or Pulmonary Atresia. J Pediatr 2023; 262:113640. [PMID: 37517650 DOI: 10.1016/j.jpeds.2023.113640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To determine the 2-year neurodevelopmental outcomes for survivors of neonatal cardiac surgery for the most common right ventricular outflow tract obstructive lesions: tetralogy of Fallot and pulmonary atresia with a ventricular septal defect. STUDY DESIGN A single-center consecutive cohort of 77 children underwent neonatal surgery for tetralogy of Fallot or pulmonary atresia with a ventricular septal defect at ≤6 weeks of age between 2006 and 2017. The patients underwent a multidisciplinary neurodevelopmental assessment at 18-24 months of age. Survivor outcomes were compared by univariable and multivariable analyses. RESULTS The 2-year mortality was 7.8% (6/77) with a postoperative in-hospital mortality of 3.9% (3/77). Freedom from reintervention by cardiac catheterization or surgical intervention at 2 years was 36%. Functional and neurodevelopmental assessment for 69 of 71 survivors was completed at a mean age of 22.6 ± 4.0 months using the Bayley Scales of Infant and Toddler Development III. The mean neurodevelopmental outcome scores were 83.4 ± 16.5 for cognitive skills, 82.2 ± 18.7 for language skills, and 81.4 ± 18.1 for motor skills. Cognitive, language, and motor delay, defined as a score of <70, was identified in 25%, 25%, and 23% of patients, respectively. Multivariable analyses for factors associated with worse neurodevelopmental outcomes identified chromosomal anomalies (P < .001) and postoperative complications (P < .03). CONCLUSIONS Cyanotic tetralogy of Fallot and pulmonary atresia with ventricular septal defect requiring neonatal repair showed similar 2-year neurodevelopmental outcomes below normative values and a high prevalence of cognitive, language and motor delays.
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Affiliation(s)
- Guillaume Leclair
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada.
| | - Adil Dingankar
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Charlene M T Robertson
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada; Complex Pediatric Therapies Follow-up Program, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Gwen Y Bond
- Complex Pediatric Therapies Follow-up Program, Glenrose Rehabilitation Hospital, Edmonton, AB, Canada
| | - Parsa Mohammadian
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Neuruppin, Germany
| | - Irina Dinu
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Konstantin Averin
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Joseph Atallah
- Departments of Pediatrics, University of Alberta, Edmonton, AB, Canada
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10
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Backer CL, Overman DM, Dearani JA, Romano JC, Tweddell JS, Kumar SR, Marino BS, Bacha EA, Jaquiss RDB, Zaidi AN, Gurvitz M, Costello JM, Pierick TA, Ravekes WJ, Reagor JA, St Louis JD, Spaeth J, Mahle WT, Shin AY, Lopez KN, Karamlou T, Welke KF, Bryant R, Husain SA, Chen JM, Kaza A, Wells WJ, Glatz AC, Cohen MI, McElhinney DB, Parra DA, Pasquali SK. Recommendations for Centers Performing Pediatric Heart Surgery in the United States. Ann Thorac Surg 2023; 116:871-907. [PMID: 37777933 DOI: 10.1016/j.athoracsur.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
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Affiliation(s)
- Carl L Backer
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - David M Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, Minnesota
| | | | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - S Ram Kumar
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, California
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Emile A Bacha
- Department of Surgery, Columbia University/New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York
| | - Robert D B Jaquiss
- Department of Surgery, UT-Southwestern, Children's Health, Dallas, Texas
| | - Ali N Zaidi
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - John M Costello
- Department of Pediatrics, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, South Carolina
| | - Trudy A Pierick
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - William J Ravekes
- Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland
| | - James A Reagor
- Department of Cardiovascular Perfusion, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James D St Louis
- Department of Surgery, Inova Children's Hospital, Fairfax, Virginia
| | - James Spaeth
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - William T Mahle
- Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Geogria
| | - Andrew Y Shin
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, California
| | - Keila N Lopez
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Karl F Welke
- Department of Surgery, Atrium Health Levine Children's Hospital, Charlotte, North Carolina
| | - Roosevelt Bryant
- Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona
| | - S Adil Husain
- Department of Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Jonathan M Chen
- Department of Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aditya Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Winfield J Wells
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, California
| | - Andrew C Glatz
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Missouri
| | - Mitchell I Cohen
- Department of Pediatrics, Inova Children's Hospital, Fairfax, Virginia
| | - Doff B McElhinney
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, California
| | - David A Parra
- Department of Pediatrics, Vanderbilt Children's Hospital, Nashville, Tennessee
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
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11
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Backer CL, Overman DM, Dearani JA, Romano JC, Tweddell JS, Ram Kumar S, Marino BS, Bacha EA, Jaquiss RDB, Zaidi AN, Gurvitz M, Costello JM, Pierick TA, Ravekes WJ, Reagor JA, St Louis JD, Spaeth J, Mahle WT, Shin AY, Lopez KN, Karamlou T, Welke KF, Bryant R, Adil Husain S, Chen JM, Kaza A, Wells WJ, Glatz AC, Cohen MI, McElhinney DB, Parra DA, Pasquali SK. Recommendations for Centers Performing Pediatric Heart Surgery in the United States. World J Pediatr Congenit Heart Surg 2023; 14:642-679. [PMID: 37737602 DOI: 10.1177/21501351231190353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
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Affiliation(s)
- Carl L Backer
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - David M Overman
- Division of Cardiovascular Surgery, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, MN, USA
| | | | - Jennifer C Romano
- Department of Cardiac Surgery, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - James S Tweddell
- Department of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - S Ram Kumar
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Emile A Bacha
- Department of Surgery, Columbia University/New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
| | - Robert D B Jaquiss
- Department of Surgery, UT-Southwestern, Children's Health, Dallas, TX, USA
| | - Ali N Zaidi
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michelle Gurvitz
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - John M Costello
- Department of Pediatrics, Medical University of South Carolina, Shawn Jenkins Children's Hospital, Charleston, SC, USA
| | - Trudy A Pierick
- Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - William J Ravekes
- Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, MD, USA
| | - James A Reagor
- Department of Cardiovascular Perfusion, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James D St Louis
- Department of Surgery, Inova Children's Hospital, Fairfax, VA, USA
| | - James Spaeth
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - William T Mahle
- Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrew Y Shin
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, CA, USA
| | - Keila N Lopez
- Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Karl F Welke
- Department of Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Roosevelt Bryant
- Department of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - S Adil Husain
- Department of Surgery, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Jonathan M Chen
- Department of Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aditya Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Winfield J Wells
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Andrew C Glatz
- Department of Pediatrics, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Mitchell I Cohen
- Department of Pediatrics, Inova Children's Hospital, Fairfax, VA, USA
| | - Doff B McElhinney
- Department of Pediatrics, Stanford Medicine Children's Health, Palo Alto, CA, USA
| | - David A Parra
- Department of Pediatrics, Vanderbilt Children's Hospital, Vanderbilt, TN, USA
| | - Sara K Pasquali
- Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
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12
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Nykanen DG. Outcomes Comparisons Based on Gross National Income: Problems Without Borders? JACC. ADVANCES 2023; 2:100397. [PMID: 38938240 PMCID: PMC11198297 DOI: 10.1016/j.jacadv.2023.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- David G. Nykanen
- Orlando Health Arnold Palmer Children’s Hospital, Orlando, Florida, USA
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13
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Ali F, Yeh MJ, Bergersen L, Gauvreau K, Polivenok I, Ronderos M, De Decker R, Kumar RK, Jenkins K, Hasan BS. Congenital Cardiac Catheterization in Low- and Middle-Income Countries: The International Quality Improvement Collaborative Catheterization Registry. JACC. ADVANCES 2023; 2:100344. [PMID: 38938241 PMCID: PMC11198277 DOI: 10.1016/j.jacadv.2023.100344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/27/2023] [Accepted: 03/14/2023] [Indexed: 06/29/2024]
Abstract
Background No published data are available on the patient, procedural characteristics, and outcomes of congenital heart disease (CHD) cardiac catheterization performed in low- and middle-income countries (LMICs). Objectives The objective of this study was to describe procedural characteristics and patient outcomes of CHD cardiac catheterizations in LMICs. Methods Cases performed between January 2019 and December 2020 from 15 centers in the International Quality Improvement Collaborative Congenital Heart Disease Catheterization Registry (IQIC-CHDCR) data were included. The Procedural Risk in Congenital Cardiac Catheterization (PREDIC3T) classification was used to stratify risk. Outcomes of interest included mortality, severe adverse events (SAEs), and procedural efficacy. Procedural efficacy, based on technical and safety endpoints, was categorized into optimal, adequate, and inadequate for 5 common interventional procedures. Results There were 3,287 cases, of which 60% (n = 1,973) were interventional cases. Most of the cases (66%) were in patients between the ages of 1 to 18 years with a median patient age of 4 years. PREDIC3T risk class 1 and 2 were most common in 37% and 38% of cases, respectively. SAEs occurred in 2.8% while the death was reported within <72 hours post catheterization 1%. The majority of device implantation procedures patent ductus arteriosus (67%) and atrial septal defect (60%) had optimal procedure efficacy outcomes. Conclusions This study demonstrates that congenital cardiac catheterization is safely performed in LMICs. Future work addressing predictors of SAEs and adverse procedural outcomes may help future quality improvement initiatives.
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Affiliation(s)
- Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | - Mary J. Yeh
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Lisa Bergersen
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Igor Polivenok
- Zaitcev Institute for General and Urgent Surgery in Kharkov, Ukraine/Novick Cardiac Alliance, Kharkov, Sloboda, Ukraine
| | - Miguel Ronderos
- Fundación Cardioinfantil de Bogota, Institut of Congnitas Heart Disease, Bogota, Colombia
| | - Rik De Decker
- Division of Cardiology, Red Cross War Memorial Children’s Hospital in Cape Town, Cape Town, South Africa
| | - Raman Krishna Kumar
- Amrita Institute for Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Kathy Jenkins
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Babar Sultan Hasan
- Division of Cardio-thoracic Sciences, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Sindh, Pakistan
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14
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Devarakonda BV, Kapoor MC. Atrial septal occluder device embolization is avoidable. Ann Card Anaesth 2023; 26:122-123. [PMID: 37706374 PMCID: PMC10284476 DOI: 10.4103/aca.aca_30_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Bhargava V. Devarakonda
- Department of Cardiac Anesthesiology, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
| | - Mukul C. Kapoor
- Department of Anesthesiology and Critical Care, Amrita School of Medicine and Amrita Institute of Medical Sciences, Faridabad, Haryana, India
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15
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Barry OM, Gudausky TM, Balzer DT, Bocks ML, Boe BA, Callahan R, El-Said H, Farias MJ, Foerster S, Goldstein BH, Holzer RJ, Janssen D, Levy P, O'Byrne ML, Rahman G, Sathanandam S, Shahanavaz S, Whiteside W, Turner ME. Safety and Short-Term Outcomes for Infants < 2.5 kg Undergoing PDA Device Closure: A C3PO Registry Study. Pediatr Cardiol 2023:10.1007/s00246-023-03147-4. [PMID: 36995404 DOI: 10.1007/s00246-023-03147-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/11/2023] [Indexed: 03/31/2023]
Abstract
To evaluate short-term procedural outcomes and safety for infants < 2.5 kg who underwent catheterization with intended patent ductus arteriosus (PDA) device closure in a multi-center registry, as performance of this procedure becomes widespread. A multi-center retrospective review was performed using data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) registry. Data were collected for all intended cases of PDA closure in infants < 2.5 kg from April 2019 to December 2020 at 13 participating sites. Successful device closure was defined as device placement at the conclusion of the catheterization. Procedural outcomes and adverse events (AE) were described, and associations between patient characteristics, procedural outcomes and AEs were analyzed. During the study period, 300 cases were performed with a median weight of 1.0 kg (range 0.7-2.4). Successful device closure was achieved in 98.7% of cases with a 1.7% incidence of level 4/5 AEs, including one periprocedural mortality. Neither failed device placement nor adverse events were significantly associated with patient age, weight or institutional volume. Higher incidence of adverse events associated with patients who had non-cardiac problems (p = 0.017) and cases with multiple devices attempted (p = 0.064). Transcatheter PDA closure in small infants can be performed with excellent short-term outcomes and safety across institutions with variable case volume.
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Affiliation(s)
- Oliver M Barry
- Division of Pediatric Cardiology, New York-Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-253, New York, NY, 10032, USA.
| | - Todd M Gudausky
- Division of Pediatric Cardiology, Medical College of Wisconsin and Herma Heart Institute at Children's Wisconsin, Milwaukee, WI, USA
| | | | | | - Brian A Boe
- Nationwide Children's Hospital, Columbus, OH, USA
| | | | | | | | - Susan Foerster
- Division of Pediatric Cardiology, Medical College of Wisconsin and Herma Heart Institute at Children's Wisconsin, Milwaukee, WI, USA
| | | | | | - Dana Janssen
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | | | | | | | | | | | | | - Mariel E Turner
- Division of Pediatric Cardiology, New York-Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-253, New York, NY, 10032, USA
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16
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Predictors of Serious Adverse Events and High-Level Cardiorespiratory Support in Patients Undergoing Transcatheter Pulmonary Vein Interventions. Pediatr Cardiol 2023; 44:806-815. [PMID: 36869157 DOI: 10.1007/s00246-023-03129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/10/2023] [Indexed: 03/05/2023]
Abstract
Patients with pulmonary vein stenosis (PVS) often require frequent transcatheter pulmonary vein (PV) interventions for management of restenosis. Predictors of serious adverse events (AEs) and need for high-level cardiorespiratory support (mechanical ventilation, vasoactive support, and/or extracorporeal membrane oxygenation) 48 h after transcatheter PV interventions have not been reported. This is a single-center retrospective cohort analysis of patients with PVS who underwent transcatheter PV interventions from 3/1/2014 to 12/31/2021. Univariate and multivariable analyses were performed using generalized estimating equations to account for within-patient correlation. 240 patients underwent 841 catheterizations involving PV interventions (median 2 catheterizations per patient [1,3]). At least one serious AE was reported in 100 (12%) cases, the most common of which were pulmonary hemorrhage (n = 20) and arrhythmia (n = 17). There were 14 severe/catastrophic AEs (1.7% of cases) including three strokes and one patient death. On multivariable analysis, age less than 6 months, low systemic arterial saturation (< 95% in patients with biventricular [BiV] physiology, < 78% in single ventricle [SV] physiology), and severely elevated mean PA pressure (≥ 45 mmHg in BiV, ≥ 17 mmHg in SV) were associated with SAEs. Age less than 1 year, hospitalization prior to catheterization, and moderate-severe RV dysfunction were associated with high-level support after catheterization. Serious AEs during transcatheter PV interventions in patients with PVS are common, although major events such as stroke or death are uncommon. Younger patients and those with abnormal hemodynamics are more likely to experience serious AEs and require high-level cardiorespiratory support after catheterization.
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17
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Incidence, Predictors, and Outcomes of Cardiac Perforation During Pediatric Cardiac Catheterization: a Retrospective Observational Study from the Congenital Cardiac Interventional Study Consortium (CCISC). Pediatr Cardiol 2023; 44:867-872. [PMID: 36705683 DOI: 10.1007/s00246-023-03103-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cardiac perforation is a rare life-threatening complication of cardiac catheterization. There is very little published literature detailing risk factors for cardiac perforation and outcomes from this complication in children. MATERIALS AND METHODS This was a retrospective study analyzing the cardiac catheterization case registry of the Congenital Cardiovascular Interventional Study Consortium. Children aged < 18 years were included during the study period of 9 years (January 2009-December 2017). The primary outcome measures were incidence of cardiac perforation, risk factors for and outcomes of patients who experience cardiac perforation during cardiac catheterization. RESULTS Cardiac perforation occurred in 50 patients from a total of 36,986 (0.14%). Cardiac perforation was more likely to occur in younger, smaller patients undergoing urgent/emergent and interventional procedures (p < 0.01). Cardiac peroration risk was significantly different across diagnostic and procedure categories (p < 0.01). Higher CRISP score (Area Under Curve [AUC] = 0.87), lower age, and procedure category (radiofrequency perforation of pulmonary valve, AUC = 0.84) were independent predictors of cardiac perforation. Cardiac perforation was associated with a significantly higher rate of mortality (14%), further emergency procedure (42%), ECMO (14%), and cardiac arrest (6%), p < 0.01. CONCLUSIONS Cardiac perforation during cardiac catheterization is a life-threatening complication with a range of associated secondary complications. Higher CRISP score, lower age, and radiofrequency perforation of pulmonary valve are independent predictors.
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18
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Yeh MJ, Lydon E, Gauvreau K, Jenkins KJ, Slater D, Bergersen L. Exploring procedure duration and risk for serious adverse events during congenital cardiac catheterization. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2023; 5:e000142. [PMID: 36643781 PMCID: PMC9835933 DOI: 10.1136/bmjsit-2022-000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/15/2022] [Indexed: 01/12/2023] Open
Abstract
Objectives While procedure length is considered an important metric for cardiothoracic surgical procedures, the relationship between procedure length and adverse events (AEs) in congenital cardiac catheterizations has little published data available. Furthermore, most existing congenital cardiac catheterization risk prediction models are built on logistic regression models. This study aimed to characterize the relationship between case length and AE occurrence in congenital cardiac catheterization while adjusting for known risk factors and to investigate the potential role of non-linear analysis in risk modeling. Design Age, case type, and procedure duration were evaluated for relationships with the primary outcome using logistic regression. Non-linearity of the associations with continuous risk factors was assessed using restricted cubic spline transformations. Setting and participants All diagnostic and interventional congenital cardiac catheterization cases performed at Boston Children's Hospital between January 1, 2014 and October 31, 2019 were analyzed. Main outcome measure The primary outcome was defined as the occurrence of any clinically significant (level 3/4/5) AE. Results A total of 7011 catheterization cases met inclusion criteria, with interventional procedures accounting for 68% of cases. Median case duration was 97 min. A multivariable model including age, procedure type, and case duration showed a significant relationship between case duration and AE occurrence (OR 1.07 per 10 min increase, 95% CI 1.06 to 1.09, p<0.001). Conclusions This study demonstrated the importance of procedure duration as a potential frontier for procedure risk management. Better understanding of the role of procedure duration in cardiac catheterizations may provide opportunities for quality improvement in patient safety and resource planning.
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Affiliation(s)
- Mary J Yeh
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
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19
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Dittrich S, Arenz C, Krogmann O, Tengler A, Meyer R, Bauer U, Hofbeck M, Beckmann A, Horke A. German Registry for Cardiac Operations and Interventions in Patients with Congenital Heart Disease: Report 2021 and 9 Years' Longitudinal Observations on Fallot and Coarctation Patients. Thorac Cardiovasc Surg 2022; 70:e21-e33. [PMID: 36174655 PMCID: PMC9536750 DOI: 10.1055/s-0042-1757175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The annual report of the German Quality Assurance of Congenital Heart Disease displays a broad overview on outcome of interventional and surgical treatment with respect to patient's age and risk categorization. Particular features of the German all-comers registry are the inclusion of all interventional and surgical procedures, the possibility to record repeated treatments with distinct individual patient assignment, and to record various procedures within one case. METHODS International Pediatric and Congenital Cardiac Code terminology for diagnoses and procedures as well as classified adverse events, also recording of demographic data, key procedural performance indicators, and key quality indicators (mortality, adverse event rates). Surgical and interventional adverse events were classified according to the Society of Thoracic Surgeons and to the Congenital Heart Disease Adjustment for Risk Method of the congenital cardiac catheterization project on outcomes. Annual analysis of all cases and additional long-term evaluation of patients after repair of Fallot and primary treatment of native coarctation of the aorta were performed. RESULTS In 2020, 5,532 patients with 6,051 cases (hospital stays) with 6,986 procedures were treated in 23 German institutions. Cases dispense on 618 newborns (10.2%), 1,532 infants (25.3%), 3,077 children (50.9%), and 824 adults (13.6%). Freedom from adverse events was 94.5% in 2,795 interventional cases, 67.9% in 2,887 surgical cases, and 42.9% in 336 cases with multiple procedures (without considering the 33 hybrid interventions). In-hospital mortality was 0.5% in interventional, 1.6% in surgical, and 5.7% in cases with multiple treatments. Long-term observation of 1,632 patient after repair of Fallot depicts the impact of previous palliation in 18% of the patients on the rate of 20.8% redo cases. Differentiated analysis of 1,864 patients with native coarctation picture clear differences of patient, age, and procedure selection and outcome. The overall redo procedure rate in this patient population is high with 30.8%. CONCLUSION Improvement in quality of care requires detailed analysis of risks, performance indicators, and outcomes. The high necessity of redo procedures in patients with complex congenital heart disease underlines the imperative need of long-term observations.
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Affiliation(s)
- Sven Dittrich
- Department of Pediatric Cardiology, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Claudia Arenz
- Department of Pediatric Heart Surgery, University of Bonn, Bonn, Germany
| | - Otto Krogmann
- Clinic for Pediatric Cardiology - Congenital Heart Defects, Heart Center Duisburg, Duisburg, Germany
| | - Anja Tengler
- Department of Pediatric Cardiology and Intensive Care, Ludwig-Maximilians-Universitat Munich, Munich, Germany
| | - Renate Meyer
- BQS Institute for Quality and Patient Safety, Hamburg, Germany
| | - Ulrike Bauer
- National Register for Congenital Heart Defects, Berlin, Germany
| | - Michael Hofbeck
- Department of Pediatric Cardiology, Pulmology and Intensive Care, University Children's Hospital, Tübingen, Germany
| | - Andreas Beckmann
- German Society for Thoracic and Cardiovascular Surgery, Berlin, Germany
| | - Alexander Horke
- Division of Congenital Heart Surgery, Hannover Medical School, Hannover, Germany
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20
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Quandt D, Callegari A, Niesse O, Meinhold A, Dave H, Knirsch W, Kretschmar O. Balloon angioplasty and stent implantation within 30 days postcongenital heart surgery (CHS) in children. J Card Surg 2022; 37:4606-4611. [PMID: 36273426 DOI: 10.1111/jocs.17057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/17/2022] [Accepted: 10/02/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study aims to assess balloon angioplasty (BAP) and stent implantation (SI) procedures early after congenital heart surgery (CHS) in children. BACKGROUND These interventions are considered potential high-risk procedures and often avoided or postponed. METHODS This is a retrospective, single centre study of all BAP and SI procedures within 30 days after CHS (01/2001 until 01/2021). RESULTS A total of 127 (96 SI, 31 BAP) procedures were performed in 104 patients at median 6.5 days (interquartile range: 1-15) after CHS. Balloon-to-stenosis ratio and balloon-to-reference vessel ratio were significantly smaller compared to stent-to-stenosis ratio and stent-to-reference vessel ratio (p < .001 and p = .005). There was a greater rise in absolute vessel diameter, greater rise in vessel diameter in relation to the stenosis and vessel diameter in relation to the reference vessel with SI (p < .001, p = .01, and p < .001). Up to 94% SIs fulfilled both success criteria (increase of vessel diameter ≥50% of minimal vessel diameter or achievement ≥75% of the reference vessel diameter). Major adverse events were more frequent in the BAP group (p = .05). Intraprocedural complications were 5/31 (16%) in the BAP group and 13/96 (13%) in the SI group (p = .77). CONCLUSION BAP and SI procedures within 30 days post-CHS can be performed safely, with a greater stent-to-stenosis ratio and a greater rise in vessel diameter with stent implantation.
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Affiliation(s)
- Daniel Quandt
- Division of Pediatric Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Alessia Callegari
- Division of Pediatric Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Anke Meinhold
- Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Department of Congenital Cardiothoracic Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Division of Pediatric Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Division of Pediatric Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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21
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Changes in Practice/Outcomes of Pediatric/Congenital Catheterization in Response to the First Wave of COVID. JACC ADVANCES 2022; 1:100143. [PMID: 36471862 PMCID: PMC9710529 DOI: 10.1016/j.jacadv.2022.100143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022]
Abstract
Background The COVID-19 pandemic has posed tremendous stress on the health care system. Its effects on pediatric/congenital catheterization program practice and performance have not been described. Objectives The purpose of this study was to evaluate how case volumes, risk-profile, and outcomes of pediatric/congenital catheterization procedures changed in response to the first wave of COVID-19 and after that wave. Methods A multicenter retrospective observational study was performed using Congenital Cardiac Catheterization Project on Outcomes Registry (C3PO) data to study changes in volume, case mix, and outcomes (high-severity adverse events [HSAEs]) during the first wave of COVID (March 1, 2020, to May 31, 2020) in comparison to the period prior to (January 1, 2019, to February 28, 2020) and after (June 1, 2020, to December 31, 2020) the first wave. Multivariable analyses adjusting for case type, hemodynamic vulnerability, and age group were performed. Hospital responses to the first wave were captured with an electronic study instrument. Results During the study period, 12,557 cases were performed at 14 C3PO hospitals (with 8% performed during the first wave of COVID and 32% in the postperiod). Center case volumes decreased from a median 32.1 cases/month (IQR: 20.7-49.0 cases/month) before COVID to 22 cases/month (IQR: 13-31 cases/month) during the first wave (P = 0.001). The proportion of cases with risk factors for HSAE increased during the first wave, specifically proportions of infants and neonates (P < 0.001) and subjects with renal insufficiency (P = 0.02), recent cardiac surgery (P < 0.001), and a higher hemodynamic vulnerability score (P = 0.02). The observed HSAE risk did not change significantly (P = 0.13). In multivariable analyses, odds of HSAE during the first wave of COVID (odds ratio: 0.75) appeared to be lower than that before COVID, but the difference was not significant (P = 0.09). Conclusions Despite increased case-mix complexity, C3PO programs maintained, if not improved, their performance in terms of HSAE. Exploratory analyses of practice changes may inform future harm-reduction efforts.
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22
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Welker CC, Huang J, Boswell MR, Spencer PJ, Theoduloz MAV, Ramakrishna H. Left Ventricular Decompression in VA-ECMO: Analysis of Techniques and Outcomes. J Cardiothorac Vasc Anesth 2022; 36:4192-4197. [PMID: 35965232 DOI: 10.1053/j.jvca.2022.07.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 07/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Carson C Welker
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jeffrey Huang
- Division of Critical Care Medicine, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Michael R Boswell
- Division of Cardiovascular Anesthesi, Mayo Clinic, Rochester, MN, United States
| | - Philip J Spencer
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, United States
| | | | - Harish Ramakrishna
- Division of Cardiovascular Anesthesia, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55901, United States.
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23
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ICU Admission Tool for Congenital Heart Catheterization (iCATCH): A Predictive Model for High Level Post-Catheterization Care and Patient Management. Pediatr Crit Care Med 2022; 23:822-830. [PMID: 35830709 DOI: 10.1097/pcc.0000000000003028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Currently, there are no prediction tools available to identify patients at risk of needing high-complexity care following cardiac catheterization for congenital heart disease. We sought to develop a method to predict the likelihood a patient will require intensive care level resources following elective cardiac catheterization. DESIGN Prospective single-center study capturing important patient and procedural characteristics for predicting discharge to the ICU. Characteristics significant at the 0.10 level in the derivation dataset (July 1, 2017 to December 31, 2019) were considered for inclusion in the final multivariable logistic regression model. The model was validated in the testing dataset (January 1, 2020 to December 31, 2020). The novel pre-procedure cardiac status (PCS) feature, collection started in January 2019, was assessed separately in the final model using the 2019 through 2020 dataset. SETTING Tertiary pediatric heart center. PATIENTS All elective cases coming from home or non-ICU who underwent a cardiac catheterization from July 2017 to December 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 2,192 cases were recorded in the derivation dataset, of which 11% of patients ( n = 245) were admitted to the ICU, while 64% ( n = 1,413) were admitted to a medical unit and 24% ( n = 534) were discharged home. In multivariable analysis, the following predictors were identified: 1) weight less than 5 kg and 5-9.9 kg, 2) presence of systemic illness, 3) recent cardiac intervention less than 90 days, and 4) ICU Admission Tool for Congenital Heart Catheterization case type risk categories (1-5), with C -statistics of 0.79 and 0.76 in the derivation and testing cohorts, respectively. The addition of the PCS feature fit into the final model resulted in a C -statistic of 0.79. CONCLUSIONS The creation of a validated pre-procedural risk prediction model for ICU admission following congenital cardiac catheterization using a large volume, single-center, academic institution will improve resource allocation and prediction of capacity needs for this complex patient population.
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24
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Bauser-Heaton H, Aggarwal V, Graziano JN, Ligon RA, Keeshan B, Stapleton G, Sutton NJ, Fleming G, El-Said H, Kim D, Ing FF. Health Care Disparities in Congenital Cardiology: Considerations Through the Lens of an Interventional Cardiologist. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100388. [PMID: 39131467 PMCID: PMC11308374 DOI: 10.1016/j.jscai.2022.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/29/2022] [Accepted: 05/23/2022] [Indexed: 08/13/2024]
Abstract
When resources in a society are dispersed unevenly, generally through allocation standards, distinct patterns emerge along lines of socially defined categories of people. Power, religion, kinship, prestige, race, ethnicity, gender, age, sexual orientation, and class all play a role in determining who has access to social goods in society. In most cases, social inequality refers to a lack of equality of outcome, but it can also refer to a lack of equality of access to opportunity. Unfortunately, health care is not immune to these social disparities and/or inequalities. These health care disparities in interventional cardiology were recently brought to the forefront by the Society for Cardiovascular Angiography and Interventions (SCAI) as a major focus of 2020-2021. In a recent publication, unique factors leading to disparities were reported to exist among the subsections of interventional cardiology. The congenital heart disease council of SCAI created a task force to further investigate the unique challenges and disparities impacting the practice of congenital heart disease and pediatric cardiology.
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Affiliation(s)
- Holly Bauser-Heaton
- Division of Cardiology, Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | | | - R. Allen Ligon
- Division of Cardiology, Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Britton Keeshan
- Division of Cardiology, Department of Pediatrics, Yale New Haven Children’s Hospital, New Haven, Connecticut
| | - Gary Stapleton
- Department of Cardiology, Texas Children’s Hospital, Houston, Texas
| | - Nicole J. Sutton
- Division of Pediatric Cardiology, The Children’s Hospital at Montefiore, Bronx, New York
| | - Gregory Fleming
- Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Howaida El-Said
- Division of Pediatric Cardiology, Rady Children’s Hospital, University of California, San Diego, California
| | - Dennis Kim
- Division of Cardiology, Department of Pediatrics, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Frank F. Ing
- Division of Pediatric Cardiology, Children’s Hospital, University of California Davis, Sacramento, California
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25
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Holzer RJ. IMPACTing the Future: Are we on the Right Track? Pediatr Cardiol 2022; 43:821-826. [PMID: 34988600 DOI: 10.1007/s00246-021-02793-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022]
Abstract
More than ten years have passed since data collection was initiated in the IMPACT registry. Over the last decade, difficulties in data access and a lack of autonomy have led to a disengagement of the congenital community, with the usefulness of IMPACT to patients and providers being questioned. This article outlines some of problems identified using an online survey among interventional congenital cardiologists, and provides possible solutions for the future.
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Affiliation(s)
- Ralf J Holzer
- David Wallace - Starr Foundation Professor of Pediatric Cardiology, Division Chief of Pediatric Cardiology, Weill Cornell Medicine, Director Pediatric Cardiac Catheterization, NewYork-Presbyterian Komansky Children's Hospital, 525 East 68th Street, Room F-677, New York, NY, 10065, USA.
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26
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Yeh MJ, Shirley L, Balzer DT, Boe BA, El-Said H, Foerster S, Gauvreau K, Gudausky TM, Hainstock MR, Maschietto N, Nicholson GT, Quinn BP, Shahanavaz S, Trucco S, Whiteside W, Bergersen L. Interpreting Quality Improvement When Introducing New Technology: A Collaborative Experience in ASD Device Closures. Pediatr Cardiol 2022; 43:596-604. [PMID: 34743224 DOI: 10.1007/s00246-021-02762-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/22/2021] [Indexed: 11/28/2022]
Abstract
The objective of this study was to evaluate the impact of the regular introduction of new technologies into interventional cardiac catheterization procedures, in this case new atrial septal defect (ASD) closure devices, while conducting a multi-center collaborative initiative to reduce radiation usage during all procedures. Data were collected prospectively by 8 C3PO institutions between January 1, 2014 and December 31, 2017 for ASD device closure procedures in the cardiac catheterization lab during a quality improvement (QI) initiative aimed at reducing patient radiation exposure. Radiation exposure was measured in dose area product per body weight (µGy*m2/kg). Use of proposed practice change strategies at the beginning and end of the QI intervention period was assessed. Radiation exposure was summarized by institution and by initial type of device used for closure. This study included 602 ASD device closures. Without changes in patient characteristics, total fluoroscopy duration, or number of digital acquisitions, median radiation exposure decreased from 37 DAP/kg to 14 DAP/kg from 2014 to 2017. While all individual centers decreased overall median DAP/kg, the use of novel devices for ASD closure correlated with a temporary period of worsening institutional radiation exposure and increased fluoroscopy time. The introduction of new ASD closure devices resulted in increased radiation exposure during a QI project designed to reduce radiation exposure. Therefore, outcome assessment must be contextualized in QI projects, hospital evaluation, and public reporting, to acknowledge the expected variation during innovation and introduction of novel therapies.
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Affiliation(s)
- Mary J Yeh
- Department of Cardiology, Boston Children's Hospital, Bader 2, Attn: Lisa Bergersen, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Lauren Shirley
- Department of Cardiology, Boston Children's Hospital, Bader 2, Attn: Lisa Bergersen, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - David T Balzer
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian A Boe
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Susan Foerster
- Division of Pediatric Cardiology, Medical College of Wisconsin and Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Bader 2, Attn: Lisa Bergersen, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Todd M Gudausky
- Division of Pediatric Cardiology, Medical College of Wisconsin and Herma Heart Institute, Children's Wisconsin, Milwaukee, WI, USA
| | - Michael R Hainstock
- Division of Pediatric Cardiology, University of Virginia Children's Hospital, University of Virginia, Charlottesville, VA, USA
| | - Nicola Maschietto
- Department of Cardiology, Boston Children's Hospital, Bader 2, Attn: Lisa Bergersen, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - George T Nicholson
- Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian P Quinn
- Department of Cardiology, Boston Children's Hospital, Bader 2, Attn: Lisa Bergersen, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Shabana Shahanavaz
- The Heart Institute, Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sara Trucco
- Heart Institute, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wendy Whiteside
- Division of Pediatric Cardiology, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Bader 2, Attn: Lisa Bergersen, 300 Longwood Avenue, Boston, MA, 02115, USA.
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27
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Stein ML, Staffa SJ, O'Brien Charles A, Callahan R, DiNardo JA, Nasr VG, Brown ML. Anesthesia in Children With Pulmonary Hypertension: Clinically Significant Serious Adverse Events Associated With Cardiac Catheterization and Noncardiac Procedures. J Cardiothorac Vasc Anesth 2022; 36:1606-1616. [PMID: 35181233 DOI: 10.1053/j.jvca.2022.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/03/2022] [Accepted: 01/09/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine the incidence of clinically significant serious adverse events in a contemporary population of pediatric patients with pulmonary hypertension who require anesthesia and identify factors associated with adverse outcomes. DESIGN A retrospective, cross-sectional study. SETTING A single-center quaternary-care freestanding children's hospital in the northeastern United States. PARTICIPANTS Pediatric patients with pulmonary hypertension based on hemodynamic criteria on cardiac catheterization during a 3-year period from 2015 to 2018. INTERVENTIONS Anesthesia care for cardiac catheterization, noncardiac surgery, and diagnostic imaging. MEASUREMENTS AND MAIN RESULTS Two hundred forty-nine children underwent 862 procedures, 592 for cardiac catheterization and 278 for noncardiac surgery and diagnostic imaging. The median age was 1.6 years, and the weight was 9.5 lbs. On index catheterization, median pulmonary artery pressure was 36 mmHg, and the pulmonary vascular resistance was 5.1 indexed Wood units. Ten percent of anesthetics were performed with a natural airway, and 80% used volatile anesthetics. Serious adverse events occurred in 26% of procedures (confidence interval [CI], 22%-30%). The rate of periprocedural cardiac arrest was 8 per 1,000 anesthetic administrations. In multivariate analysis, younger age (adjusted odds ratio [aOR], 1.4 per year; CI, 1.1-1.9; p = 0.01), location in the catheterization laboratory (aOR, 5.1; CI, 1.7-16; p = 0.004), and longer procedure duration (aOR, 1.3 per 30 minutes; CI, 1.1-1.4; p = 0.001) were associated with serious adverse events. Patients with a tracheostomy in place were less likely to experience an adverse event (aOR, 0.1; CI, 0.04-0.5; p = 0.001). The primary anesthetic technique was not associated with adverse events. Interventional cardiac catheterization was associated with an increased incidence of adverse events compared with diagnostic catheterization (42% v 21%; OR, 2.23; CI, 1.5-3.3; p < 0.001). CONCLUSIONS Serious adverse events were common in this cohort. Careful planning to minimize anesthesia time in young children with pulmonary hypertension should be undertaken, and these factors considered in designing risk mitigation strategies.
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Affiliation(s)
- Mary Lyn Stein
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Amy O'Brien Charles
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ryan Callahan
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - James A DiNardo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Morgan L Brown
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
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28
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Quinn BP, Yeh M, Gauvreau K, Ali F, Balzer D, Barry O, Batlivala S, Berman D, Foerster S, Goldstein B, Hainstock M, Holzer R, Janssen D, O'Byrne ML, Shirley L, Trucco S, Whiteside W, Bergersen L. Procedural Risk in Congenital Cardiac Catheterization (PREDIC 3T). J Am Heart Assoc 2021; 11:e022832. [PMID: 34935425 PMCID: PMC9075192 DOI: 10.1161/jaha.121.022832] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Advancements in the field, including novel procedures and multiple interventions, require an updated approach to accurately assess patient risk. This study aims to modernize patient hemodynamic and procedural risk classification through the creation of risk assessment tools to be used in congenital cardiac catheterization. Methods and Results Data were collected for all cases performed at sites participating in the C3PO (Congenital Cardiac Catheterization Project on Outcomes) multicenter registry. Between January 2014 and December 2017, 23 119 cases were recorded in 13 participating institutions, of which 88% of patients were <18 years of age and 25% <1 year of age; a high‐severity adverse event occurred in 1193 (5.2%). Case types were defined by procedure(s) performed and grouped on the basis of association with the outcome, high‐severity adverse event. Thirty‐four unique case types were determined and stratified into 6 risk categories. Six hemodynamic indicator variables were empirically assessed, and a novel hemodynamic vulnerability score was determined by the frequency of high‐severity adverse events. In a multivariable model, case‐type risk category (odds ratios for category: 0=0.46, 1=1.00, 2=1.40, 3=2.68, 4=3.64, and 5=5.25; all P≤0.005) and hemodynamic vulnerability score (odds ratio for score: 0=1.00, 1=1.27, 2=1.89, and ≥3=2.03; all P≤0.006) remained independent predictors of patient risk. Conclusions These case‐type risk categories and the weighted hemodynamic vulnerability score both serve as independent predictors of patient risk for high‐severity adverse events. This contemporary procedure‐type risk metric and weighted hemodynamic vulnerability score will improve our understanding of patient and procedural outcomes.
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Affiliation(s)
- Brian P Quinn
- Department of Cardiology Boston Children's Hospital Boston MA
| | - Mary Yeh
- Department of Cardiology Boston Children's Hospital Boston MA
| | | | - Fatima Ali
- Section of Pediatric Cardiology Department of Pediatrics and Child Health The Aga Khan University Hospital Karachi Pakistan
| | - David Balzer
- Division of Pediatric Cardiology St. Louis Children's Hospital St. Louis MO
| | - Oliver Barry
- The Congenital Heart Center New York Presbyterian/Morgan Stanley Children's Hospital New York NY
| | - Sarosh Batlivala
- The Heart Institute Cincinnati Children's Hospital Cincinnati OH.,Department of Pediatrics University of Cincinnati College of Medicine Cincinnati OH
| | - Darren Berman
- The Heart Center Nationwide Children's Hospital Columbus OH
| | - Susan Foerster
- Division of Pediatric Cardiology Children's Wisconsin Milwaukee WI
| | - Bryan Goldstein
- Heart Institute UPMC Children's Hospital of Pittsburgh Pittsburgh PA.,Department of Pediatrics University of Pittsburgh School of Medicine Pittsburgh PA
| | - Michael Hainstock
- Division of Pediatric Cardiology University of Virginia Children's HospitalUniversity of Virginia Charlottesville VA
| | - Ralf Holzer
- Division of Pediatric Cardiology Department of Pediatrics Weill Cornell Medicine New York NY
| | - Dana Janssen
- Division of Pediatric Cardiology Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center Nashville TN
| | - Michael L O'Byrne
- Division of Cardiology Children's Hospital of Philadelphia Philadelphia PA.,Department of Pediatrics Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Lauren Shirley
- Department of Cardiology Boston Children's Hospital Boston MA
| | - Sara Trucco
- Heart Institute UPMC Children's Hospital of Pittsburgh Pittsburgh PA.,Department of Pediatrics University of Pittsburgh School of Medicine Pittsburgh PA
| | - Wendy Whiteside
- Division of Pediatric Cardiology University of Michigan Medical School Ann Arbor MI
| | - Lisa Bergersen
- Department of Cardiology Boston Children's Hospital Boston MA
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O'Callaghan B, Shepherd E, Taliotis D, Bentham J, Kenny D, Smith B, Franco SR, Morgan GJ. Validating a risk assessment tool in United Kingdom and Irish paediatric cardiac catheterisation practice. Cardiol Young 2021; 32:1-8. [PMID: 34645531 DOI: 10.1017/s1047951121004170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND No established risk prediction tool exists in United Kingdom and Irish Paediatric Cardiology practice for patients undergoing cardiac catheterisation. The Catheterisation RISk score for Paediatrics is used primarily in North American practice to assess risk prior to cardiac catheterisation. Validating the utility and transferability of such a tool in practice provides the opportunity to employ an already established risk assessment tool in everyday practice. AIMS To ascertain whether the Catheterisation RISk score for Paediatrics assessment tool can accurately predict complications within United Kingdom and Irish congenital catheterisation practice. METHODS Clinical and procedural data including National Institute for Cardiovascular Outcomes Research derived outcome data from 1500 patients across five large congenital cardiology centres in the United Kingdom and Ireland were retrospectively collected. Catheterisation RISk score for Paediatrics were then calculated for each case and compared with the observed procedural outcomes. Chi-square analysis was used to determine the relationship between observed and predicted events. RESULTS Ninety-eight (6.6%) patients in this study experienced a significant complication as qualified by National Institute for Cardiovascular Outcomes Research classification. 4% experienced a moderate complication, 2.3% experienced a major complication and 0.3% experienced a catastrophic complication resulting in death. Calculated Catheterisation RISk score for Paediatrics scores correlated well with all observed adverse events for paediatric patients across all CRISP categories. The association was also transferable to adult congenital heart disease patients in lower Catheterisation RISk score for Paediatrics categories (CRISP 1-3). CONCLUSION The Catheterisation RISk score for Paediatrics score accurately predicts significant complications in congenital catheterisation practice in the United Kingdom and Ireland. Our data validated the Catheterisation RISk score for Paediatrics assessment tool in five congenital centres using National Institute for Cardiovascular Outcomes Research-derived outcome data.
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Affiliation(s)
- Barry O'Callaghan
- The Heart Institute, Children's Hospital of Colorado, University of Colorado, Denver, CO, USA
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Emma Shepherd
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Demetris Taliotis
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Trust, Bristol, UK
| | - James Bentham
- Leeds Congenital Heart Unit, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Damien Kenny
- Department of Pediatric and Congenital Cardiology, Children's Health Ireland Crumlin, Dublin, Ireland
| | - Benjamin Smith
- Department of Pediatric and Congenital Cardiology, Royal Hospital for Children, Glasgow, NHS Greater Glasgow & Clyde, Glasgow, UK
| | | | - Gareth J Morgan
- The Heart Institute, Children's Hospital of Colorado, University of Colorado, Denver, CO, USA
- Department of Pediatric and Congenital Cardiology, The Evelina Children's Hospital, Guy's and St Thomas's NHS Trust, London, UK
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O'Byrne ML, Glatz AC. Managing confounding and effect modification in pediatric/congenital interventional cardiology research. Catheter Cardiovasc Interv 2021; 98:1159-1166. [PMID: 34420250 DOI: 10.1002/ccd.29925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/27/2021] [Accepted: 08/01/2021] [Indexed: 11/08/2022]
Abstract
Measuring the effect of a treatment on outcomes is an important goal for research in pediatric/congenital interventional cardiology. The breadth of anatomic and physiologic variations, patient ages, and genetic syndromes and noncardiac comorbid conditions all represent sources of potential confounding and effect modification that are major obstacles to this goal. If not accounted for, these factors can obscure the "true" treatment effect and lead to spurious conclusions about the relative efficacy and/or safety of therapies. In this review, we discuss the importance of confounding and effect modification in pediatric/congenital interventional cardiology research. We define these terms and discuss strategies (both in study design and data analysis) to mitigate error introduced by confounding and effect modification. The importance of confounding by indication in pediatric/congenital cardiology is discussed along with specific methods to address it.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute and Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew C Glatz
- Division of Cardiology and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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O'Byrne ML, Kennedy KF, Steven JM, Hill KD, Chamberlain RC, Millenson ME, Smith CL, Dori Y, Gillespie MJ, Rome JJ, Glatz AC. Outcomes of Operator-Directed Sedation and Anesthesiologist Care in the Pediatric/Congenital Catheterization Laboratory: A Study Utilizing Data From the IMPACT Registry. JACC Cardiovasc Interv 2021; 14:401-413. [PMID: 33602437 DOI: 10.1016/j.jcin.2020.10.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to assess contemporary use of operator directed sedation (ODS) and anesthesiologist care (AC) in the pediatric/congenital cardiac catheterization laboratory (PCCL), specifically evaluating whether the use of operator-directed sedation was associated with increased risk of major adverse events. BACKGROUND The safety of ODS relative to AC during PCCL procedures has been questioned. METHODS A multicenter, retrospective cohort study was performed studying procedures habitually performed with ODS or AC at IMPACT (Improving Adult and Congenital Treatment) registry hospitals using ODS for ≥5% of cases. The risks for major adverse events (MAE) for ODS and AC cases were compared, adjusted for case mix. Current recommendations were evaluated by comparing the ratio of observed to expected MAE for cases in which ODS was inappropriate (inconsistent with those guidelines) with those for similar risk AC cases, as well as those in which ODS or AC was appropriate. RESULTS Of the hospitals submitting data to IMPACT, 28 of 101 met inclusion criteria. Of the 7,042 cases performed using ODS at these centers, 88% would be inappropriate. Use of ODS was associated with lower likelihood of MAE both in observed results (p < 0.0001) and after adjusting for case-mix (odds ratio: 0.81; p = 0.006). Use of AC was also associated with longer adjusted fluoroscopy and procedure times (p < 0.0001 for both). The observed/expected ratio for ODS cases with high pre-procedural risk (inappropriate for ODS) was significantly lower than that for AC cases with comparable pre-procedural risk. Across a range of pre-procedural risks, there was no stratum in which risk for MAE was lower for AC than ODS. CONCLUSIONS Across a range of hospitals, ODS was used safely and with improved efficiency. Clinical judgment better identified cases in which ODS could be used than pre-procedural risk score. This should inform future guidelines for the use of ODS and AC in the catheterization laboratory.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Kevin F Kennedy
- Mid America Heart Institute St. Luke's Health System, Kansas City, Missouri, USA
| | - James M Steven
- Department of Anesthesia and Critical Care, The Children's Hospital of Philadelphia and Department of Anesthesia Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin D Hill
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Reid C Chamberlain
- Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Marisa E Millenson
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher L Smith
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yoav Dori
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan J Rome
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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O'Byrne ML, Huang J, Asztalos I, Smith CL, Dori Y, Gillespie MJ, Rome JJ, Glatz AC. Pediatric/Congenital Cardiac Catheterization Quality: An Analysis of Existing Metrics. JACC Cardiovasc Interv 2021; 13:2853-2864. [PMID: 33357522 DOI: 10.1016/j.jcin.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/19/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to enumerate and categorize quality metrics relevant to the pediatric/congenital cardiac catheterization laboratory (PCCL). BACKGROUND Diagnostic and interventional catheterization procedures are an increasingly important part of the care of young patients with cardiac disease. Measurement of the performance of PCCL programs in a stringent and consistent fashion is a crucial step toward improving outcomes. To the best of our knowledge, a systematic evaluation of current quality metrics in PCCL has not been performed previously. METHODS Potential metrics were evaluated by: 1) a systematic review of peer-reviewed research; 2) a review of metrics from organizations interested in quality improvement, patient safety, and/or PCCL programs; and 3) a survey of U.S. PCCL cardiologists. Collected metrics were grouped on 2 dimensions: 1) Institute of Medicine domains; and 2) the Donabedian structure/process/outcome framework. Survey responses were dichotomized between favorable and unfavorable responses and then compared within and between categories. RESULTS In the systematic review, 6 metrics were identified (from 9 publications), all focused on safety either as an outcome (adverse events [AEs], mortality, and failure to rescue along with radiation exposure) or as a structure (procedure volume or operator experience). Four organizations measure quality metrics of PCCL programs, of which only 1 publicly reports data. For the survey, 229 cardiologists from 118 hospital programs responded (66% of individuals and 72% of hospital programs). The highest favorable ratings were for safety metrics (p < 0.001), of which major AEs, failure to rescue, and procedure-specific AEs had the highest ratings. Of respondents, 67% stated that current risk adjustment were not effective. Favorability ratings for hospital characteristics, PCCL characteristics, and quality improvement processes were significantly lower than for safety and less consistent within categories. CONCLUSIONS There is a limited number of PCCL quality metrics, primarily focused on safety. Confidence in current risk adjustment methodology is low. The knowledge gaps identified should guide future research in the development of new quality metrics.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Cardiovascular Outcomes, Quality, and Evaluative Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Jing Huang
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Biostatistics Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Pennsylvania, USA; Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ivor Asztalos
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher L Smith
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yoav Dori
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew J Gillespie
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jonathan J Rome
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew C Glatz
- Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Zettler E, Rivera BK, Stiver C, Boe B, Cua C, Ball MK, Smith CV, Slaughter JL, Chen B, Callahan R, Backes CH. Primary pulmonary vein stenosis among premature infants with single-vessel disease. J Perinatol 2021; 41:1621-1626. [PMID: 32989220 PMCID: PMC8593792 DOI: 10.1038/s41372-020-00830-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/25/2020] [Accepted: 09/14/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Describe outcomes among preterm infants diagnosed with single-vessel primary pulmonary vein stenosis (PPVS) initially treated using conservative management (active surveillance with deferral of treatment). STUDY DESIGN Retrospective cohort study at a single, tertiary-center (2009-2019) among infants <37 weeks' gestation with single-vessel PPVS. Infants were classified into two categories: disease progression and disease stabilization. Cardiopulmonary outcomes were examined, and a Kaplan-Meier survival analysis performed. RESULTS Twenty infants were included. Compared to infants in the stable group (0/10, 0%), all infants in the progressive group had development of at least severe stenosis or atresia (10/10, 100%; P < 0.01). Severe pulmonary hypertension at diagnosis was increased in the progressive (5/10, 50%) versus the stable group (0/10, 0%; P = 0.03). Survival was lower among infants in the progressive than the stable group (log-rank test, P < 0.01). CONCLUSION Among preterm infants with single-vessel PPVS, risk stratification may be possible, wherein more targeted, individualized therapies could be applied.
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Affiliation(s)
- Eli Zettler
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian K Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Corey Stiver
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Boe
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Clifford Cua
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA
| | - Molly K Ball
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Charles V Smith
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Jonathan L Slaughter
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Bernadette Chen
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ryan Callahan
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Carl H Backes
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
- The Heart Center at Nationwide Children's Hospital, Columbus, OH, USA.
- Division of Neonatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.
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Gaies M, Romano JC, Whiteside W. An Intensivist, a Surgeon, and an Interventionalist Walk Into a Bar…. JACC Cardiovasc Interv 2021; 13:2865-2867. [PMID: 33357523 DOI: 10.1016/j.jcin.2020.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Gaies
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA.
| | - Jennifer C Romano
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA; Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Wendy Whiteside
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Barry OM, Ali F, Ronderos M, Sudhaker A, Kumar RK, Mood MC, Corona-Villalobos C, Nguyen DT, Doherty-Schmeck K, Bergersen L, Gauvreau K, Jenkins KJ, Hasan BS. Pilot phase experience of the International Quality Improvement Collaborative catheterization registry. Catheter Cardiovasc Interv 2021; 97:127-134. [PMID: 32294315 DOI: 10.1002/ccd.28908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/23/2020] [Accepted: 03/31/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To describe the development of a quality collaborative for congenital cardiac catheterization centers in low and middle-income countries (LMICs) including pilot study data and a novel procedural efficacy measure. BACKGROUND Absence of congenital cardiac catheterization registries in LMICs led to the development of the International Quality Improvement Collaborative Congenital Heart Disease Catheterization Registry (IQIC-CHDCR). As a foundation for this initiative, the IQIC is a collaboration of pediatric cardiac surgical programs from LMICs. Participation in IQIC has been associated with improved patient outcomes. METHODS A web-based registry was designed through a collaborative process. A pilot study was conducted from October through December 2017 at seven existing IQIC sites. Demographic, hemodynamic, and adverse event data were obtained and a novel tool to assess procedural efficacy was applied to five specific procedures. Procedural efficacy was categorized using ideal, adequate, and inadequate. RESULTS A total of 429 cases were entered. Twenty-five adverse events were reported. The five procedures for which procedural efficacy was measured represented 48% of cases (n = 208) and 71% had complete data for analysis (n = 146). Procedure efficacy was ideal most frequently in patent ductus arteriosus (95%) and atrial septal defect (90%) device closure, and inadequate most frequently in coarctation procedures (100%), and aortic and pulmonary valvuloplasties (50%). CONCLUSIONS The IQIC-CHDCR has designed a feasible collaborative to capture catheterization data in LMICs. The novel tool for procedural efficacy will provide valuable means to identify areas for quality improvement. This pilot study and lessons learned culminated in the full launch of the IQIC-CHDCR.
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Affiliation(s)
- Oliver M Barry
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
| | | | - Abish Sudhaker
- Amrita Institute for Medical Sciences and Research Centre, Kochi, Kerala, India
| | - R Krishna Kumar
- Amrita Institute for Medical Sciences and Research Centre, Kochi, Kerala, India
| | | | - Carlos Corona-Villalobos
- American British Cowdray Medical Center, I.A.P. and Instituto Nacional de Pediatria, Mexico City, Mexico
| | | | | | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Babar S Hasan
- Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
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Yang P, Wu Z, Liu Z, Zhang J, Zhou H, Ji X, Yi Q, Li M. Unplanned Surgery After Transcatheter Closure of Ventricular Septal Defect in Children: Causes and Risk Factors. Front Pediatr 2021; 9:772138. [PMID: 34917563 PMCID: PMC8670304 DOI: 10.3389/fped.2021.772138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the causes and risk factors of unplanned surgery after transcatheter closure of ventricular septal defect (VSD) in children. Methods: A total of 773 patients with VSD who had the devices transcatheter released between January 2013 and December 2018 in our institution were retrospectively reviewed. Univariate and multivariate analyses were used to identify the risk factors for unplanned surgery. Results: Twenty four patients (3.1%) underwent unplanned surgery after transcatheter closure of VSD. The most common cause for unplanned surgery was new-onset or worsening aortic regurgitation (14/24; 58.3%), followed by occluder migration (4/24; 16.7%), complete atrioventricular block (2/24; 8.3%), severe hemolysis (2/24; 8.3%), residual shunt (1/24; 4.2%), and occluder edge near the tricuspid valve chordae (1/24; 4.2%). Logistic regression analysis revealed that primary aortic valve prolapse (OR: 5.507, 95%CI: 1.673-18.123, P = 0.005); intracristal VSD (OR: 8.731, 95%CI: 2.274-33.527, P = 0.002); eccentric occluder (OR: 4.191, 95%CI: 1.233-14.246, P = 0.022); larger occluder size (OR: 1.645, 95%CI: 1.331-2.033, P < 0.001); and pulmonary artery systolic pressure ≥45 mmHg (OR: 4.003, 95%CI: 1.073-14.941, P = 0.039) were risk factors for unplanned surgery. Conclusions: New-onset or worsening aortic regurgitation was the primary cause for unplanned surgery after transcatheter closure of VSD in children. Primary aortic valve prolapse, intracristal VSD, eccentric occluder, larger occluder size, pulmonary artery systolic pressure ≥45 mmHg could increase the risk of unplanned surgery.
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Affiliation(s)
- Penghui Yang
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhijun Wu
- Department of Pediatrics, Chongqing Iron and Steel General Hospital, Chongqing, China
| | - Zhiyuan Liu
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jing Zhang
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hao Zhou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojuan Ji
- National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Department of Ultrasound Investigations, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qijian Yi
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Mi Li
- Department of Cardiovascular Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Disorders, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Schure A. Sedation and anaesthesia for cardiac catheterisation. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.6.s2.2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Since the introduction of cardiac catheterisation for Paediatric Cardiology in 1947, the subspecialty has seen dramatic changes. The advancement of non-invasive imaging techniques such as echocardiography, CT and cardiac MRI has shifted the focus for paediatric cardiac catheterisations from a primarily diagnostic tool (to define anatomy, assess haemodynamics and calculate shunts) to an important treatment option for various congenital heart defects.
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Brown MA, Vo N, Pohlman J, Moehlmann M, Foerster SR. Congenital right internal mammary artery to portal vein arteriovenous malformation. Clin Imaging 2020; 71:101-105. [PMID: 33186870 DOI: 10.1016/j.clinimag.2020.10.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 10/23/2022]
Abstract
Neonatal cases of systemic artery to portal venous system arteriovenous malformations (AVMs) can present unique challenges in terms of diagnosis, management, and treatment. Prompt identification of these AVMs is necessary for minimizing long-term sequelae and optimizing prognosis. Our report describes the diagnosis and successful endovascular coil embolization of a congenital right internal mammary artery (IMA) to portal vein AVM in a young infant initially presenting during routine fetal screening with an incidentally discovered congenital thoracic vascular abnormality.
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Affiliation(s)
- Mason A Brown
- Aurora St. Luke's Medical Center, Departments of Diagnostic and Interventional Radiology, Milwaukee, WI, United States of America
| | - Nghia Vo
- Children's Hospital of Wisconsin, Department of Pediatric Radiology, Milwaukee, WI, United States of America
| | - Joshua Pohlman
- Children's Hospital of Wisconsin, Department of Pediatric Radiology, Milwaukee, WI, United States of America
| | - Matthew Moehlmann
- Herma Heart Institute, Medical College of Wisconsin, Children's Hospital of Wisconsin, Division of Pediatric Cardiology, Milwaukee, WI, United States of America
| | - Susan R Foerster
- Herma Heart Institute, Medical College of Wisconsin, Children's Hospital of Wisconsin, Division of Pediatric Cardiology, Milwaukee, WI, United States of America
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Hussain S, Hoodbhoy Z, Ali F, Hasan E, Alvi N, Hussain A, Ishrat K, Ur Rahman Z, Qamruddin A, Parvin A, Hasan BS. Reduction of cardiac iron overload by optimising iron chelation therapy in transfusion dependent thalassaemia using cardiac T2* MRI: a quality improvement project from Pakistan. Arch Dis Child 2020; 105:1041-1048. [PMID: 32994214 DOI: 10.1136/archdischild-2020-319203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Cardiac T2* MRI (T2*CMR), for accurate estimation of myocardial siderosis, was introduced as part of a QI collaborative to optimise chelation therapy in order to improve cardiac morbidity in transfusion dependent thalassaemia (TDT) patients. We report the impact of this QI initiative from two thalassaemia centres from this collaborative. DESIGN AND SETTING A key driver based quality initiative was implemented to improve chelation in TDT patients registered at these two centres in Karachi, Pakistan. Protocol optimisation and compliance to treatment through training, communication and feedback were used as the drivers for QI intervention. Preintervention variables (demographics, chelation history, T2*CMR, echocardiography and holters) were collected from January 2015 to December 2016) and compared with variables in the post implementation phase (January to December 2019). A standardised adverse event severity for chelators and its management was devised for safe drug therapy as well as ensuring compliance to the regimen. Preintervention and postintervention variables were compared using non-parametric test. P value<0.05 was statistically significant. RESULTS 100 patients with TDT, median age 17 (9-34) years, were included. An increase or stabilisation of T2*CMR was documented in 82% patients in the postintervention phase especially in patients with severe myocardial iron overload (5.5 vs 5.3 ms, p <0.01). Significantly fewer patients had abnormal echocardiographic findings (3.5% vs 26%, p <0.05) in the postintervention versus preintervention period. CONCLUSION This QI initiative improved the chelation therapy leading to improved cardiac status in TDT patients at the participating centres.
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Affiliation(s)
| | - Zahra Hoodbhoy
- Department of Pediatrics and Child Health, The Aga Khan University and Hospital, Karachi, Sindh, Pakistan
| | - Fatima Ali
- Department of Pediatrics and Child Health, The Aga Khan University and Hospital, Karachi, Sindh, Pakistan
| | - Erum Hasan
- Kashif Iqbal Thalassaemia Care Centre, Karachi, Sindh, Pakistan
| | - Najveen Alvi
- Department of Pediatrics and Child Health, The Aga Khan University and Hospital, Karachi, Sindh, Pakistan
| | | | | | | | | | - Azra Parvin
- Fatimid Foundation, Karachi, Sindh, Pakistan
| | - Babar S Hasan
- Department of Pediatrics and Child Health, The Aga Khan University and Hospital, Karachi, Sindh, Pakistan
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Setiawan CT, Landrigan-Ossar M. Pediatric Anesthesia Outside the Operating Room: Case Management. Anesthesiol Clin 2020; 38:587-604. [PMID: 32792186 DOI: 10.1016/j.anclin.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anesthesiology teams care for children in diverse locations, including diagnostic and interventional radiology, gastroenterology and pulmonary endoscopy suites, radiation oncology units, and cardiac catheterization laboratories. To provide safe, high-quality care, anesthesiologists working in these environments must understand the unique environmental and perioperative considerations and risks involved with each remote location and patient population. Once these variables are addressed, anesthesia and procedural teams can coordinate to ensure that patients and families receive the same high-quality care that they have come to expect in the operating room. This article also describes some of the considerations for anesthetic care in outfield locations.
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Affiliation(s)
- Christopher Tan Setiawan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Anesthesiology, Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Mary Landrigan-Ossar
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
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Valencia-Arango LM, Fajardo-Escolar AP, Segura-Salguero JC, Sáenz-Quispe S, Rincón-Restrepo C, Posada A, Ronderos V, Perea-Bello AH. [Anesthetic management of neonates undergoing diagnostic and therapeutic cardiac catheterization: a systematic literature review]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2020; 70:278-287. [PMID: 32684289 PMCID: PMC9373387 DOI: 10.1016/j.bjan.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several interventional cardiology procedures are required in neonates with congenital heart disease. Interventional cardiology procedures have a higher risk of cardiac arrest compared to other interventions. At present, there is great heterogeneity in the perioperative management of congenital heart disease neonates undergoing diagnostic cardiac catheterization or therapeutic cardiac catheterization. STUDY OBJECTIVES Primary aim: Provide a systematic review of the most effective and/or safe anesthetic and perioperative management in neonates with congenital heart disease who undergo diagnostic cardiac catheterization or therapeutic cardiac catheterization. Secondary aim: Identify the medications, monitoring parameters and airway management used in the same population. DESIGN Systematic literature review. SETTING Catheterization laboratory. METHODS Literature was searched (December 2017) in electronic databases Medline, EMBASE, ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database. MAIN RESULTS From 130 records identified, four studies met inclusion criteria and quality assessment. None of the studies were relevant to the primary objective. Regarding the secondary objectives, one study compared the efficacy and adverse effects of racemic ketamine and its S(+) ketamine enantiomer, one study reported the efficacy of subarachnoid anesthesia for high-risk children undergoing diagnostic cardiac catheterization, one study identified the factors associated to high severity adverse events related to sedation, anesthesia and airway, and one study retrospectively analyzed cardiac catheterization procedures in neonates weighing less than 2.5 kg. CONCLUSION There are no evidence-based recommendations available for congenital heart disease neonates undergoing cardiac catheterization. More studies are required to evaluate the ideal anesthetic and perioperative management in this population.
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Affiliation(s)
- Lina M Valencia-Arango
- Hospital Universitario San Ignacio. Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia
| | | | - Juan C Segura-Salguero
- Hospital Universitario San Ignacio. Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia
| | - Santiago Sáenz-Quispe
- Hospital Universitario San Ignacio. Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia
| | - Carolina Rincón-Restrepo
- Hospital Universitario San Ignacio. Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia
| | - Adriana Posada
- Universidad Javeriana. Facultad de Medicina, Bogotá, Colombia
| | - Vivian Ronderos
- Universidad Javeriana. Facultad de Medicina, Bogotá, Colombia
| | - Ana H Perea-Bello
- Hospital Universitario San Ignacio. Universidad Javeriana, Facultad de Medicina, Bogotá, Colombia.
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Holzer RJ, Dayton JD. Registries, Risk Calculators, and Risk-Adjusted Outcomes: Current Usage, Limitations, and Future Prospects. Pediatr Cardiol 2020; 41:443-458. [PMID: 32198591 DOI: 10.1007/s00246-020-02300-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
Small study sizes are a limiting factor in assessing outcome measures in pediatric cardiology. It is even more difficult to assess the outcomes of congenital catheterizations where the sample sizes are even smaller, particularly on a individual institutional level. The creation of multicenter registries is a method by which investigators can pool data to better assess quality and outcome measures of these procedures. No registry is perfect with several being available today, each with its own strengths and weaknesses. In addition, there are a multitude of methods currently used to assess quality and outcomes from the data contained in these registries, each having its own limitations as well. Nonetheless, multicenter registrities remain one of the best available options to improve the quality of care for pediatric interventional cardiac catheterization. Below, we provide an overview of the current state of quality assessment/improvement in pediatric interventional cardiology including a review of the available registrities and the metrics used to measure quality of care and outcomes.
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Affiliation(s)
- Ralf J Holzer
- NewYork-Presbyterian Komansky Children's Hospital, New York, USA.
- Weill Cornell Medicine, New York, USA.
- David Wallace - Starr Foundation, Division of Pediatric Cardiology, Pediatric Cardiac Catheterization, NewYork-Presbyterian Komansky Children's Hospital, New york, USA.
| | - Jeffrey D Dayton
- NewYork-Presbyterian Komansky Children's Hospital, New York, USA
- Weill Cornell Medicine, New York, USA
- Department of Pediatrics, 525 East 68th Street, Room F-677, New York, NY, 10065, USA
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Goldstein BH, Bergersen L, Armstrong AK, Boe BA, El-Said H, Porras D, Shahanavaz S, Leahy RA, Kreutzer J, Zampi JD, Hainstock MR, Gudausky TM, Nicholson GT, Gauvreau K, Goodman A, Petit CJ. Adverse Events, Radiation Exposure, and Reinterventions Following Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 2020; 75:363-376. [DOI: 10.1016/j.jacc.2019.11.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/26/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022]
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Transcatheter closure of a perimembranous ventricular septal defect with Nit-Occlud Lê VSD Coil: A French multicentre study. Arch Cardiovasc Dis 2020; 113:104-112. [PMID: 31982353 DOI: 10.1016/j.acvd.2019.11.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 11/18/2019] [Accepted: 11/21/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Transcatheter perimembranous ventricular septal defect (pmVSD) closure remains challenging and is seldom used in France given the risk of atrioventricular block (AVB). pmVSD closure with the Nit-Occlud Lê VSD coil was recently introduced in France as an alternative to occluder devices. AIMS To study the safety and feasibility of pmVSD closure with the Nit-Occlud Lê VSD coil. METHODS All consecutives cases of pmVSD closure with the Nit-Occlud Lê VSD coil in 20 tertiary French centres were included between January 2015 and December 2018. RESULTS Among 46 procedures in five centres, indications for pmVSD closure were left ventricle overload (76.1%), exertional dyspnoea (17.4%), history of infective endocarditis (4.3%) and mild pulmonary hypertension (2.2%). The median (interquartile [IQR]) age of the patients was 13.9 (5.7-31.8) years. Aneurismal tissue was identified in 91.3% of patients. VSD median (IQR) size was 8 (7-10) mm on the left ventricle side and 5 (4-6) mm on the right ventricle side. Implantation was successful in 40 patients (87.0%; 95% confidence interval [CI] 73.7-95.1%). Severe complications occurred in six patients (13.0%, 95% CI 4.9-26.3%), mainly severe haemolysis (8.7%, 95% CI 2.4-20.8%). One aortic valve lesion required surgical aortic valvuloplasty. Occurrence of severe complications was significantly related to the presence of haemolysis (P=0.001), residual shunt (P=0.007) and multi-exit VSD (P=0.005). Residual shunt was observed in 40% of cases with the implanted device shortly after closure and 15% after a median follow-up of 27 months. No immediate or delayed device embolization or complete AVB was recorded. CONCLUSION pmVSD closure with the Nit-Occlud Lê VSD Coil is feasible in older children and adults. However, residual shunting (leading to haemolysis) is a dreaded complication that should not be tolerated. pmVSD closure with the Nit-Occlud Lê VSD as a therapeutic strategy remains controversial and is limited to selected patients.
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Jaswal V, Singh Thingnam SK, Prasad Gourav K, Halder V. Delayed embolization of ductal occluder device into the aorta with near-complete obstruction of the aorta and critical cardiac decompensation. J Card Surg 2020; 35:696-699. [PMID: 31971271 DOI: 10.1111/jocs.14434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Delayed embolization of ductal occluder device into the aorta after transcatheter closure of a patent ductus arteriosus (PDA) with almost complete obstruction of the aorta is extremely rare. Our patient had delayed migration of a ductal occluder device into the descending thoracic aorta (DTA) 6 months after its deployment. Because of critical biventricular dysfunction, urgent surgical removal of the device from the descending aorta was done via left posterolateral thoracotomy without using cardiopulmonary bypass. PDA was not closed because of doubt about the reversibility of pulmonary artery hypertension and severe right ventricular dysfunction so that it can act as an outlet to the decompensated right ventricle. The patient made an uneventful recovery. The patient was started on pulmonary vasodilators and is planned for right heart catheterization study after 2 months to check for the operability of PDA.
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Affiliation(s)
- Vivek Jaswal
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shyam Kumar Singh Thingnam
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Krishna Prasad Gourav
- Department of Anaesthesia and Critical Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikram Halder
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Sun Z, Li D, Wang Y, An Q. Surgical removal of part of an occluder to treat iatrogenic coarctation of the aorta: a case report. BMC Surg 2020; 20:17. [PMID: 31952492 PMCID: PMC6969450 DOI: 10.1186/s12893-020-0682-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Iatrogenic aortic stenosis is a serious complication and potentially fatal due to erosion of the aortic wall. Timely management is necessary to prevent complications. Case presentation A 2-year-old boy underwent surgery to remove part of an Amplatzer occluder after patent ductus arteriosus (PDA) device embolization in the thoracic aorta. He exhibited moderate to severe obstruction with erosion of the intimal layer of the aorta caused by the device, part of which was retrieved surgically with restructuring of the thoracic aorta segment and occluder remnant. The patient’s postoperative course was uneventful. Conclusions When possible, retrieving only part of an embolized device can be advocated because it reduces the risk of aortic and pulmonary artery damage.
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Holzer RJ. “Failure to Rescue”: An Imperfect Measure Well Suited to Complement an Imperfect World. J Am Heart Assoc 2019; 8:e014356. [PMID: 31619105 PMCID: PMC6898857 DOI: 10.1161/jaha.119.014356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ralf J. Holzer
- NewYork‐Presbyterian Komansky Children's Hospital New York NY
- Weill Cornell Medicine New York NY
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Cardiopulmonary Resuscitation in the Pediatric Cardiac Catheterization Laboratory: A Report From the American Heart Association's Get With the Guidelines-Resuscitation Registry. Pediatr Crit Care Med 2019; 20:1040-1047. [PMID: 31232852 DOI: 10.1097/pcc.0000000000002038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Hospitalized children with underlying heart disease are at high risk for cardiac arrest, particularly when they undergo invasive catheterization procedures for diagnostic and therapeutic interventions. Outcomes for children experiencing cardiac arrest in the cardiac catheterization laboratory remain under-reported with few studies reporting survival beyond the catheterization laboratory. We aim to describe survival outcomes after cardiac arrest in the cardiac catheterization laboratory while identifying risk factors associated with hospital mortality after these events. DESIGN Retrospective observational study of data from a multicenter cardiac arrest registry from November 2005 to November 2016. Cardiac arrest in the cardiac catheterization laboratory was defined as the need for chest compressions greater than or equal to 1 minute in the cardiac catheterization laboratory. Primary outcome was survival to discharge. Variables analyzed using generalized estimating equations for association with survival included age, illness category (surgical cardiac, medical cardiac), preexisting conditions, pharmacologic interventions, and event duration. SETTING American Heart Association's Get With the Guidelines-Resuscitation registry of in-hospital cardiac arrest. PATIENTS Consecutive patients less than 18 years old experiencing an index (i.e., first) cardiac arrest event reported to the Get With the Guidelines-Resuscitation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 203 patients met definition of index cardiac arrest in the cardiac catheterization laboratory composed primarily of surgical and medical cardiac patients (54% and 41%, respectively). Children less than 1 year old comprised the majority of patients, 58% (117/203). Overall survival to hospital discharge was 69% (141/203). No differences in survival were observed between surgical and medical cardiac patients (p = 0.15). The majority of deaths (69%, 43/62) occurred in patients less than 1 year old. Bradycardia (with pulse) followed by pulseless electrical activity/asystole were the most common first documented rhythms observed (50% and 27%, respectively). Preexisting metabolic/electrolyte abnormalities (p = 0.02), need for vasoactive infusions (p = 0.03) prior to arrest, and use of calcium products (p = 0.005) were found to be significantly associated with lower rates of survival to discharge on multivariable regression. CONCLUSIONS The majority of children experiencing cardiac arrest in the cardiac catheterization laboratory in this large multicenter registry analysis survived to hospital discharge, with no observable difference in outcomes between surgical and medical cardiac patients. Future investigations that focus on stratifying medical complexity in addition to procedural characteristics at the time of catheterization are needed to better identify risks for mortality after cardiac arrest in the cardiac catheterization laboratory.
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O'Byrne ML, Kennedy KF, Jayaram N, Bergersen LJ, Gillespie MJ, Dori Y, Silber JH, Kawut SM, Rome JJ, Glatz AC. Failure to Rescue as an Outcome Metric for Pediatric and Congenital Cardiac Catheterization Laboratory Programs: Analysis of Data From the IMPACT Registry. J Am Heart Assoc 2019; 8:e013151. [PMID: 31619106 PMCID: PMC6898805 DOI: 10.1161/jaha.119.013151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Risk‐adjusted adverse event (AE) rates have been used to measure the quality of pediatric and congenital cardiac catheterization laboratories. In other settings, failure to rescue (FTR) has demonstrated utility as a quality metric. Methods and Results A multicenter retrospective cohort study was performed using data from the IMPACT (Improving Adult and Congenital Treatment) Registry between January 2010 and December 2016. A modified FTR metric was developed for pediatric and congenital cardiac catheterization laboratories and then compared with pooled AEs. The associations between patient‐ and hospital‐level factors and outcomes were evaluated using hierarchical logistic regression models. Hospital risk standardized ratios were then calculated. Rankings of risk standardized ratios for each outcome were compared to determine whether AEs and FTR identified the same high‐ and low‐performing centers. During the study period, 77 580 catheterizations were performed at 91 hospitals. Higher annual hospital catheterization volume was associated with lower odds of FTR (odds ratio: 0.68 per 300 cases; P=0.0003). No association was seen between catheterization volume and odds of AEs. Odds of AEs were instead associated with patient‐ and procedure‐level factors. There was no correlation between risk standardized ratio ranks for FTR and pooled AEs (P=0.46). Hospital ranks by catheterization volume and FTR were associated (r=−0.28, P=0.01) with the largest volume hospitals having the lowest risk of FTR. Conclusions In contrast to AEs, FTR was not strongly associated with patient‐ and procedure‐level factors and was significantly associated with pediatric and congenital cardiac catheterization laboratory volume. Hospital rankings based on FTR and AEs were not significantly correlated. We conclude that FTR is a complementary measure of catheterization laboratory quality and should be included in future research and quality‐improvement projects.
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Affiliation(s)
- Michael L O'Byrne
- Division of Cardiology Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA.,Leonard Davis Institute University of Pennsylvania Philadelphia PA.,Center for Cardiovascular Outcomes, Quality, and Evaluative Research University of Pennsylvania Philadelphia PA.,Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia Philadelphia PA
| | - Kevin F Kennedy
- Mid America Heart Institute St. Luke's Health System Kansas City MO
| | - Natalie Jayaram
- Mid America Heart Institute St. Luke's Health System Kansas City MO.,Division of Cardiology Department of Pediatrics Children's Mercy Hospitals and Clinics Kansas City MO
| | - Lisa J Bergersen
- Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Matthew J Gillespie
- Division of Cardiology Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA
| | - Yoav Dori
- Division of Cardiology Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA
| | - Jeffrey H Silber
- Leonard Davis Institute University of Pennsylvania Philadelphia PA.,Divisions of Hematology Oncology, Critical Care Medicine, and Outcomes Research Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA
| | - Steven M Kawut
- Division of Pulmonary and Critical Care Medicine Hospital of the University of Pennsylvania Department of Medicine Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine The University of Pennsylvania Philadelphia PA
| | - Jonathan J Rome
- Division of Cardiology Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA
| | - Andrew C Glatz
- Division of Cardiology Department of Pediatrics Perelman School of Medicine The Children's Hospital of Philadelphia University of Pennsylvania Philadelphia PA.,Center for Pediatric Clinical Effectiveness The Children's Hospital of Philadelphia Philadelphia PA
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Brown ML, DiNardo JA, Nasr VG. Anesthesia in Pediatric Patients With Congenital Heart Disease Undergoing Noncardiac Surgery: Defining the Risk. J Cardiothorac Vasc Anesth 2019; 34:470-478. [PMID: 31345716 DOI: 10.1053/j.jvca.2019.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 01/13/2023]
Abstract
The incidence of moderate to severe congenital heart disease (CHD) in the United States is estimated to be 6 per 1,000 live-born, full-term infants. Recent advances in pediatric cardiology, surgery, and critical care have improved significantly the survival rates of patients with CHD leading to an increase in prevalence in both children and adults. Children with CHD significant enough to require cardiac surgery frequently also undergo noncardiac surgical procedures. With this increased demand for procedures that require anesthesia, all anesthesiologists, and more specifically, pediatric anesthesiologists will encounter patients with repaired or unrepaired CHD and other cardiac diseases in their practice. They often are faced with the question, "Is this patient too high risk for anesthesia?" The objective of this literature review is to provide a greater understanding of patients at high risk and to quantify the risk for patients, their families, and clinicians. In addition, specific high-risk lesions (single ventricle, Williams-Beuren syndrome, pulmonary hypertension, cardiomyopathies, and ventricular assist devices) are described.
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Affiliation(s)
- Morgan L Brown
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - James A DiNardo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Viviane G Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA.
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