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Fricke K, Mellander M, Hanséus K, Tran P, Synnergren M, Johansson Ramgren J, Rydberg A, Sunnegårdh J, Dalén M, Sjöberg G, Weismann CG, Liuba, P. Impact of Left Ventricular Morphology on Adverse Outcomes Following Stage 1 Palliation for Hypoplastic Left Heart Syndrome: 20 Years of National Data From Sweden. J Am Heart Assoc 2022; 11:e022929. [PMID: 35348003 PMCID: PMC9075443 DOI: 10.1161/jaha.121.022929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Hypoplastic left heart syndrome is associated with significant morbidity and mortality. We aimed to assess the influence of left ventricular morphology and choice of shunt on adverse outcome in patients with hypoplastic left heart syndrome and stage 1 palliation.
Methods and Results
This was a retrospective analysis of patients with hypoplastic left heart syndrome with stage 1 palliation between 1999 and 2018 in Sweden. Patients (n=167) were grouped based on the anatomic subtypes aortic‐mitral atresia, aortic atresia‐mitral stenosis (AA‐MS), and aortic‐mitral stenosis. The left ventricular phenotypes including globular left ventricle (Glob‐LV), miniaturized and slit‐like left ventricle (LV), and the incidence of major adverse events (MAEs) including mortality were assessed. The overall mortality and MAEs were 31% and 41%, respectively. AA‐MS (35%) was associated with both mortality (all other subtypes versus AA‐MS: interstage‐I: hazard ratio [HR], 2.7;
P
=0.006; overall: HR, 2.2;
P
=0.005) and MAEs (HR, 2.4;
P
=0.0009). Glob‐LV (57%), noticed in all patients with AA‐MS, 61% of patients with aortic stenosis‐mitral stenosis, and 19% of patients with aortic atresia‐mitral atresia, was associated with both mortality (all other left ventricular phenotypes versus Glob‐LV: interstage‐I: HR, 4.5;
P
=0.004; overall: HR, 3.4;
P
=0.0007) and MAEs (HR, 2.7;
P
=0.0007). There was no difference in mortality and MAEs between patients with AA‐MS and without AA‐MS with Glob‐LV (
P
>0.15). Patients with AA‐MS (35%) or Glob‐LV (38%) palliated with a Blalock‐Taussig shunt had higher overall mortality compared with those palliated with Sano shunts, irrespective of the stage 1 palliation year (AA‐MS: HR, 2.6;
P
=0.04; Glob‐ LV: HR, 2.1;
P
=0.03).
Conclusions
Glob‐LV and AA‐MS are independent morphological risk factors for adverse short‐ and long‐ term outcome, especially if a Blalock‐Taussig shunt is used as part of stage 1 palliation. These findings are important for the clinical management of patients with hypoplastic left heart syndrome.
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Affiliation(s)
- Katrin Fricke
- Cardiology Pediatric Heart Centre Skåne University Hospital Lund Sweden
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
| | - Mats Mellander
- Department of Pediatrics Institute of Clinical SciencesSahlgrenska Academy Gothenburg Sweden
- Children´s Heart Centre Sahlgrenska University Hospital Gothenburg Sweden
| | - Katarina Hanséus
- Cardiology Pediatric Heart Centre Skåne University Hospital Lund Sweden
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
| | - Phan‐Kiet Tran
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
- Cardiac Surgery Pediatric Heart Centre Skåne University Hospital Lund Sweden
| | - Mats Synnergren
- Department of Pediatrics Institute of Clinical SciencesSahlgrenska Academy Gothenburg Sweden
- Children´s Heart Centre Sahlgrenska University Hospital Gothenburg Sweden
| | - Jens Johansson Ramgren
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
- Cardiac Surgery Pediatric Heart Centre Skåne University Hospital Lund Sweden
| | - Annika Rydberg
- Department of Clinical Sciences, Pediatrics Umeå University Umeå Sweden
| | - Jan Sunnegårdh
- Department of Pediatrics Institute of Clinical SciencesSahlgrenska Academy Gothenburg Sweden
- Children´s Heart Centre Sahlgrenska University Hospital Gothenburg Sweden
| | - Magnus Dalén
- Department of Cardiothoracic Surgery Karolinska University Hospital Stockholm Sweden
- Department of Molecular Medicine and Surgery Karolinska Institute Stockholm Sweden
| | - Gunnar Sjöberg
- Department of Women's and Children's Health Karolinska Institute Stockholm Sweden
| | - Constance G. Weismann
- Cardiology Pediatric Heart Centre Skåne University Hospital Lund Sweden
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
| | - Petru Liuba,
- Cardiology Pediatric Heart Centre Skåne University Hospital Lund Sweden
- Pediatrics Department of Clinical Sciences Lund University Lund Sweden
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Risk Factors of Thrombotic Complications and Antithrombotic Therapy in Paediatric Cardiosurgical Patients. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The development of cardiosurgical care for paediatric and neonatal patients is undergoing the rapid growth. Complex, multi-stage reconstructive operations and the use of invasive monitoring are associated with high risk of venous and arterial thrombosis.The cardiac surgery patient is inherently unique, since it requires controlled anticoagulation during cardiopulmonary bypass. Moreover, the most cardiovascular pediatric patients require antithrombotic measures over the perioperative period. In addition to medication support with the use of various groups of antithrombotic agents, vascular access management is justified in order to minimize the risk of thromboembolic complications, which can affect both the functional status, and common and inter-stage mortality.The purpose of this review was to systematize the available data on risk factors contributing to the development of thrombotic complications in patients with congenital heart disease.An information search was carried out using Internet resources (PubMed, Web of Science, eLibrary.ru); literature sources for period 2015–2020 were analysed. As a result of the analysis of the literature data age-dependent features of the haemostatic system, and associated with the defect pathophysiology, and undergone reconstructive interventions were described. The issues of pathophysiology of univentricular heart defects and risk factors associated with thrombosis were also covered.Moreover, aspects of intraoperative anti-thrombotic support are discussed, as well as measures to prevent thromboembolic complications in this population.Coordinated actions of haematologists, cardiologists, anaesthesiologists, intensivists, and cardiac surgeons will allow achieving a fine balance between risks of bleeding and thrombosis in the population of paediatric patients undergoing cardiovascular surgery.
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Twite MD. Sir William Harvey, Congenital Heart Disease and Anesthesia. Semin Cardiothorac Vasc Anesth 2017; 21:121-122. [PMID: 28506196 DOI: 10.1177/1089253217704509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mark D Twite
- 1 Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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