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Adair AB, Gong W, Lindsell CJ, Clay MA. Association between weight-for-length percentile and ICU length of stay in patients with a single ventricle undergoing bidirectional Glenn repair: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024; 48:469-478. [PMID: 38417181 DOI: 10.1002/jpen.2616] [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] [Received: 07/09/2022] [Revised: 12/31/2023] [Accepted: 01/28/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Poor weight gain has been identified as an independent risk factor for increased surgical morbidity and mortality for patients with single-ventricle physiology undergoing staged surgical palliation. Conversely, excessive weight gain has also emerged as an independent risk factor predicting increased morbidity and mortality in a single-center study. Given this novel single-center concept, we investigated the impact of excessive weight on patients with single-ventricle physiology undergoing bidirectional Glenn palliation in a multicenter study model. METHODS Patients from the Pediatric Heart Network Single Ventricle Reconstruction Trial (n = 387) were analyzed in a retrospective cohort study examining the independent effect of weight percentile on intensive care unit (ICU) length of stay (LOS) and ventilator days. Locally estimated scatterplot smoothing (LOESS) regression was used to plot weight-for-length (WFL) percentiles by ICU LOS and ventilator days. Unadjusted and adjusted ordinal regression was used to model ICU LOS and ventilator days. RESULTS Scatterplots and LOESS regression curves demonstrated increasing ICU LOS and ventilator days for increasing WFL percentiles. Unadjusted ordinal regression analysis of ICU LOS demonstrated a trend of increasing ICU LOS for increasing WFL percentiles that was not statistically significant (P = 0.11). A similar trend was demonstrated in adjusted ordinal regression that was not statistically significant (P = 0.48). Unadjusted and adjusted ordinal regression analysis of ventilator days did not reach statistical significance (P = 0.07). CONCLUSION Excessive weight gain has a clinically relevant but not statistically significant association with increased ICU LOS and ventilator days for those patients in the >90th WFL percentile for age.
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Affiliation(s)
- Austin B Adair
- Department of Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatric Cardiac Critical Care, Dell Children's Medical Center, Austin, Texas, USA
| | - Wu Gong
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Christopher J Lindsell
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Mark A Clay
- Department of Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatric Cardiac Critical Care, Medical City Dallas Hospital, Dallas, Texas, USA
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2
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Khaira GK, Joffe AR, Guerra GG, Matenchuk BA, Dinu I, Bond G, Alaklabi M, Robertson CMT, Sivarajan VB. A complicated Glenn procedure: risk factors and association with adverse long-term neurodevelopmental and functional outcomes. Cardiol Young 2023; 33:1536-1543. [PMID: 36000320 DOI: 10.1017/s104795112200261x] [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: 11/07/2022]
Abstract
OBJECTIVES To determine potentially modifiable risk factors for a complicated Glenn procedure (cGP) and whether a cGP predicted adverse neurodevelopmental and functional outcomes. A cGP was defined as post-operative death, heart transplant, extracorporeal life support, Glenn takedown, or prolonged ventilation. METHODS All 169 patients having a Glenn procedure from 2012 to 2017 were included. Neurodevelopmental assessments were performed at age 2 years in consenting survivors (n = 156/159 survivors). The Bayley Scales of Infant and Toddler Development-3rd Edition (Bayley-III) and the Adaptive Behavior Assessment System-2nd Edition (ABAS-II) were administered. Adaptive functional outcomes were determined by the General Adaptive Composite (GAC) score from the ABAS-II. Predictors of outcomes were determined using univariate and multiple variable linear or Cox regressions. RESULTS Of patients who had a Glenn procedure, 10/169 (6%) died by 2 years of age and 27/169 (16%) had a cGP. Variables statistically significantly associated with a cGP were the inotrope score on post-operative day 1 (HR 1.04, 95%CI 1.01, 1.06; p = 0.010) and use of inhaled nitric oxide post-operatively (HR 7.31, 95%CI 3.19, 16.76; p < 0.001). A cGP was independently statistically significantly associated with adverse Bayley-III Cognitive (ES -10.60, 95%CI -17.09, -4.11; p = 0.002) and Language (ES -11.43, 95%CI -19.25, -3.60; p = 0.004) scores and adverse GAC score (ES -14.89, 95%CI -22.86, -6.92; p < 0.001). CONCLUSIONS Higher inotrope score and inhaled nitric oxide used post-operatively were associated with a cGP. A cGP was independently associated with adverse 2-year neurodevelopmental and functional outcomes. Whether early recognition and intervention for risk of a cGP can prevent adverse outcomes warrants study.
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Affiliation(s)
- Gurpreet K Khaira
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Pediatric Critical Care, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Ari R Joffe
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Pediatric Critical Care, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Gonzalo G Guerra
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Pediatric Critical Care, Stollery Children's Hospital, Edmonton, Alberta, Canada
- Pediatric Cardiac Intensive Care Unit, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | | | - Irina Dinu
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Gwen Bond
- Complex Pediatric Therapies Follow-Up Program, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - M Alaklabi
- Division of Pediatric Cardiovascular Surgery, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Charlene M T Robertson
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Complex Pediatric Therapies Follow-Up Program, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - V Ben Sivarajan
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Pediatric Critical Care, Stollery Children's Hospital, Edmonton, Alberta, Canada
- Pediatric Cardiac Intensive Care Unit, Stollery Children's Hospital, Edmonton, Alberta, Canada
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Almasarweh SI, Suntharos P, Saini A, Prieto L, Sasaki J. Contemporary risk factors for a longer hospital stay following bidirectional cavopulmonary anastomosis. Cardiol Young 2023; 33:1529-1535. [PMID: 35997027 DOI: 10.1017/s1047951122002694] [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: 11/06/2022]
Abstract
BACKGROUND Despite high survival after bidirectional cavopulmonary anastomosis, a considerable number of patients suffer significant post-operative morbidities related to prolonged length of stay. METHODS A single-center retrospective cohort study of all consecutive patients undergoing a first-time bidirectional cavopulmonary anastomosis from 2006 to 2019. RESULTS Prolonged length of stay was defined as hospital stay greater than the 75th percentile for our cohort. Of 195 patients who met inclusion criteria, the median post-operative length of stay was 8 days (interquartile range, 4-15 days). Prolonged length of stay was defined as greater than 15 days. In multivariate analysis, greater than mild systemic atrioventricular valve regurgitation (odds ratio 3.7, 95% CI 1.05-13.068, p = 0.04), longer length of stay after the initial palliative procedure (odds ratio 1.028, 95% CI 1.004-1.05, p = 0.02), and pre-operative higher superior vena cava oxygen saturation (odds ratio 0.922, 95% CI 0.85-0.99, p = 0.04) maintained statistical significance as independent risk and protective factors for prolonged length of stay. A one-level increase in the severity of pre-operative systemic atrioventricular valve regurgitation was associated with a multiplicative change in the odds ratio of prolonged length of stay of 5.45 (p = 0.005) independent of the severity of systemic ventricular dysfunction. CONCLUSION Pre-operative characteristics with greater than mild systemic atrioventricular valve regurgitation, longer length of stay after the initial palliative procedure, and lower superior vena cava oxygen saturation were associated with prolonged length of stay after a first-time bidirectional cavopulmonary anastomosis.
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Affiliation(s)
- Saleem I Almasarweh
- Division of Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, GE, USA
| | | | - Ashish Saini
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Lourdes Prieto
- Department of Cardiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Jun Sasaki
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine/NewYork-Presbyterian Komansky Children's Hospital, New York, NY, USA
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Tricuspid Valve Regurgitation in Hypoplastic Left Heart Syndrome: Current Insights and Future Perspectives. J Cardiovasc Dev Dis 2023; 10:jcdd10030111. [PMID: 36975875 PMCID: PMC10051129 DOI: 10.3390/jcdd10030111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023] Open
Abstract
Hypoplastic Left Heart Syndrome (HLHS) is a congenital heart defect that requires a three-stage surgical palliation to create a single ventricle system in the right side of the heart. Of patients undergoing this cardiac palliation series, 25% will develop tricuspid regurgitation (TR), which is associated with an increased mortality risk. Valvular regurgitation in this population has been extensively studied to understand indicators and mechanisms of comorbidity. In this article, we review the current state of research on TR in HLHS, including identified valvular anomalies and geometric properties as the main reasons for the poor prognosis. After this review, we present some suggestions for future TR-related studies to answer the central question: What are the predictors of TR onset during the three palliation stages? These studies involve (i) the use of engineering-based metrics to evaluate valve leaflet strains and predict tissue material properties, (ii) perform multivariate analyses to identify TR predictors, and (iii) develop predictive models, particularly using longitudinally tracked patient cohorts to foretell patient-specific trajectories. Regarded together, these ongoing and future efforts will result in the development of innovative tools that can aid in surgical timing decisions, in prophylactic surgical valve repair, and in the refinement of current intervention techniques.
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Song H, Li X, Huang H, Xie C, Qu W. Postoperative virtual pressure difference as a new index for the risk assessment of liver resection from biomechanical analysis. Comput Biol Med 2023; 157:106725. [PMID: 36913851 DOI: 10.1016/j.compbiomed.2023.106725] [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: 11/09/2022] [Revised: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023]
Abstract
In the realm of hepatectomy, traditional methods for postoperative risk assessment are limited in their ability to provide comprehensive and intuitive evaluations of donor risk. To address this issue, there is a need for the development of more multifaceted indicators to assess the risk in hepatectomy donors. In an effort to improve postoperative risk assessments, a computational fluid dynamics (CFD) model was developed to analyze blood flow properties, such as streamlines, vorticity, and pressure, in 10 eligible donors. By comparing the correlation between vorticity, maximum velocity, postoperative virtual pressure difference and TB, a novel index - postoperative virtual pressure difference - was proposed from a biomechanical perspective. This index demonstrated a high correlation (0.98) with total bilirubin values. Donors who underwent right liver lobe resections had greater pressure gradient values than those who underwent left liver lobe resected donors due to the denser streamlines and higher velocity and vorticity values of the former group. Compared with traditional medical methods, the biofluid dynamic analysis using CFD offers advantages in terms of accuracy, efficiency, and intuition.
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Affiliation(s)
- Hongqing Song
- University of Science and Technology Beijing, Beijing, 100083, China
| | - Xiaofan Li
- University of Science and Technology Beijing, Beijing, 100083, China
| | - Hao Huang
- Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Chiyu Xie
- University of Science and Technology Beijing, Beijing, 100083, China
| | - Wei Qu
- Liver Transplantation Section, Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China.
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Azhar A, Eid R, Elakaby A, Abdelsalam M, Al-Ata J, Alkhushi N, Bahaidarah S, Zaher Z, Maghrabi K, Noaman N, Abdelmohsen G. Outcomes of bidirectional Glenn surgery done without prior cardiac catheterization. Egypt Heart J 2022; 74:57. [PMID: 35925522 PMCID: PMC9352820 DOI: 10.1186/s43044-022-00296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Cardiac catheterization is usually done routinely in patients with univentricular hearts before palliative Bidirectional Glenn (BDG) surgery. The objective of this study was to compare the outcomes of patients with physiological univentricular hearts and restrictive pulmonary flow that did not undergo routine cardiac catheterization before BDG with the patients that did have cardiac catheterization done. We retrospectively reviewed the data of all patients with single ventricle physiology and restrictive pulmonary blood flow who underwent BDG surgery from January 2016 till December 2020. Patients were divided into two groups: the catheterization and the non-catheterization groups. Results Out of 93 patients, 25 (27%) underwent BDG surgery without prior cardiac catheterization. The median age of patients was ten months, interquartile range (IQR) was 5–18 months. Tricuspid atresia represented 36% of the non-catheterization group, while unbalanced atrioventricular septal defect and hypoplastic left heart syndrome represented 19% and 17.6% of the catheterization group. No patients in the catheterization group were excluded from further BDG surgery based on the catheterization data. Moreover, no significant differences were found between the patients' groups regarding the length of hospital stay, length of intensive care unit stay, postoperative oxygen saturation, or survival (P = 0.266, P = 0.763, P = 0.543, P = 0456). Conclusions Although pre-BDG cardiac catheterization is the routine and standard practice, in certain situations, some patients with single ventricle physiology and restrictive pulmonary blood flow may go directly to BDG without cardiac catheterization if noninvasive imaging is satisfactory on a case-by-case basis and according to center experience. Pre-BDG catheterization could be reserved for patients with limited echocardiographic studies, high-risk patients, or those indicated for catheter intervention before BDG surgery.
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Dietzman TW, Soria S, DePaolo J, Gillespie MJ, Mascio C, Dori Y, O'Byrne ML, Rome JJ, Glatz AC. Influence of Antegrade Pulmonary Blood Flow on Outcomes of Superior Cavopulmonary Connection. Ann Thorac Surg 2022; 114:1771-1777. [PMID: 35341786 DOI: 10.1016/j.athoracsur.2022.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND We sought to characterize short- and long-term outcomes after superior cavopulmonary connection (SCPC) in children eligible for inclusion of antegrade pulmonary blood flow (APBF) in the SCPC circuit, exploring whether maintaining APBF was associated with outcomes. METHODS This was a retrospective cohort study of patients with single-ventricle heart disease and APBF who underwent SCPC at our center between January 1, 2000, and September 30, 2017. Patients were divided into 2 groups: APBF eliminated (APBF-), and APBF maintained (APBF+) at the time of SCPC. RESULTS Of 149 patients, 108 (72.5%) were in APBF- and 41 (27.5%) were in APBF+. Of those in APBF+, 5 (12.2%) subsequently had APBF eliminated after SCPC. Patients in APBF+ had a higher prevalence of chest tube duration >10 days and underwent more interventions during the post-SCPC hospitalization (1.9% vs 12%; P = .008 for both) but had shorter surgical support times at SCPC (P < .0001). There were no differences in post-SCPC intensive care unit or hospital length of stay. During the study period, 82 patients (76%) in APBF- and 22 patients (54%) in APBF+ underwent Fontan completion. Patients in APBF+ had a greater weight gain from SCPC to Fontan (6.7 [1.8-22] kg vs 8.15 [4.4-20.6] kg; P = .012) and a shorter hospital length of stay after Fontan (9 [4-107] days vs 7.5 [4-14] days; P = .044). CONCLUSIONS Short-term morbidity associated with maintaining APBF at the time of SCPC is modest, but longer term outcomes suggest potential benefits in those in whom APBF can be successfully maintained.
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Affiliation(s)
- Thomas W Dietzman
- Division of Cardiac Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Stefania Soria
- Division of Cardiology, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - John DePaolo
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Matthew J Gillespie
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher Mascio
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yoav Dori
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael L O'Byrne
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan J Rome
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrew C Glatz
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Euringer C, Kido T, Ruf B, Burri M, Heinisch PP, Vodiskar J, Strbad M, Cleuziou J, Dilber D, Hager A, Ewert P, Hörer J, Ono M. Management of failing bidirectional cavopulmonary shunt: Influence of additional systemic-to-pulmonary-artery shunt with classic Glenn physiology. JTCVS OPEN 2022; 11:373-387. [PMID: 36172411 PMCID: PMC9510880 DOI: 10.1016/j.xjon.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/03/2022] [Indexed: 11/02/2022]
Abstract
Objectives Methods Results Conclusions
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Meyer HM, Marange-Chikuni D, Anaesthesia MM, Zühlke L, Roussow B, Human P, Brooks A. Outcomes After Bidirectional Glenn Shunt in a Tertiary-Care Pediatric Hospital in South Africa. J Cardiothorac Vasc Anesth 2022; 36:1573-1581. [PMID: 35151565 DOI: 10.1053/j.jvca.2022.01.003] [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: 10/18/2021] [Revised: 12/29/2021] [Accepted: 01/03/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Large data sets have been published on short- and long-term outcomes following bidirectional Glenn surgery (BDG), or partial cavopulmonary connection, in high-income countries. Data from low-income and middle-income countries are few and often limited to the immediate postoperative period. The primary outcome was any in-hospital postoperative complication, assessed according to predefined criteria, in children who underwent BDG surgery at Red Cross War Memorial Children's Hospital. DESIGN A retrospective cohort study. SETTING A tertiary teaching hospital. PARTICIPANTS The study authors identified 61 children (<18 years of age) who underwent BDG over 8 years. The median age of patients undergoing BDG was 2.5 years (interquartile range, 1.4-5.5 years). INTERVENTIONS BDG surgery. MEASUREMENTS AND MAIN RESULTS Thirty-five patients (57.4%) had a postoperative complication, with some patients (17 of 61, 27.9%) having more than 1 complication. The most frequent complications were infective (29.5%). Univariate analysis found that postoperative complications were associated with the use of nitric oxide (p = 0.004) and a longer duration of anesthesia (p = 0.045) and surgery (p = 0.004). Patients with complications spent longer in the pediatric intensive care unit (ICU) (p < 0.001) and in the hospital (p < 0.012). On multivariate analysis, a priori risk factors based on previous studies were not found to be statistically significant. A total of 37.3% of patients completed their single-ventricle palliation, and 30.5% of patients were lost to follow-up. CONCLUSIONS Important findings were the older age at which the BDG was performed compared to high-income countries, an acceptable mortality rate of 3.3%, infection being the most common complication, the association of a complication with increased ICU and hospital lengths of stay, and the high rate of patients lost to follow-up.
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Affiliation(s)
- Heidi M Meyer
- Division of Paediatric Anaesthesia, Department of Anaesthesia & Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
| | - Danai Marange-Chikuni
- Department of Anaesthesia and Critical Care Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Sally Mugabe Central Hospital, Harare, Zimbabwe
| | - MMed Anaesthesia
- Department of Anaesthesia and Critical Care Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Sally Mugabe Central Hospital, Harare, Zimbabwe
| | - Liesl Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Beyra Roussow
- Division of Paediatric Critical Care, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Paul Human
- Chris Barnard Division of Cardiothoracic Surgery and Cardiovascular Research Unit, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Andre Brooks
- Chris Barnard Division of Cardiothoracic Surgery and Cardiovascular Research Unit, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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Weisert M, Menteer J, Durazo-Arvizu R, Wood J, Su J. EARLY PREDICTION OF FAILURE TO PROGRESS IN SINGLE VENTRICLE PALLIATION: A STEP TOWARD PERSONALIZING CARE FOR SEVERE CONGENITAL HEART DISEASE. J Heart Lung Transplant 2022; 41:1268-1276. [DOI: 10.1016/j.healun.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/29/2022] [Accepted: 06/02/2022] [Indexed: 10/18/2022] Open
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Ukil Isildak F, Yavuz Y. The role of neutrophil-to-lymphocyte ratio in predicting mortality after bidirectional Glenn procedure. Cardiol Young 2022; 32:1-7. [PMID: 35491699 DOI: 10.1017/s1047951122001457] [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
This study aimed to address the role of various inflammation-related blood indices for the assessment of in-hospital outcomes in subjects undergoing Glenn procedure. Subjects who underwent the Glenn procedure for hypoplastic left heart syndrome were analysed retrospectively. Subjects were divided into two groups: Group 1 consisted of 78 patients who were discharged, and Group 2 included 12 patients who died after surgery. Post-operative third-day neutrophil count and neutrophil-to-lymphocyte ratio value were significantly higher in the exitus group compared to the discharged group (p = 0.006 and p = 0.003, respectively). Third-day neutrophil-to-lymphocyte ratio was positively correlated with duration of intubation (r = 0.253, p = 0.018), length of stay in ICU (r = 0.296, p = 0.006) and length of hospital stay (r = 0.297, p = 0.005). Multiple logistic regression analysis revealed that patients with high third-day neutrophil-to-lymphocyte ratio (≥6) had 14.227-fold higher risk of death compared to those with lower values. In addition, higher pulmonary arterial pressure was associated with increased risk of death. Receiver operating characteristics analysis revealed that neutrophil-to-lymphocyte ratio had 66.67% sensitivity, 84% specificity, 81.61% accuracy, 40.00% positive predictive value and 94.03% negative predictive value with a cut-off point of ≥6 to predict mortality. Third-day neutrophil-to-lymphocyte ratio and increased post-operative pulmonary arterial pressure are significant predictors for in-hospital mortality in Glenn procedure recipients. A cut-off value of ≥6 for third-day neutrophil-to-lymphocyte ratio predicts mortality with 66.67% sensitivity and 84% specificity. Given its simplicity and availability, post-operative neutrophil-to-lymphocyte ratio should be monitored on a daily basis to identify patients with high risk for mortality after Glenn procedure.
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Affiliation(s)
- Fatma Ukil Isildak
- Department of Anesthesia and Reanimation, Istanbul Provincial Health Directorate Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Yavuz
- Department of Anesthesia and Reanimation, Istanbul Provincial Health Directorate Kartal Kosuyolu High Speciality Training and Research Hospital, Istanbul, Turkey
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Greenberg JW, Pribble CM, Singareddy A, Ta NA, Sescleifer AM, Fiore AC, Huddleston CB. The Failed Bidirectional Glenn Shunt: Risk Factors for Poor Outcomes and the Role of Early Reoperation. World J Pediatr Congenit Heart Surg 2021; 12:760-764. [PMID: 34846973 DOI: 10.1177/21501351211044129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Bidirectional Glenn shunt (BDG) failure carries high morbidity and mortality but the clinical factors associated with failure and the optimal management strategy are understudied. Methods: A total of 217 patients undergoing BDG at our institution between 1989 and 2020 were retrospectively reviewed and categorized as success or failure. Failure was defined as the need for reoperation (BDG takedown, reoperation for correction of cardiac defect, and/or transplantation) at any time postoperatively; operative mortality (death attributable to BDG malfunction occurring during the index hospitalization for BDG or within 30 days of discharge); or late mortality (death directly attributable to BDG malfunction occurring prior to Fontan or next-stage palliation). Univariate and binary logistic regression analyses were performed. Results: BDG failure occurred in 14 (6.5%) patients. Univariate predictors were: hypoplastic left heart syndrome (P = .037), right ventricular (RV) dominance (P = .010), greater pre-BDG pulmonary vascular resistance (PVR) (P = .012), concomitant atrioventricular valve repair (P = .020), prolonged pleural drainage (P = .001), intensive care unit (P<.001) and hospital (P = .002) stays, and extracorporeal membrane oxygenation (ECMO) requirement (P<.001). Multivariate predictors were: RV dominance (P = .002), greater PVR (P = .041), ICU (P<.001) and hospital (P = .020) stays, and need for ECMO (P<.001). As many as 10 of 14 (71%) patients with BDG failure died. Reoperation was performed for 10 patients with BDG failure. Five reoperation patients survived until discharge, with four patients alive at last follow-up (mean 7.9 years). Survivors underwent reoperation earlier than nonsurvivors (36 vs. 94 days). Conclusions: BDG failure carries high mortality, but preoperative predictors and postoperative indicators of failure exist. Early BDG takedown and insertion of aorta-pulmonary shunt may allow survival.
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Affiliation(s)
- Jason W Greenberg
- 12274Saint Louis University School of Medicine and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Chase M Pribble
- 12274Saint Louis University School of Medicine and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Aashray Singareddy
- 12274Saint Louis University School of Medicine and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Ngoc-Anh Ta
- 12274Saint Louis University School of Medicine and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Anne M Sescleifer
- 12274Saint Louis University School of Medicine and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Andrew C Fiore
- 12274Saint Louis University School of Medicine and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | - Charles B Huddleston
- 12274Saint Louis University School of Medicine and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
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13
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Ono M, Burri M, Mayr B, Anderl L, Strbad M, Cleuziou J, Hager A, Hörer J, Lange R. Risk Factors for Failed Fontan Procedure After Stage 2 Palliation. Ann Thorac Surg 2021; 112:610-618. [DOI: 10.1016/j.athoracsur.2020.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
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14
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Bichell DP. Commentary: Cardiac surgery in the developing world: Matching patient selection to longitudinal care. J Thorac Cardiovasc Surg 2021; 163:424-425. [PMID: 34134891 DOI: 10.1016/j.jtcvs.2021.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 11/19/2022]
Affiliation(s)
- David P Bichell
- Department of Cardiac Surgery, Monroe Carell, Jr, Children's Hospital, Vanderbilt University Medical Center, Nashville, Tenn.
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15
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Kido T, Ono M, Anderl L, Burri M, Strbad M, Balling G, Cleuziou J, Hager A, Ewert P, Hörer J. Factors influencing length of intensive care unit stay following a bidirectional cavopulmonary shunt. Interact Cardiovasc Thorac Surg 2021; 33:124-130. [PMID: 33738489 DOI: 10.1093/icvts/ivab061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/15/2020] [Accepted: 01/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The goal of this study was to identify the risk factors for prolonged length of stay (LOS) in the intensive care unit (ICU) after a bidirectional cavopulmonary shunt (BCPS) procedure and its impact on the number of deaths. METHODS In total, 556 patients who underwent BCPS between January 1998 and December 2019 were included in the study. RESULTS Eighteen patients died while in the ICU, and 35 died after discharge from the ICU. Reduced ventricular function was significantly associated with death during the ICU stay (P = 0.002). In patients who were discharged alive from the ICU, LOS in the ICU [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.02-1.06; P < 0.001] and a dominant right ventricle (HR 2.41, 95% CI 1.03-6.63; P = 0.04) were independent risk factors for death. Receiver operating characteristic analysis identified a cut-off value for length of ICU stay of 19 days. Mean pulmonary artery pressure (HR 1.03, 95% CI 1.01-1.05; P = 0.04) was a significant risk factor for a prolonged ICU stay. CONCLUSIONS Prolonged LOS in the ICU with a cut-off value of 19 days after BCPS was a significant risk factor for mortality. High pulmonary artery pressure at BCPS was a significant risk factor for a prolonged ICU stay.
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Affiliation(s)
- Takashi Kido
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Masamichi Ono
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Lisa Anderl
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Martina Strbad
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Gunter Balling
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Cneter Munich, Technische Universität München, Munich, Germany
| | - Julie Cleuziou
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Cneter Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Cneter Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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16
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Ono M, Kido T, Burri M, Anderl L, Ruf B, Cleuziou J, Strbad M, Hager A, Hörer J, Lange R. Risk Factors for Thrombus Formation at Stage 2 Palliation and Its Effect on Long-Term Outcome in Patients With Univentricular Heart. Semin Thorac Cardiovasc Surg 2021; 34:669-679. [PMID: 33691189 DOI: 10.1053/j.semtcvs.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/01/2021] [Indexed: 01/19/2023]
Abstract
Thrombus formation is a feared complication following bidirectional cavopulmonary shunt (BCPS). We aimed to investigate the effect of thrombus formation on outcome. BCPS was performed in 525 patients at our center between 1998 and 2018. The impacts of thrombus formation on survival and probability of Fontan completion were analyzed, and risk factors for thrombus formation were examined. Thrombus formation occurred in 30 patients (5.7%). Compared with the remaining 495 patients, there was no significant difference in the median age at BCPS (4.9 vs 4.7 months; P = 0.587). However, unbalanced atrioventricular septal defects (17 vs 5%; P = 0.008) and preoperative ventricular dysfunction (23.3 vs 8%; P = 0.004) were more frequent in patients who developed a thrombus. Thrombolytic therapy was performed in all patients and surgical thrombus removal was required in 13 patients. In-hospital mortality was higher in patients with thrombus (30.0 vs 2.2%; P < 0.001). Of 505 hospital survivors, an estimated survival at 1 year after hospital discharge following BCPS was 84.4% (95% CI, 76.1-92.7%) in patients with thrombus and 96.8% (95% CI, 96.0-97.6%) in those without (P < 0.001). Cumulative incidence of Fontan completion at 3 years after BCPS was 52.8% (95% CI, 30.3-75.2%) in patients with thrombus and 90.1% (95% CI, 87.2-92.9%) in those without (P = 0.004). Higher left atrial pressure (OR = 1.165; P = 0.029) and longer cardiopulmonary bypass time (OR = 1.013, P = 0.001) at BCPS were independent risk factors for thrombus formation after BCPS. Thrombus formation after BCPS poses a significant risk for survival and Fontan completion. Preoperative higher left atrial pressure and longer cardiopulmonary bypass time are significant risk factors.
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Affiliation(s)
- Masamichi Ono
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Germany.
| | - Takashi Kido
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany
| | - Lisa Anderl
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Germany
| | - Bettina Ruf
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Germany
| | - Julie Cleuziou
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Germany; German Center for Cardiovascular Research, Munich, Germany
| | - Martina Strbad
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technische Universität München, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Germany; German Center for Cardiovascular Research, Munich, Germany
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17
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Lawrence KM, Ittenbach RF, Hunt ML, Kaplinski M, Ravishankar C, Rychik J, Steven JM, Fuller SM, Nicolson SC, Gaynor JW, Spray TL, Mascio CE. Attrition between the superior cavopulmonary connection and the Fontan procedure in hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2020; 162:385-393. [PMID: 33581902 DOI: 10.1016/j.jtcvs.2020.10.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We investigated the incidence and predictors of failure to undergo the Fontan in children with hypoplastic left heart syndrome who survived superior cavopulmonary connection. METHODS The cohort consists of all patients with hypoplastic left heart syndrome who survived to hospital discharge after superior cavopulmonary connection between 1988 and 2017. The primary outcome was attrition, which was defined as death, nonsuitability for the Fontan, or cardiac transplantation before the Fontan. Subjects were excluded if they were awaiting the Fontan, were lost to follow-up, or underwent biventricular repair. The study period was divided into 4 eras based on changes in operative or medical management. Attrition was estimated with 95% confidence intervals, and predictors were identified using adjusted, logistic regression models. RESULTS Of the 856 hospital survivors after superior cavopulmonary connection, 52 died, 7 were deemed unsuitable for Fontan, and 12 underwent or were awaiting heart transplant. Overall attrition was 8.3% (71/856). Attrition rate did not change significantly across eras. A best-fitting multiple logistic regression model was used, adjusting for superior cavopulmonary connection year and other influential covariates: right ventricle to pulmonary artery shunt at Norwood (P < .01), total support time at superior cavopulmonary connection (P < .01), atrioventricular valve reconstruction at superior cavopulmonary connection (P = .02), performance of other procedures at superior cavopulmonary connection (P = .01), and length of stay after superior cavopulmonary connection (P < .01). CONCLUSIONS In this study spanning more than 3 decades, 8.3% of children with hypoplastic left heart syndrome failed to undergo the Fontan after superior cavopulmonary connection. This attrition rate has not decreased over 30 years. Use of a right ventricle to pulmonary artery shunt at the Norwood procedure was associated with increased attrition.
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Affiliation(s)
- Kendall M Lawrence
- Department of Surgery, Weill Cornell New York Presbyterian, New York, NY
| | - Richard F Ittenbach
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mallory L Hunt
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Michelle Kaplinski
- Division of Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, Calif
| | - Chitra Ravishankar
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jack Rychik
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - James M Steven
- Division of Cardiac Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Stephanie M Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Susan C Nicolson
- Division of Cardiac Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Thomas L Spray
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Christopher E Mascio
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa.
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18
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Dohain AM, Ismail MF, Elmahrouk AF, Hamouda TE, Arafat AA, Helal A, Edrees A, Alamri RM, Al-Mojaddidi AMA, Abdelmotaleb ME, Elassal AA, Al-Radi OO, Jamjoom AA. The outcomes of bidirectional Glenn before and after 4 months of age: A comparative study. J Card Surg 2020; 35:3326-3333. [PMID: 33032371 DOI: 10.1111/jocs.15055] [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] [Received: 07/03/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aim to present our experience with the bidirectional Glenn (BDG) in patients less than 4 months of age and to compare their outcomes with the patients who underwent BDG after the age of 4 months. METHODS A retrospective review of data was performed for patients who underwent the BDG procedure from 2002 to 2018 at our institutions. We reviewed the patients' demographics, echocardiographic findings, cardiac catheterization data, operative details, postoperative data, and outcome variables. RESULTS The study was conducted on 213 patients. At the time of the BDG operation, 32 patients were younger than 4 months (younger group) and 181 patients were older than 4 months (older group). The preoperative mean pulmonary artery pressure was significantly higher in the younger group (p = .035) but there were no significant differences between both groups in Qp/Qs, ventricular end-diastolic pressure, indexed pulmonary vascular resistance, and preoperative oxygen saturation. However, the initial postoperative oxygen saturation of the younger group was lower than the older group (p = .007). The duration of mechanical ventilation, duration of pleural drainage, ICU stay, and hospital stay after BDG were significantly longer in the younger group compared to the older group. The early mortality was higher in the younger group, but this difference did not reach statistical significance (p = .283). CONCLUSION Performing BDG procedure in infants less than 4 months of age is safe, with favorable outcomes. Early BDG is associated with a less-smooth postoperative course without a significant increase in early or late mortality.
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Affiliation(s)
- Ahmed M Dohain
- Department of Pediatrics, Pediatric Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Mohamed F Ismail
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Mansoura University, Mansoura, Egypt
| | - Ahmed F Elmahrouk
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Tamer E Hamouda
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Benha University, Benha, Egypt
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Abdelmonem Helal
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt.,Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Azzahra Edrees
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Rawan M Alamri
- Department of Surgery, Cardiac Surgery Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M A Al-Mojaddidi
- Department of Pediatrics, Pediatric Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed E Abdelmotaleb
- Department of Pediatrics, Pediatric Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Elassal
- Department of Surgery, Cardiac Surgery Division, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Zagazig University, Zagazig, Egypt
| | - Osman O Al-Radi
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Cardiac Surgery Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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19
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Kowatari R, Suzuki Y, Daitoku K, Fukuda I. Long-term results of additional pulmonary blood flow with bidirectional cavopulmonary shunt. J Cardiothorac Surg 2020; 15:279. [PMID: 32993722 PMCID: PMC7526092 DOI: 10.1186/s13019-020-01335-4] [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] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
Objective We evaluated additional pulmonary blood flow at the time of bidirectional cavopulmonary shunt and its effects on the Fontan procedure and long-term outcome of Fontan circulation and liver function. Methods We included 22 patients (16 boys, 6 girls) having undergone bidirectional cavopulmonary shunt with additional pulmonary blood flow between April 2002 and January 2016. Mean age and body weight were 20 ± 13 months and 7.5 ± 6.5 kg, respectively. We retrospectively evaluated the patients’ clinical data, including cardiac catheterization data, liver function, and liver fibrosis markers. Results All patients were alive with a New York Heart Association status of I at the long-term follow-up. Changes between pre-bidirectional cavopulmonary shunt and 101 months after the Fontan procedure included the following: the cardiothoracic ratio of chest X-ray decreased from 52.2 ± 3.9% to 41.8 ± 5.9% (p < 0.001); systemic ventricle end-diastolic pressure decreased from 11.4 ± 3.2 mmHg to 6.9 ± 3.6 mmHg (p < 0.001); and the pulmonary artery index decreased from 485.1 ± 272.3 to 269.5 ± 100.5 (p = 0.02). Type IV collagen, hyaluronic acid, and procollagen levels increased over the normal range 116 months after the Fontan procedure. Conclusions The additional pulmonary blood flow at the time of bidirectional cavopulmonary shunt may contribute to pulmonary arterial growth at the Fontan procedure with low pulmonary arterial resistance and without ventricle volume overload. The Fontan circulation was well-maintained at the long-term follow-up, while liver fibrosis markers were above their normal values.
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Affiliation(s)
- Ryosuke Kowatari
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan.
| | - Yasuyuki Suzuki
- Department of Cardiovascular Surgery, Ibaraki Clinical Education and Training Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University School of Medicine, 5 Zaifucho, Hirosaki, Aomori, 036-8562, Japan
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20
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Risk factors for morbidity and mortality after a bidirectional Glenn shunt in Northern Thailand. Gen Thorac Cardiovasc Surg 2020; 69:451-457. [PMID: 32783183 DOI: 10.1007/s11748-020-01461-9] [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] [Received: 12/26/2019] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Owing to the evolution of surgical techniques, the survival rate of patients undergoing a bidirectional Glenn shunt has improved. However, the morbidity and mortality are still high. The aims of this study were to determine the survival rate and risk factors influencing the morbidity and mortality in patients with a functional univentricular heart after a bidirectional Glenn shunt. METHODS One hundred and fifty-one patients who had undergone a bidirectional Glenn operation were enrolled. Early worse outcomes were defined as postoperative death within 30 days and a hospital stay ≥ 30 days. RESULTS The median age was 7.1 years (range 0.3-26 years). The median age at the time of the Glenn operation was 2.2 years (range 0.2-15.9 years). The survival rates of patients at 1-, 5-, 10- and 15-year after the Glenn operation were 89%, 79%, 75%, and 72%, respectively. The predictors for the mortality were preoperative mean pulmonary artery pressure ≥ 17 mmHg, preoperative pulmonary vascular resistance index ≥ 3.1 Wood Units·m2 and atrioventricular valve regurgitation. In addition, the independent predictors of an early worse outcome included preoperative mean pulmonary artery pressure ≥ 17 mmHg and diaphragmatic paralysis. CONCLUSION The presence of preoperative atrioventricular valve regurgitation, preoperative mean pulmonary artery pressure ≥ 17 mmHg, preoperative pulmonary vascular resistance index ≥ 3.1 Wood Units·m2, or diaphragmatic paralysis were found to be independent risk factors requiring the good patients' selection for the Glenn operation and early aggressive management of the diaphragmatic paralysis for reducing morbidity to ensure successful candidature for Fontan completion.
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21
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Ma K, Qi L, Hua Z, Yang K, Zhang H, Li S, Zhang S, He F, Wang G. Effectiveness of Bidirectional Glenn Shunt Placement for Palliation in Complex Congenitally Corrected Transposed Great Arteries. Tex Heart Inst J 2020; 47:15-22. [PMID: 32148447 DOI: 10.14503/thij-17-6555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Surgery for complex congenitally corrected transposed great arteries is one of the greatest challenges in cardiovascular surgery. We report our experience with bidirectional Glenn shunt placement as a palliative procedure for complex congenitally corrected transposition. We retrospectively identified 50 consecutive patients who had been diagnosed with congenitally corrected transposition accompanied by left ventricular outflow tract obstruction and ventricular septal defect and who had then undergone palliative bidirectional Glenn shunt placement at our institution from January 2005 through December 2014. Patients were divided into 3 groups according to subsequent surgeries: Fontan completion (total cavopulmonary connection, 13 patients) (group 1), anatomic repair (hemi-Mustard and Rastelli procedures without Glenn takedown, 11 patients) (group 2), and prolonged palliation (no further surgery, 26 patients) (group 3). After shunt placement, no patient died or had ventricular dysfunction. Overall, mean oxygen saturation increased significantly from 79.5% ± 13.5% preoperatively to 94.1% ± 7.3% (P <0.001). The median time from shunt placement to Fontan completion and anatomic repair, respectively, was 2.1 years (range, 1.6-5.2 yr) and 1.1 years (range, 0.6-2.4 yr). Only 2 late deaths occurred, both in group 1. In group 3, time from shunt placement to latest follow-up was 4.5 years (range, 2.3-8 yr). At latest follow-up, mean oxygen saturation was 91.6% ± 10.3%, and no patients had impaired ventricular function. Bidirectional Glenn shunt placement as an optional palliative procedure for complex congenitally corrected transposition has favorable outcomes. Later, patients can feasibly be treated by Fontan completion or anatomic repair. Use of a bidirectional Glenn shunt for open-ended palliation is also acceptable.
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22
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Miana LA, Manuel V, Turquetto AL, Issa HN, Guerreiro GP, Caneo LF, Jatene FB, Jatene MB. Atrioventricular Valve Repair in Single Ventricle Physiology: Timing Matters. World J Pediatr Congenit Heart Surg 2019; 11:22-28. [PMID: 31835992 DOI: 10.1177/2150135119884916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Atrioventricular valve (AVV) regurgitation in patients with single ventricle (SV) physiology severely impacts prognosis; the appropriate timing for surgical treatment is unknown. We sought to study the results of surgical treatment of AVV regurgitation in SV patients and evaluate risk factors for mortality. METHODS Medical records of 81 consecutive patients with moderate or severe AAV regurgitation who were submitted to AVV repair or replacement during any stage of univentricular palliation between January 2013 and May 2017 were examined. We studied demographic data and perioperative factors looking for predictors that might have influenced the results. Binary logistic regression was used to assess the impact on postoperative ventricular dysfunction and mortality. RESULTS Median age and weight were seven months (interquartile range [IQR]: 3-24) and 5.2 kg (IQR: 3.7-11.2), respectively. Seventy (86.4%) patients underwent AVV repair, and 11 (13.6%) patients underwent AVV replacement. There was an association between AVV repair effectiveness and timing of intervention (P = .004). Atrioventricular valve intervention at the time of initial surgical palliation was associated with more ineffective repairs (P = .001), while AVV replacement was more common between Glenn and Fontan procedures (P = .004). Overall 30-day mortality was 30.5% (25 patients). In-hospital mortality was 49.4%, and it was higher when AVV repair was performed concomitant with initial (stage 1) palliation (64.1% vs 35.7%; P = .01) and when an effective repair was not achieved (75% vs 41%; P = .008). Multivariable analysis identified timing concomitant with stage 1 palliation as an independent risk factor for mortality (P = .01); meanwhile, an effective repair was a protective factor against in-hospital mortality (P = .05). CONCLUSION Univentricular physiology with AVV regurgitation is a high-risk group of patients. Surgery for AVV regurgitation at stage 1 palliation was associated with less effective repair and higher mortality in this initial experience. On the other hand, effective repair determined better outcomes, highlighting the importance of experience and the learning curve in the management of such patients.
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Affiliation(s)
- Leonardo A Miana
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Valdano Manuel
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
| | - Aida Luísa Turquetto
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Hugo Neder Issa
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Gustavo Pampolha Guerreiro
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz Fernando Caneo
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fábio Biscegli Jatene
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcelo Biscegli Jatene
- Division of Cardiovascular Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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23
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Herrmann JL, Brown JW. The Superior Cavopulmonary Connection: History and Current Perspectives. World J Pediatr Congenit Heart Surg 2019; 10:216-222. [DOI: 10.1177/2150135119825560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The development of the superior cavopulmonary connection is a rich illustration of international influences in congenital cardiac surgery. The bidirectional Glenn and hemi-Fontan procedures have improved survival as both definitive and staged functional single ventricle palliation. The optimal timing of the second-stage superior cavopulmonary procedures varies by center but for low- and intermediate-risk patients, this may be within three to six months after the Norwood procedure. The list of risk factors continues to grow but the most frequently cited factors include atrioventricular valve regurgitation, decreased ventricular function, need for reintervention, and failure to attain nutritional and growth goals. Ongoing prospective, multi-institutional studies, particularly those fostered internationally by the World Society for Pediatric and Congenital Heart Surgery and other associations, will hopefully provide further clarification of the complex management issues related to patients with functional single ventricle physiology.
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Affiliation(s)
- Jeremy L. Herrmann
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Children’s Health at Indiana University Health, Indianapolis, IN, USA
| | - John W. Brown
- Division of Thoracic and Cardiovascular Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Children’s Health at Indiana University Health, Indianapolis, IN, USA
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Hormaza VM, Conaway M, Schneider DS, Vergales JE. The effect of right ventricular function on survival and morbidity following stage 2 palliation: An analysis of the single ventricle reconstruction trial public data set. CONGENIT HEART DIS 2018; 14:274-279. [PMID: 30506893 DOI: 10.1111/chd.12722] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 09/24/2018] [Accepted: 10/20/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Limited information is known on how right ventricular function affects outcomes after stage 2 palliation. We evaluated the impact of different right ventricular indices prior to stage 2 palliation on morbidity and mortality. DESIGN Retrospective study design. SETTING Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set. PATIENT Any variant of stage 1 palliation and all anatomic hypoplastic left heart syndrome variants in the trial were evaluated. Echocardiograms prior to stage 2 palliation were analyzed and compared between those who failed and those who survived. INTERVENTION None. OUTCOME MEASURES Mortality was defined as death, listed for transplant, or transplanted after stage 2 palliation. Morbidity was evaluated as hospital length of stay and duration of intubation. RESULTS A total of 283 patients met criteria for analysis. Of those, only 18 patients failed stage 2. Right ventricular fractional area change was less in those who failed (30% vs 34%, P = .039) and right ventricular indexed end-diastolic volume and end-systolic volume were larger in those who failed (142.74 mL/ BSA1.3 vs 111.29 mL/BSA1.3 , P = .023, 88.45 mL/ BSA1.3 vs 62.75 mL/ BSA1.3 , P = .025, respectively). Larger right ventricular indexed end-diastolic and systolic volumes were associated with failure (OR 1.17 [1.01-1.35] P = .021, OR 1.25 [1.03-1.52] P = .021, respectively). Every 10% increase in RV ejection fraction had a 63% decrease in length of stay and a 68% decrease in duration of intubation (P = .014, and P = .039, respectively). CONCLUSION Patients with decreased right ventricular fractional area change and larger right ventricular indexed end-diastolic and systolic volumes were more likely to fail stage 2 palliation. Those with preserved right ventricular function had a shorter hospital length of stay and duration of intubation. Echocardiographic measurements of right ventricular indices during the interstage period can be utilized to determine the prognosis following stage 2 palliation.
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Affiliation(s)
- Vanessa Marie Hormaza
- Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Mark Conaway
- Division of Translational Research and Statistics, Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia
| | - Daniel Scott Schneider
- Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Jeffrey Eric Vergales
- Division of Cardiology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
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Tran S, Sullivan PM, Cleveland J, Kumar SR, Takao C. Elevated Pulmonary Artery Pressure, Not Pulmonary Vascular Resistance, is an Independent Predictor of Short-Term Morbidity Following Bidirectional Cavopulmonary Connection. Pediatr Cardiol 2018; 39:1572-1580. [PMID: 29948033 DOI: 10.1007/s00246-018-1932-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/07/2018] [Indexed: 11/24/2022]
Abstract
Single ventricle palliation relies on the pulmonary vasculature accommodating non-pulsatile systemic venous return. Mean pulmonary artery pressure (MPAP) and indexed pulmonary vascular resistance (PVRi) are two measures that impact pulmonary blood flow following bidirectional cavopulmonary connection (BCPC). The purpose of the study was to determine which hemodynamic features are associated with adverse outcomes after BCPC. Pre-operative hemodynamic data and post-operative morbidity and mortality in 250 patients undergoing BCPC at a single center from 2008 to 2014 were reviewed. Patients were then separated into 5 physiologic states based on MPAP, PVRi, and degree of pulmonary to systemic blood flow (Qp:Qs). There were 9 (3.6%) deaths, and 49 patients (20%) sustained major morbidity. An ROC curve identified MPAP > 16 mmHg as an inflection point. Pre-BCPC sildenafil and oxygen use, ventricular dysfunction, and MPAP > 16 mmHg (OR 4.1 [95% CI 1.8-9.2]) were independently associated with morbidity. MPAP > 16 mmHg (OR 6.7 [95% CI 1.6-28]) and pre-BCPC oxygen use were associated with hospital mortality. PVRi was not associated with morbidity or mortality. Of the five physiologic states, patients with high MPAP, low PVRi, and low Qp:Qs fared the worst, with the highest risk of major morbidity (OR 8.6 [3.0-24.9]) and highest risk of mortality (OR 8.0 [1.5-41.3]) when compared to their reference groups (low MPAP, low PVRi). Elevated MPAP, need for pre-operative oxygen support, sildenafil use, and systemic ventricular systolic dysfunction predict morbidity following BCPC. Specifically, patients with elevated MPAP not due to elevated PVRi or pulmonary blood flow had the highest risk of morbidity and mortality.
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Affiliation(s)
- Susanna Tran
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, USA. .,, PO Box 572007, Tarzana, CA, 91357, USA.
| | - Patrick M Sullivan
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, USA.,Department of Pediatrics, University of South California, Los Angeles, USA
| | - John Cleveland
- Division of Cardiothoracic Surgery, Children's Hospital Los Angeles, Los Angeles, USA.,Department of Surgery, Keck School of Medicine, University of South California, Los Angeles, USA
| | - S Ram Kumar
- Division of Cardiothoracic Surgery, Children's Hospital Los Angeles, Los Angeles, USA.,Department of Pediatrics, University of South California, Los Angeles, USA.,Department of Surgery, Keck School of Medicine, University of South California, Los Angeles, USA
| | - Cheryl Takao
- Division of Cardiology, Children's Hospital Los Angeles, Los Angeles, USA.,Department of Pediatrics, University of South California, Los Angeles, USA
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Abstract
The care of children with hypoplastic left heart syndrome is constantly evolving. Prenatal diagnosis of hypoplastic left heart syndrome will aid in counselling of parents, and selected fetuses may be candidates for in utero intervention. Following birth, palliation can be undertaken through staged operations: Norwood (or hybrid) in the 1st week of life, superior cavopulmonary connection at 4-6 months of life, and finally total cavopulmonary connection (Fontan) at 2-4 years of age. Children with hypoplastic left heart syndrome are at risk of circulatory failure their entire life, and selected patients may undergo heart transplantation. In this review article, we summarise recent advances in the critical care management of patients with hypoplastic left heart syndrome as were discussed in a focused session at the 12th International Conference of the Paediatric Cardiac Intensive Care Society held on 9 December, 2016, in Miami Beach, Florida.
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Chacon-Portillo MA, Zea-Vera R, Zhu H, Dickerson HA, Adachi I, Heinle JS, Fraser CD, Mery CM. Pulsatile Glenn as long-term palliation for single ventricle physiology patients. CONGENIT HEART DIS 2018; 13:927-934. [PMID: 30280502 DOI: 10.1111/chd.12664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There are limited studies analyzing pulsatile Glenn as a long-term palliation strategy for single ventricle patients. This study sought to determine their outcomes at a single institution. DESIGN A retrospective review was performed. SETTING Study performed at a single pediatric hospital. PATIENTS All single ventricle patients who underwent pulsatile Glenn from 1995 to 2016 were included. OUTCOME MEASURES Pulsatile Glenn failure was defined as takedown, transplant, or death. Further palliation was defined as Fontan, 1.5, or biventricular repair. Risk factors were assessed by Cox multivariable competing risk analyses. RESULTS Seventy-eight patients underwent pulsatile Glenn at age 9 months (interquartile range, 5-14). In total, 28% had heterotaxy, 18% had a genetic syndrome, and 24% had an abnormal inferior vena cava. There were 3 (4%) perioperative mortalities. Further palliation was performed in 41 (53%) patients with a median time-to-palliation of 4 years (interquartile range, 3-5). Pulsatile Glenn failure occurred in 10 (13%) patients with 8 total mortalities. Five- and 10-year transplant-free survival were 91% and 84%, respectively. At a median follow-up of 6 years (interquartile range, 2-8), 27 patients (35%) remained with PG (age 7 years [interquartile range, 3-11], oxygen saturation 83% ± 4%). Preoperative moderate-severe atrioventricular valve regurgitation (AVVR) (hazard ratio 7.77; 95% confidence interval 1.80-33.43; P =.005) and higher pulmonary vascular resistance (hazard ratio 2.59; 95% confidence interval 1.08-6.15; P =.031) were predictors of pulsatile Glenn failure after adjusting for covariates. Reaching further palliation was less likely in patients with preoperative moderate-severe AVVR (hazard ratio 0.22, 95% confidence interval 0.08-0.59; P =.002). CONCLUSION Pulsatile Glenn can be an effective tool to be used in challenging circumstances, these patients can have a favorable long-term prognosis without reducing their suitability for further palliation.
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Affiliation(s)
- Martin A Chacon-Portillo
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Huirong Zhu
- Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas
| | - Heather A Dickerson
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Carlos M Mery
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Sharma R. The bidirectional Glenn shunt for univentricular hearts. Indian J Thorac Cardiovasc Surg 2018; 34:453-456. [PMID: 33060916 PMCID: PMC7525681 DOI: 10.1007/s12055-018-0653-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/18/2018] [Accepted: 01/25/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
- Rajesh Sharma
- Department of Pediatric Cardiac Surgery, Jaypee Hospital, Sector 128, Noida, Uttar Pradesh 201304 India
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29
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George-Hyslop CS, Thomas J, Fazari LG. Understanding Stage II Bidirectional Cavopulmonary Shunts. Crit Care Nurse 2018; 37:59-71. [PMID: 29196588 DOI: 10.4037/ccn2017327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Despite improvements in surgical technique and medical management, single-ventricle lesions remain one of the most challenging congenital heart anomalies to treat, and mortality rates are high. Most infants who have single-ventricle palliation undergo a sequence of surgeries to optimize pulmonary and systemic blood flow. The first surgery to separate pulmonary and systemic blood flow is the bidirectional cavopulmonary shunt. This article describes single-ventricle lesions and gives a basic overview of outcomes and strategies to improve interstage mortality. Preoperative investigations that evaluate stage II candidacy are reviewed along with surgical approaches and postoperative physiology. Although mortality rates are low and decreasing in patients with bidirectional cavopulmonary shunts, morbidity is still a challenge. Nurses must understand the pertinent anatomy and physiology and recognize postoperative complications early in order to reduce morbidity. Postoperative complications, management, outcomes and nursing care are discussed.
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Affiliation(s)
- Cecilia St George-Hyslop
- Cecilia St. George-Hyslop is an interprofessional education specialist in the cardiac critical care unit, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada. .,Jennifer Thomas is a pediatric nurse practitioner in the Single Ventricle Team at the Labatt Family Heart Centre, Hospital for Sick Children. .,Linda G. Fazari is a pediatric nurse practitioner in the cardiac critical care unit at the Labatt Family Heart Centre, Hospital for Sick Children.
| | - Jennifer Thomas
- Cecilia St. George-Hyslop is an interprofessional education specialist in the cardiac critical care unit, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Jennifer Thomas is a pediatric nurse practitioner in the Single Ventricle Team at the Labatt Family Heart Centre, Hospital for Sick Children.,Linda G. Fazari is a pediatric nurse practitioner in the cardiac critical care unit at the Labatt Family Heart Centre, Hospital for Sick Children
| | - Linda G Fazari
- Cecilia St. George-Hyslop is an interprofessional education specialist in the cardiac critical care unit, Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Jennifer Thomas is a pediatric nurse practitioner in the Single Ventricle Team at the Labatt Family Heart Centre, Hospital for Sick Children.,Linda G. Fazari is a pediatric nurse practitioner in the cardiac critical care unit at the Labatt Family Heart Centre, Hospital for Sick Children
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30
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Cleveland JD, Tran S, Takao C, Wells WJ, Starnes VA, Kumar SR. Need for Pulmonary Arterioplasty During Glenn Independently Predicts Inferior Surgical Outcome. Ann Thorac Surg 2018; 106:156-164. [DOI: 10.1016/j.athoracsur.2018.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 11/17/2022]
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31
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Cua CL, McConnell PI, Meza JM, Hill KD, Zhang S, Hersey D, Karamlou T, Jacobs JP, Jacobs ML, Galantowicz M. Hybrid Palliation: Outcomes After the Comprehensive Stage 2 Procedure. Ann Thorac Surg 2018; 105:1455-1460. [DOI: 10.1016/j.athoracsur.2017.11.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/17/2017] [Accepted: 11/10/2017] [Indexed: 12/20/2022]
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Di Maria MV, Mulvahill M, Jaggers J, Ivy DD, Younoszai AK. Predictive value of presuperior cavopulmonary anastomosis cardiac catheterization at increased altitude. CONGENIT HEART DIS 2018; 13:311-318. [DOI: 10.1111/chd.12574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/17/2017] [Accepted: 12/19/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Michael V. Di Maria
- Department of Pediatrics, Children's Hospital Colorado Heart Institute; University of Colorado School of Medicine; Aurora Colorado USA
| | - Matthew Mulvahill
- Biostatistics Core, Department of Pediatrics; University of Colorado School of Medicine; Aurora Colorado USA
| | - James Jaggers
- Department of Surgery, Children's Hospital Colorado Heart Institute; University of Colorado School of Medicine; Aurora Colorado USA
| | - David Dunbar Ivy
- Department of Pediatrics, Children's Hospital Colorado Heart Institute; University of Colorado School of Medicine; Aurora Colorado USA
| | - Adel K. Younoszai
- Department of Pediatrics, Children's Hospital Colorado Heart Institute; University of Colorado School of Medicine; Aurora Colorado USA
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Is My Patient Too Blue? Who Can Benefit From Early Intervention After a Bidirectional Cavopulmonary Anastomosis? Pediatr Crit Care Med 2018; 19:81-82. [PMID: 29303895 DOI: 10.1097/pcc.0000000000001404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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34
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Measurement of Dead Space Fraction Upon ICU Admission Predicts Length of Stay and Clinical Outcomes Following Bidirectional Cavopulmonary Anastomosis. Pediatr Crit Care Med 2018; 19:23-31. [PMID: 29189669 DOI: 10.1097/pcc.0000000000001378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Increased alveolar dead space fraction has been associated with prolonged mechanical ventilation and increased mortality in pediatric patients with respiratory failure. The association of alveolar dead space fraction with clinical outcomes in patients undergoing bidirectional cavopulmonary anastomosis for single ventricle congenital heart disease has not been reported. We describe an association of alveolar dead space fraction with postoperative outcomes in patients undergoing bidirectional cavopulmonary anastomosis. DESIGN In a retrospective case-control study, we examined for associations between alveolar dead space fraction ([PaCO2 - end-tidal CO2]/PaCO2), arterial oxyhemoglobin saturation, and transpulmonary gradient upon postoperative ICU admission with a composite primary outcome (requirement for surgical or catheter-based intervention, death, or transplant prior to hospital discharge, defining cases) and several secondary endpoints in infants following bidirectional cavopulmonary anastomosis. SETTINGS Cardiac ICU in a tertiary care pediatric hospital. PATIENTS Patients undergoing bidirectional cavopulmonary anastomosis at our institution between 2011 and 2016. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Of 191 patients undergoing bidirectional cavopulmonary anastomosis, 28 patients were cases and 163 were controls. Alveolar dead space fraction was significantly higher in the case (0.26 ± 0.09) versus control group (0.17 ± 0.09; p < 0.001); alveolar dead space fraction at admission was less than 0.12 in 0% of cases and was greater than 0.28 in 35% of cases. Admission arterial oxyhemoglobin saturation was significantly lower in the case (77% ± 12%) versus control group (83% ± 9%; p < 0.05). Sensitivity and specificity for future case versus control assignment was best when prebidirectional cavopulmonary anastomosis risk factors, admission alveolar dead space fraction (AUC, 0.74), and arterial oxyhemoglobin saturation (AUC, 0.65) were combined in a summarial model (AUC, 0.83). For a given arterial oxyhemoglobin saturation, the odds of becoming a case increased on average by 181% for every 0.1 unit increase in alveolar dead space fraction. Admission alveolar dead space fraction and arterial oxyhemoglobin saturation were linearly associated with prolonged ICU length of stay, hospital length of stay, duration of mechanical ventilation, and duration of thoracic drainage (p < 0.001 for all). CONCLUSIONS Following bidirectional cavopulmonary anastomosis, alveolar dead space fraction in excess of 0.28 or arterial oxyhemoglobin saturation less than 78% upon ICU admission indicates an increased likelihood of requiring intervention prior to hospital discharge. Increasing alveolar dead space fraction and decreasing arterial oxyhemoglobin saturation are associated with increased lengths of stay.
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Nichay NR, Gorbatykh YN, Kornilov IA, Soynov IA, Kulyabin YY, Gorbatykh AV, Ivantsov SM, Bogachev-Prokophiev AV, Karaskov AM. Risk Factors For Unfavorable Outcomes After Bidirectional Cavopulmonary Anastomosis. World J Pediatr Congenit Heart Surg 2017; 8:575-583. [DOI: 10.1177/2150135117728505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Bidirectional cavopulmonary anastomosis (BCPA) is an important preliminary step toward the Fontan procedure; thus, understanding of risk factors for morbidity and mortality after BCPA may ultimately promote improved rates of success with Fontan completion and general survival. This study evaluated survival and predictors of unfavorable outcomes in patients after BCPA. Methods: Clinical data of 157 patients who underwent BCPA from 2003 to 2015 at a single center were retrospectively analyzed. Results: Three-year and nine-year survival after BCPA were 87.1% ± 2.8% and 85.8% ± 2.9%, respectively. Freedom from unfavorable outcomes (mortality, BCPA takedown, nonsuitability for Fontan procedure) was 83.8% ± 3.1% at three years and 73.5% ± 4.8% at nine years. Multivariate proportional hazards regression analysis revealed that total anomalous pulmonary venous connection (TAPVC; hazard ratio [HR]: 3.74, 95% confidence interval [CI]: 1.35-10.36; P = .01) and increased mean pressure in BCPA circuit (HR: 1.17, 95% CI: 1.02-1.34; P = .03) were independent risk factors for unfavorable outcomes. Postoperative mean pressure in BCPA circuit in patients with poor outcomes was median 16 mm Hg (interquartile range [IQR]: 14-18 mm Hg) versus median 14 mm Hg (IQR: 12-15.5 mm Hg) in patients with favorable outcomes ( P < .01). Preoperative (HR: 1.87, 95% CI: 1.20-2.91; P < .01) and postoperative atrioventricular valve regurgitation (AVVR; HR: 2.22, 95% CI: 1.24-3.94; P < .01) were also associated with unfavorable outcome in univariate Cox regression. Conclusions: Elevated mean pressure in the BCPA circuit is the main predictor of unfavorable outcome; therefore, thorough preoperative examination and careful patient selection are critical points for successful intermediate-stage and later Fontan completion. Total anomalous pulmonary venous connection and insufficient correction of AVVR worsen the prognosis in this patient group.
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Affiliation(s)
- Nataliya R. Nichay
- Department of Congenital Heart Disease, Siberian Biomedical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russian Federation
| | - Yuriy N. Gorbatykh
- Department of Congenital Heart Disease, Siberian Biomedical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russian Federation
| | - Igor A. Kornilov
- Department of Anesthesiology, Siberian Biomedical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russian Federation
| | - Ilya A. Soynov
- Department of Congenital Heart Disease, Siberian Biomedical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russian Federation
| | - Yuriy Y. Kulyabin
- Department of Congenital Heart Disease, Siberian Biomedical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russian Federation
| | - Artem V. Gorbatykh
- Department of Congenital Heart Disease, Siberian Biomedical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russian Federation
| | - Sergey M. Ivantsov
- Department of Congenital Heart Disease, Siberian Biomedical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russian Federation
| | - Alexander V. Bogachev-Prokophiev
- Department of Congenital Heart Disease, Siberian Biomedical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russian Federation
| | - Alexander M. Karaskov
- Department of Congenital Heart Disease, Siberian Biomedical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russian Federation
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Pająk J, Buczyński M, Stanek P, Zalewski G, Wites M, Szydłowski L, Mazurek B, Tomkiewicz-Pająk L. Preoperative single ventricle function determines early outcome after second-stage palliation of single ventricle heart. Cardiovasc Ultrasound 2017; 15:21. [PMID: 28893257 PMCID: PMC5594433 DOI: 10.1186/s12947-017-0114-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/05/2017] [Indexed: 11/21/2022] Open
Abstract
Background Second-stage palliation with hemi-Fontan or bidirectional Glenn procedures has improved the outcomes of patients treated for single-ventricle heart disease. The aim of this study was to retrospectively analyze risk factors for death after second-stage palliation of single-ventricle heart and to compare therapeutic results achieved with the hemi-Fontan and bidirectional Glenn procedures. Material and methods We analyzed 60 patients who had undergone second-stage palliation for single-ventricle heart. Group HF consisted of 23 (38.3%) children who had been operated with the hemi-Fontan method; Group BDG consisted of 37 (61.7%) who had been operated with the bidirectional Glenn method. The analysis focused on 30-day postoperative mortality rates, clinical and echocardiographic data, and early complications. Results The patients’ ages at the time of repair was 33 ± 11.2 weeks; weight was 6.7 ± 1.2 kg. The most common anatomic subtype was hypoplastic left heart syndrome, in 36 (60%) patients. The early mortality rate was 13.3%. Significant preoperative atrioventricular valve regurgitation, single-ventricle heart dysfunction, pneumonia/sepsis, and arrhythmias were associated with higher mortality rates after second-stage palliation. Multivariate analysis identified significant preoperative single-ventricle heart dysfunction as an independent predictor of early death after second-stage palliation. No differences were found in the analyzed variables after bidirectional Glenn compared with hemi-Fontan procedures. Conclusion Significant preoperative atrioventricular valve regurgitation, arrhythmias and pneumonia/sepsis are closely correlated with mortality in patients with single-ventricle heart after second-stage palliation. Preoperative significant single-ventricle heart dysfunction is an independent mortality predictor in this group of patients. There are no differences in clinical, echocardiographic data, or outcomes in patients treated with the hemi-Fontan compared with bidirectional Glenn procedures.
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Affiliation(s)
- Jacek Pająk
- Pediatric Heart Surgery and General Pediatric Surgery Department, Medical University of Warsaw, ul. Żwirki i Wigury 63A, 02-091, Warszawa, Poland.
| | - Michał Buczyński
- Pediatric Heart Surgery and General Pediatric Surgery Department, Medical University of Warsaw, ul. Żwirki i Wigury 63A, 02-091, Warszawa, Poland
| | - Piotr Stanek
- Pediatric Heart Surgery Department, The Independent Public Clinical Hospital no. 6 of the Medical University of Silesia, Katowice, Poland
| | - Grzegorz Zalewski
- Pediatric Heart Surgery Department, The Independent Public Clinical Hospital no. 6 of the Medical University of Silesia, Katowice, Poland
| | - Marek Wites
- Pediatric Heart Surgery Department, The Independent Public Clinical Hospital no. 6 of the Medical University of Silesia, Katowice, Poland
| | - Lesław Szydłowski
- Department of Pediatric Cardiology, Medical University of Silesia, Katowice, Poland
| | - Bogusław Mazurek
- Department of Pediatric Cardiology, Medical University of Silesia, Katowice, Poland
| | - Lidia Tomkiewicz-Pająk
- Institute of Cardiology, Jagiellonian University, Medical College and John Paul II Hospital, Krakow, Poland
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First-in-Human Closed-Chest Transcatheter Superior Cavopulmonary Anastomosis. J Am Coll Cardiol 2017; 70:745-752. [PMID: 28774381 DOI: 10.1016/j.jacc.2017.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the care of patients with congenital heart disease, percutaneous interventional treatments have supplanted many surgical approaches for simple lesions, such as atrial septal defect. By contrast, complex congenital heart defects continue to require open-heart surgery. In single-ventricle patients, a staged approach is employed, which requires multiple open-heart surgeries and significant attendant morbidity and mortality. A nonsurgical transcatheter alternative would be attractive. OBJECTIVES The authors sought to show the feasibility of catheter-only, closed-chest, large-vessel anastomosis (superior vena cava and pulmonary artery [PA] or bidirectional Glenn operation equivalent) in a patient. METHODS In preclinical testing over a decade, the authors developed the techniques and technology needed for nonsurgical crossing from a donor (superior vena cava) to a recipient (PA) vessel and endovascular stent-based anastomosis of those blood vessels. The authors undertook this transcatheter approach for an adult with untreated congenital heart disease with severe cyanosis and significant surgical risk. They rehearsed the procedure step by step using contrast-enhanced cardiac computed tomography and a patient-specific 3-dimensional printed heart model. RESULTS The authors describe a first-in-human, fully percutaneous superior cavopulmonary anastomosis (bidirectional Glenn operation equivalent). The patient, a 35-year-old woman, was homebound due to dyspnea and worsening cyanosis. She was diagnosed with functional single ventricle and very limited pulmonary blood flow. The heart team believed surgical palliation conferred high operative risk due to the patient's complete condition. With the percutaneous procedure, the patient recovered uneventfully and remained improved clinically after 6 months. CONCLUSIONS This procedure may provide a viable alternative to one of the foundational open-heart surgeries currently performed to treat single-ventricle congenital heart disease.
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Meza JM, Hickey E, McCrindle B, Blackstone E, Anderson B, Overman D, Kirklin JK, Karamlou T, Caldarone C, Kim R, DeCampli W, Jacobs M, Guleserian K, Jacobs JP, Jaquiss R. The Optimal Timing of Stage-2-Palliation After the Norwood Operation. Ann Thorac Surg 2017; 105:193-199. [PMID: 28847537 DOI: 10.1016/j.athoracsur.2017.05.041] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The effect of the timing of stage-2-palliation (S2P) on survival through single ventricle palliation remains unknown. This study investigated the optimal timing of S2P that minimizes pre-S2P attrition and maximizes post-S2P survival. METHODS The Congenital Heart Surgeons' Society's critical left ventricular outflow tract obstruction cohort was used. Survival analysis was performed using multiphase parametric hazard analysis. Separate risk factors for death after the Norwood and after S2P were identified. Based on the multivariable models, infants were stratified as low, intermediate, or high risk. Cumulative 2-year, post-Norwood survival was predicted. Optimal timing was determined using conditional survival analysis and plotted as 2-year, post-Norwood survival versus age at S2P. RESULTS A Norwood operation was performed in 534 neonates from 21 institutions. The S2P was performed in 71%, at a median age of 5.1 months (IQR: 4.3 to 6.0), and 22% died after Norwood. By 5 years after S2P, 10% of infants had died. For low- and intermediate-risk infants, performing S2P after age 3 months was associated with 89% ± 3% and 82% ± 3% 2-year survival, respectively. Undergoing an interval cardiac reoperation or moderate-severe right ventricular dysfunction before S2P were high-risk features. Among high-risk infants, 2-year survival was 63% ± 5%, and even lower when S2P was performed before age 6 months. CONCLUSIONS Performing S2P after age 3 months may optimize survival of low- and intermediate-risk infants. High-risk infants are unlikely to complete three-stage palliation, and early S2P may increase their risk of mortality. We infer that early referral for cardiac transplantation may increase their chance of survival.
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Affiliation(s)
- James M Meza
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario
| | - Edward Hickey
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario
| | - Brian McCrindle
- Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario
| | - Eugene Blackstone
- Division of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Brett Anderson
- Division of Cardiology, Morgan-Stanley Children's Hospital/New York Presbyterian Hospital, New York, New York
| | - David Overman
- Division of Pediatric Cardiovascular Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - James K Kirklin
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Tara Karamlou
- Division of Thoracic and Cardiovascular Surgery, Phoenix Children's Hospital, Phoenix, Arizona
| | - Christopher Caldarone
- Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario
| | - Richard Kim
- Division of Cardiothoracic Surgery, Los Angeles Children's Hospital, Los Angeles, California
| | - William DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Florida
| | - Marshall Jacobs
- Division of Cardiac Surgery, Johns Hopkins Heart and Vascular Institute, Baltimore, Maryland
| | - Kristine Guleserian
- Division of Cardiovascular Surgery, Niklaus Children's Hospital, Miami, Florida
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Robert Jaquiss
- Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, Texas.
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Meza JM, Hickey EJ, Blackstone EH, Jaquiss RDB, Anderson BR, Williams WG, Cai S, Van Arsdell GS, Karamlou T, McCrindle BW. The Optimal Timing of Stage 2 Palliation for Hypoplastic Left Heart Syndrome: An Analysis of the Pediatric Heart Network Single Ventricle Reconstruction Trial Public Data Set. Circulation 2017; 136:1737-1748. [PMID: 28687711 DOI: 10.1161/circulationaha.117.028481] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/26/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND In infants requiring 3-stage single-ventricle palliation for hypoplastic left heart syndrome, attrition after the Norwood procedure remains significant. The effect of the timing of stage 2 palliation (S2P), a physician-modifiable factor, on long-term survival is not well understood. We hypothesized that an optimal interval between the Norwood and S2P that both minimizes pre-S2P attrition and maximizes post-S2P survival exists and is associated with individual patient characteristics. METHODS The National Institutes of Health/National Heart, Lung, and Blood Institute Pediatric Heart Network Single Ventricle Reconstruction Trial public data set was used. Transplant-free survival (TFS) was modeled from (1) Norwood to S2P and (2) S2P to 3 years by using parametric hazard analysis. Factors associated with death or heart transplantation were determined for each interval. To account for staged procedures, risk-adjusted, 3-year, post-Norwood TFS (the probability of TFS at 3 years given survival to S2P) was calculated using parametric conditional survival analysis. TFS from the Norwood to S2P was first predicted. TFS after S2P to 3 years was then predicted and adjusted for attrition before S2P by multiplying by the estimate of TFS to S2P. The optimal timing of S2P was determined by generating nomograms of risk-adjusted, 3-year, post-Norwood, TFS versus the interval from the Norwood to S2P. RESULTS Of 547 included patients, 399 survived to S2P (73%). Of the survivors to S2P, 349 (87%) survived to 3-year follow-up. The median interval from the Norwood to S2P was 5.1 (interquartile range, 4.1-6.0) months. The risk-adjusted, 3-year, TFS was 68±7%. A Norwood-S2P interval of 3 to 6 months was associated with greatest 3-year TFS overall and in patients with few risk factors. In patients with multiple risk factors, TFS was severely compromised, regardless of the timing of S2P and most severely when S2P was performed early. No difference in the optimal timing of S2P existed when stratified by shunt type. CONCLUSIONS In infants with few risk factors, progressing to S2P at 3 to 6 months after the Norwood procedure was associated with maximal TFS. Early S2P did not rescue patients with greater risk factor burdens. Instead, referral for heart transplantation may offer their best chance at long-term survival. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT00115934.
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Affiliation(s)
- James M Meza
- From Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada (J.M.M., E.J.H., W.G.W., S.C., G.S.V.A.); Departments of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B.); Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, TX (R.D.B.J.); Division of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ (T.K.); and Division of Pediatric Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada (B.W.M.).
| | - Edward J Hickey
- From Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada (J.M.M., E.J.H., W.G.W., S.C., G.S.V.A.); Departments of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B.); Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, TX (R.D.B.J.); Division of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ (T.K.); and Division of Pediatric Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada (B.W.M.)
| | - Eugene H Blackstone
- From Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada (J.M.M., E.J.H., W.G.W., S.C., G.S.V.A.); Departments of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B.); Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, TX (R.D.B.J.); Division of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ (T.K.); and Division of Pediatric Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada (B.W.M.)
| | - Robert D B Jaquiss
- From Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada (J.M.M., E.J.H., W.G.W., S.C., G.S.V.A.); Departments of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B.); Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, TX (R.D.B.J.); Division of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ (T.K.); and Division of Pediatric Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada (B.W.M.)
| | - Brett R Anderson
- From Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada (J.M.M., E.J.H., W.G.W., S.C., G.S.V.A.); Departments of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B.); Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, TX (R.D.B.J.); Division of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ (T.K.); and Division of Pediatric Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada (B.W.M.)
| | - William G Williams
- From Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada (J.M.M., E.J.H., W.G.W., S.C., G.S.V.A.); Departments of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B.); Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, TX (R.D.B.J.); Division of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ (T.K.); and Division of Pediatric Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada (B.W.M.)
| | - Sally Cai
- From Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada (J.M.M., E.J.H., W.G.W., S.C., G.S.V.A.); Departments of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B.); Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, TX (R.D.B.J.); Division of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ (T.K.); and Division of Pediatric Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada (B.W.M.)
| | - Glen S Van Arsdell
- From Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada (J.M.M., E.J.H., W.G.W., S.C., G.S.V.A.); Departments of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B.); Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, TX (R.D.B.J.); Division of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ (T.K.); and Division of Pediatric Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada (B.W.M.)
| | - Tara Karamlou
- From Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada (J.M.M., E.J.H., W.G.W., S.C., G.S.V.A.); Departments of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B.); Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, TX (R.D.B.J.); Division of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ (T.K.); and Division of Pediatric Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada (B.W.M.)
| | - Brian W McCrindle
- From Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, ON, Canada (J.M.M., E.J.H., W.G.W., S.C., G.S.V.A.); Departments of Thoracic and Cardiovascular Surgery and Quantitative Health Sciences, Cleveland Clinic, OH (E.H.B.); Division of Pediatric Cardiothoracic Surgery, Children's Medical Center, Dallas, TX (R.D.B.J.); Division of Pediatric Cardiology, New York Presbyterian-Morgan Stanley Children's Hospital, Columbia University Medical Center (B.R.A.); Division of Cardiothoracic Surgery, Phoenix Children's Hospital, Phoenix, AZ (T.K.); and Division of Pediatric Cardiology, The Hospital for Sick Children, University of Toronto, Ontario, Canada (B.W.M.)
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Meza JM, Jaquiss RDB, Anderson BR, Moga MA, Kirklin JK, Sarris G, Williams WG, McCrindle BW. Current Practices in the Timing of Stage 2 Palliation. World J Pediatr Congenit Heart Surg 2017; 8:135-141. [PMID: 28329463 DOI: 10.1177/2150135116677253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Mortality through single-ventricle palliation remains high and the effect of the timing of stage 2 palliation (S2P) is not well understood. We investigated current practice patterns in the timing of S2P across two professional societies and compared them to actual practice patterns from two databases of patients who underwent S2P. METHODS A ten-question survey was distributed to the members of the Congenital Heart Surgeons' Society (CHSS) and the European Congenital Heart Surgeons' Association (ECHSA). Results were summarized using descriptive statistics. Surgeon-reported preferences were compared to clinical data from the CHSS Critical Left Ventricular Outflow Tract Obstruction (LVOTO) Registry and the Pediatric Heart Network Single Ventricle Reconstruction (SVR) database. RESULTS Overall, 38% (88 of 232) of surgeons from 74 institutions responded, of which 70% (62 of 88) were CHSS members and 30% (26 of 88) were ECHSA members. Surgeons reported performing S2P at a median of five months after stage 1 (interquartile range [IQR]: 4.5-6), with no difference between CHSS and ECHSA surgeons. Surgeons reported performing nonelective S2P at a median of 4.5 months after stage 1 (IQR: 3.5-5.5), again with no difference by society. No difference existed between the surgeon-reported preferences and patient data in the Critical LVOTO and SVR databases for the timing of elective (5 vs 5.1 vs 5.3 months, P = .19) or nonelective S2P (4.5 vs 4.6 vs 4.2 months, P = .06). CONCLUSION There was a remarkable lack of variation in surgeon preferences regarding the timing of S2P. This may represent a natural standardization of practice across congenital heart surgery, which is notable, given the current lack of guidelines regarding the timing of S2P.
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Affiliation(s)
- James M Meza
- 1 John W. Kirklin/David Ashburn Fellow, Congenital Heart Surgeons' Society Data Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Robert D B Jaquiss
- 2 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Brett R Anderson
- 3 Division of Cardiology, Department of Pediatrics, Morgan-Stanley Children's Hospital/New York Presbyterian Hospital, New York, NY, USA
| | - Michael-Alice Moga
- 4 Division of Critical Care Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - James K Kirklin
- 5 Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Sarris
- 6 Department of Pediatric Heart Surgery, IASO Children's Hospital, Athens, Greece
| | - William G Williams
- 7 Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brian W McCrindle
- 8 Division of Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Bradley SM. Optimal timing for stage II: Waiting for Godot. J Thorac Cardiovasc Surg 2017; 154:226-227. [PMID: 28365013 DOI: 10.1016/j.jtcvs.2017.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Scott M Bradley
- Section of Pediatric Cardiac Surgery, Medical University of South Carolina, Charleston, SC.
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Sizarov A, Raimondi F, Bonnet D, Boudjemline Y. Vascular anatomy in children with univentricular hearts regarding transcatheter bidirectional Glenn anastomosis. Arch Cardiovasc Dis 2017; 110:223-233. [DOI: 10.1016/j.acvd.2016.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/27/2016] [Accepted: 09/15/2016] [Indexed: 11/28/2022]
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Evans CF, Sorkin JD, Abraham DS, Wehman B, Kaushal S, Rosenthal GL. Interstage Weight Gain Is Associated With Survival After First-Stage Single-Ventricle Palliation. Ann Thorac Surg 2017; 104:674-680. [PMID: 28347534 DOI: 10.1016/j.athoracsur.2016.12.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 12/11/2016] [Accepted: 12/19/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND Low birth and operative weight have been identified as risk factors for death after first-stage single-ventricle palliation. We hypothesize that weight gain after the first-stage operation is associated with transplant-free interstage survival to admission for the second-stage operation. METHODS We used historical data from the National Pediatric Cardiology Quality Improvement Collaborative database to conduct a longitudinal study to assess the association between weight gain and transplant-free interstage survival. The primary predictor was weight gain. The primary outcome was transplant-free survival. We constructed a repeated-measures logistic regression model using the general estimating equation method to examine the association between weight gain and transplant-free interstage survival. RESULTS The study population included 1,501 infants who were discharged alive from the first-stage single-ventricle palliation between June 2008 and January 2015. Patients who underwent a hybrid operation (n = 132) or were lost to follow-up (n = 11) were excluded. Transplant-free interstage survival was 90% (1,228 of 1,358). The mean weight gain was 2.5 (SD, 1.0) kg. Adjusted for age at the time of each measurement, the number of measurements, age at discharge from the first-stage operation, sex, diagnosis, postoperative arrhythmia, postoperative complications, and discharge antibiotic therapy, each 100-g increase in weight was associated with an odds ratio of transplant-free interstage survival of 1.03 (95% confidence limit, 1.01, 1.05). CONCLUSIONS After first-stage single-ventricle palliation, interstage weight gain is significantly associated with transplant-free interstage survival.
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Affiliation(s)
- Charles F Evans
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
| | - John D Sorkin
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Danielle S Abraham
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Brody Wehman
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sunjay Kaushal
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland
| | - Geoffrey L Rosenthal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
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Hill GD, Rudd NA, Ghanayem NS, Hehir DA, Bartz PJ. Center Variability in Timing of Stage 2 Palliation and Association with Interstage Mortality: A Report from the National Pediatric Cardiology Quality Improvement Collaborative. Pediatr Cardiol 2016; 37:1516-1524. [PMID: 27558553 DOI: 10.1007/s00246-016-1465-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/16/2016] [Indexed: 11/27/2022]
Abstract
For infants with single-ventricle lesions with aortic arch hypoplasia, the interstage period from discharge following stage 1 palliation (S1P) until stage 2 palliation (S2P) remains high risk. Significant variability among institutions exists around the timing of S2P. We sought to describe institutional variation in timing of S2P, determine the association between timing of S2P and interstage mortality, and determine the impact of earlier S2P on hospital morbidity and mortality. The National Pediatric Cardiology Quality Improvement Collaborative registry was queried. Centers were divided based on median age at S2P into early (n = 15) and late (n = 16) centers using a cutoff of 153 days. Groups were compared using Chi-squared or Wilcoxon rank-sum test. Multivariable logistic regression was used to determine risk factors for interstage mortality. The final cohort included 789 patients from 31 centers. There was intra- and inter-center variability in timing of S2P, with the median age by center ranging from 109 to 214 days. Late centers had a higher mortality (9.9 vs. 5.7 %, p = 0.03) than early centers. However, the event rate (late: 8.2 vs. early: 5.8 deaths per 10,000 interstage days) was not different by group (p = 0.26). Survival to hospital discharge and hospital length of stay following S2P were similar between groups. In conclusion, in a large multi-institution collaborative, the median age at S2P varies among centers. Although optimal timing of S2P remains unclear, centers performing early S2P did not experience worse S2P outcomes and experienced less interstage mortality.
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Affiliation(s)
- Garick D Hill
- Divison of Cardiology, Department of Pediatrics, Medical College of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
| | - Nancy A Rudd
- Divison of Cardiology, Department of Pediatrics, Medical College of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Nancy S Ghanayem
- Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David A Hehir
- Division of Cardiac Critical Care, Department of Pediatrics, Nemours Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Peter J Bartz
- Divison of Cardiology, Department of Pediatrics, Medical College of Wisconsin, 9000 W Wisconsin Ave, Milwaukee, WI, 53226, USA
- Division of Adult Cardiovascular Medicine, Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Zhang T, Shi Y, Wu K, Hua Z, Li S, Hu S, Zhang H. Uncontrolled Antegrade Pulmonary Blood Flow and Delayed Fontan Completion After the Bidirectional Glenn Procedure: Real-World Outcomes in China. Ann Thorac Surg 2016; 101:1530-8. [PMID: 26794884 DOI: 10.1016/j.athoracsur.2015.10.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 10/18/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Given the low rate of Fontan completion, an aggressive policy for maintaining antegrade pulmonary blood flow (AnPBF) during the bidirectional Glenn procedure (BDG) was developed for the functional single ventricle. METHODS From 2008 to 2013, 294 patients who underwent the BDG were divided into two groups: group 1 (uncontrolled AnPBF, n = 270) and group 2 (controlled AnPBF, n = 24). Pulmonary artery banding was performed because of the high central venous pressure in group 2. In group 1, the patients who underwent BDG from 2008 to 2012 were further divided into group DF (delayed Fontan completion, n = 109) and group FC (Fontan completion, n = 42). RESULTS The Fontan completion rate was 16.3%, and the average interval time was 2.2 ± 1.1 years. The delay of Fontan completion did not reduce body weight gain or the survival rate. Furthermore, oxygen saturation was slightly reduced in group DF. Although no impairments of heart function were observed, the uncontrolled AnPBF in group DF resulted in an increase in ventricular end-diastolic diameter and aggravation of atrioventricular valve regurgitation over 24 months after BDG. Logistic regression analysis revealed that systemic right ventricular morphology was a risk factor for the aggravation of valve regurgitation. CONCLUSIONS The low Fontan achievement rate is a critical issue in China. Although the patients with delayed Fontan completion exhibited an acceptable survival rate and acceptable body weight gain, uncontrolled AnPBF was associated with ventricular enlargement and aggravation of valve regurgitation. Strategies for improving the Fontan completion rate in China should be explored and could benefit outcomes.
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Affiliation(s)
- Tao Zhang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China; Department of Cardiac Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China; Department of Cardio-Thoracic Surgery, Shouguang People's Hospital, Shandong, China
| | - Yisheng Shi
- Department of Echocardiology, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China
| | - Kaihong Wu
- Department Cardiac Surgery, Nanjing Children Hospital, Nanjing, China
| | - Zhongdong Hua
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China
| | - Shoujun Li
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China
| | - Shengshou Hu
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China
| | - Hao Zhang
- Center for Pediatric Cardiac Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Beijing, China.
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Prior Innominate Vein Occlusion Does Not Preclude Successful Bidirectional Superior Cavopulmonary Connection. Ann Thorac Surg 2015; 100:162-6. [DOI: 10.1016/j.athoracsur.2015.03.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 11/21/2022]
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Liu VJ, Yong MS, d’Udekem Y, Weintraub RG, Praporski S, Brizard CP, Konstantinov IE. Outcomes of Atrioventricular Valve Operation in Patients With Fontan Circulation. Ann Thorac Surg 2015; 99:1632-8. [DOI: 10.1016/j.athoracsur.2015.01.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/27/2014] [Accepted: 01/06/2015] [Indexed: 10/23/2022]
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Abstract
BACKGROUND Infants born with a single cardiac ventricle require a 3-stage surgical palliation performed during the first few years of life for long-term survival. We aimed to determine the extent to which the emergency department services were used between the second and third surgical stages. METHODS A retrospective chart review was performed on patients who underwent stage II palliation at our institution between 2006 and 2011. Data analyses were performed using Mann-Whitney U tests or χ tests as appropriate. RESULTS Fifty patients underwent stage II palliation during the study period, 47 of which survived to hospital discharge. Thirty-one (66%) patients required 95 emergency department visits before stage III. The most common chief complaints were respiratory (n = 39) and gastrointestinal (n = 18 visits) in nature. Age and weight at time of stage II surgery, dominant ventricle, and data from discharge echocardiograms were not significantly different between patients who did and did not require emergency department visits. Median postoperative length of stay after stage II palliation was longer in patients using the emergency department, 11 (interquartile range, 6-17) versus 7 (interquartile range, 5-8) days, P = 0.015. Moreover, patients with lengths of stay greater than 10 days were 6 times more likely to require emergency department services (odds ratio, 6.0; 95% confidence intervals, 1.4-25.4). CONCLUSIONS Emergency department use by patients with a single cardiac ventricle is common after their second surgical stage, especially in patients with more complicated postoperative courses. This study emphasizes the important role of the emergency department in the care of these challenging patients.
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Atrioventricular valve regurgitation at diagnosis in single-ventricle patients: does it affect longitudinal outcomes? Cardiol Young 2014; 24:813-21. [PMID: 24047677 DOI: 10.1017/s104795111300108x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Significant atrioventricular valve regurgitation at diagnosis in single-ventricle patients has been associated with mortality and morbidity. However, longitudinal data on the effect of valve regurgitation at diagnosis on outcomes in the era of surgical valve interventions are scarce. MATERIALS AND METHODS This is a retrospective review of single-ventricle patients admitted to a regional centre from 2005 to 2008. Data were reviewed from birth to 18 months, and association of atrioventricular valve regurgitation at diagnosis with mortality and morbidity was evaluated. RESULTS A total of 118 patients were studied, 73% with a single right ventricle. At diagnosis, 37 patients (31%) had mild, 5 (4%) had mild to moderate, and 4 (3%) had ≥ moderate atrioventricular valve regurgitation. Moderate or greater valve regurgitation was associated with mortality (HR 5.51, 95% CI 1.24-24.61, p = 0.025), and all four patients with ≥ moderate valve regurgitation died. However, valve regurgitation was not associated with mortality for left ventricle patients. In all, 12 patients (10%) had surgical atrioventricular valve interventions. There were no independent predictors of valve intervention, and no patient having an intervention had > mild valve regurgitation at diagnosis. There was no association between valve regurgitation and days of hospitalisation or chest tube drainage. CONCLUSION Significant atrioventricular valve regurgitation at diagnosis remains a risk factor for mortality in single-ventricle patients, although it may be less important for single left ventricle patients. However, it is not associated with increased morbidity or surgical atrioventricular valve intervention in survivors. Reliably predicting surgical atrioventricular valve intervention remains a challenge in single-ventricle patients.
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Building foundations for transcatheter intervascular anastomoses: 3D anatomy of the great vessels in large experimental animals. Interact Cardiovasc Thorac Surg 2014; 19:543-51. [DOI: 10.1093/icvts/ivu210] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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