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Zinyandu T, Knight JH, Thomas AS, Claxton J, Montero A, Shaw FR, Kochilas LK. Long-term Outcomes After Surgical Intervention for Congenital Supravalvar Aortic Stenosis in Children. Ann Thorac Surg 2024; 117:965-972. [PMID: 38302053 PMCID: PMC11055682 DOI: 10.1016/j.athoracsur.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 01/04/2024] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Primary supravalvar aortic stenosis (SVAS) is a rare congenital cardiovascular condition that can coexist with Williams-Beuren syndrome, coronary artery involvement, aortic coarctation, and pulmonary artery stenosis. SVAS repair can be achieved with low perioperative mortality, but long-term survival remains less well understood. We used the Pediatric Cardiac Care Consortium, a multicenter United States-based registry for pediatric cardiac operations, to assess long-term outcomes after SVAS repair. METHODS We used Kaplan-Meier plots and Cox proportional hazards regression to examine factors associated with postdischarge deaths. These included sex, age-group, weight z-score, coexisting conditions (Williams-Beuren syndrome, coronary artery involvement, coarctation, and pulmonary artery stenosis), surgical techniques, and era, defined as early (1982-1995) or late (1996-2003). Survival was assessed by matching with the National Death Index through 2021. RESULTS Of 333 patients who met inclusion criteria, 313 (94.0%) survived to discharge and 188 (60.1%) had identifiers for National Death Index matching. Over a median follow-up of 25.2 years (interquartile range, 21.1-29.4 years), 17 deaths occurred. The 30-year survival after discharge from SVAS repair was 88.7% (95% CI, 82.9%-94.8%). Infantile surgery and non-Williams-Beuren syndrome were associated with decreased 30-year survival. From the various repairs, the 2-sinus technique had better outcomes compared with all other types, except the 3-sinus technique (nonsignificant difference). Adjusted analysis revealed infantile age and type of repair as associated with postdischarge probability of death. CONCLUSIONS These data demonstrate favorable long-term outcomes after SVAS repair, except for the infantile group that was associated with more diffuse arteriopathy. As techniques continue to evolve, future studies are warranted to investigate their long-term outcomes.
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Affiliation(s)
- Tawanda Zinyandu
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica H Knight
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, Georgia
| | - Amanda S Thomas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - J'Neka Claxton
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Alejandro Montero
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Fawwaz R Shaw
- Department of Cardiothoracic Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lazaros K Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia.
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Beshish AG, Brady M, Golloshi K, Cote O, Gathoo A, Menon A, Qian J, Zinyandu T, Shaw FR, Maher KO, Deshpande SR. Impact of Antegrade Pulmonary Blood Flow as Patients Progress Through Single-Ventricle Palliations. Ann Thorac Surg 2024; 117:983-989. [PMID: 37527698 DOI: 10.1016/j.athoracsur.2023.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/01/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The impact of antegrade pulmonary blood flow (APBF) during single-ventricle (SV) palliation continues to be debated. We sought to assess its impact on the hemodynamic profile and the short- and long-term outcomes of patients progressing through stages of SV palliation. METHODS A retrospective single-center study was conducted of SV patients who underwent surgery between January 2010 and December 2020. Patients with APBF were matched to those with no APBF by a propensity score based on body surface area, sex, and type of systemic ventricle. Analysis was performed using appropriate statistics with a significance level of P = .05. RESULTS Sixty-three patients with APBF were matched with 95 patients with no APBF. At the pre-stage 2 catheterization, APBF patients had a larger left pulmonary artery diameter (z score, 0.1 vs -0.8; P < .042). Patients with APBF had shorter cardiopulmonary bypass time (57.0 vs 79.0 minutes), shorter duration of mechanical ventilation (14.1 vs 17.4 hours), and shorter hospital length of stay (5.0 vs 7.0 days) at stage 2 palliation (P < .05). In the multivariable Cox regression analysis, patients with hypoplastic pulmonary arteries (z scores < -2; adjusted hazard ratio, 9.17) and patients with chromosomal abnormalities/genetic syndrome (adjusted hazard ratio, 4.03) were at increased risk for poor outcomes (P < .05). During the follow-up period, there was no significant difference in risk of the composite poor outcome and long-term survival between groups. CONCLUSIONS SV patients with APBF had shorter cardiopulmonary bypass time, duration of mechanical ventilation, and hospital length of stay after stage 2 palliation. Patients with hypoplastic pulmonary arteries or chromosomal abnormalities/genetic syndromes had increased risk for poor outcomes. Maintaining APBF has better short-term outcomes, but there are no long-term hemodynamic or survival benefits.
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Affiliation(s)
- Asaad G Beshish
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia.
| | | | | | - Olivia Cote
- Emory University School of Medicine, Atlanta, Georgia
| | - Asmita Gathoo
- Emory University School of Medicine, Atlanta, Georgia
| | - Ambika Menon
- Emory University School of Medicine, Atlanta, Georgia
| | - Joshua Qian
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Fawwaz R Shaw
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Kevin O Maher
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Shriprasad R Deshpande
- Division of Cardiology, Department of Pediatrics, Georgetown University School of Medicine, Children's National Hospital, Washington, DC
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Auerbach SR, Arshad A, Azeka E, Cantor RS, Kirklin JK, Koehl D, Menteer J, Peng DM, Ravekes W, Shaw FR, Shih R, Simmonds J, Ballweg J. Impact of prolonged ischemic time on pediatric heart transplantation outcomes: Improved outcomes in the most recent era. J Heart Lung Transplant 2024:S1053-2498(24)01521-3. [PMID: 38460619 DOI: 10.1016/j.healun.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 02/24/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND Impacts of ischemic time (IT) on pediatric heart transplant outcomes are multifactorial. We aimed to analyze the effect of prolonged IT on graft loss after pediatric heart transplantation. We hypothesized that graft survival with prolonged IT has improved across eras. METHODS Patients <18 years old in the Pediatric Heart Transplant Society database were included (N=6,765) and stratified by diagnosis and era (1993-2004, 2005-2009, and 2010-2019). Severe graft failure (SGF) was defined as death, retransplant, or need for mechanical circulatory support in the first 7 days post-transplant. Descriptive statistical methods were used to compare differences between patient characteristics and IT. Kaplan-Meier survival analysis compared freedom from graft loss, rejection, and infection. Multivariable analysis was performed for graft loss and SGF (hazard and logistic regression modeling, respectively). RESULTS Diagnoses were cardiomyopathy (N = 3,246) and congenital heart disease (CHD; N = 3,305). CHD were younger, more likely to have an IT ≥4.5 hours, and more likely to require extracorporeal membrane oxygenation or mechanical ventilation at transplant (all p < 0.001). Median IT was 3.6 hours (interquartile range 2.98-4.31; range 0-10.5). IT was associated with early graft loss (HR 1.012, 95% CI 1.005-1.019), but not when analyzed only in the most recent era. IT was associated with SGF (OR 1.016 95%CI 1.003-1.030). CONCLUSIONS Donor IT was independently associated with an increased risk of graft loss, albeit with a small effect relative to other risk factors. Graft survival with prolonged IT has improved in the most recent era but the risk of SGF persists.
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Affiliation(s)
- Scott R Auerbach
- Department of Pediatrics, Division of Cardiology, University of Colorado Denver Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Adam Arshad
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Estela Azeka
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, Birmingham, Alabama
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, Birmingham, Alabama
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, Birmingham, Alabama
| | - JonDavid Menteer
- Children's Hospital Los Angeles and Department of Pediatrics, Division of Cardiology University of Southern California, Los Angeles, California
| | - David M Peng
- Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - William Ravekes
- Division of Cardiology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fawwaz R Shaw
- Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Renata Shih
- Division of Pediatric Cardiology, University of Florida, Gainesville, Florida; Congenital Heart Center, University of Florida, Gainesville, Fla, University of Florida, Gainesville, Florida
| | - Jacob Simmonds
- Department of Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Jean Ballweg
- Department of Pediatrics, University of Nebraska, Omaha, Nebraska
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Miller JC, Velani RN, Miller WD, Thomas AS, Shaw FR, Kochilas L. Long-term Outcomes After Interrupted Aortic Arch Repair. Ann Thorac Surg 2024:S0003-4975(24)00110-3. [PMID: 38360344 DOI: 10.1016/j.athoracsur.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/05/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Interrupted aortic arch (IAA) is associated with left ventricular outflow tract obstruction (LVOTO) and DiGeorge syndrome. High-risk infantile surgery is required to address IAA, with limited data available on long-term outcomes. We used the Pediatric Cardiac Care Consortium, a multicenter US-based registry for pediatric cardiac interventions, to assess long-term outcomes after IAA repair by patient characteristics and surgical approach. METHODS This is a retrospective cohort study of patients undergoing IAA repair between 1982 and 2003. Kaplan-Meier plots and Cox proportional hazards regression were used to examine associations with postdischarge deaths tracked by matching with the US National Death Index. RESULTS Of 390 patients meeting inclusion criteria, 309 (79.2%) survived to discharge. During a median follow-up of 23.6 years, 30-year survival reached 80.7% for patients surviving hospital discharge after initial IAA repair. Adjusted analysis revealed higher risk of death for type B vs type A (adjusted hazard ratio [aHR], 3.32; 95% CI, 1.48-7.44), staged repair (aHR, 2.50; 95% CI, 1.14-5.50), and LVOTO interventions during initial hospitalization (aHR, 4.12; 95% CI, 1.83-9.27) but not for LVOTO without need for interventions or presence of DiGeorge syndrome. There was a trend toward improved in-hospital and long-term survival over time during the study period. CONCLUSIONS Staged repair, type B IAA, and need for LVOTO intervention during initial hospitalization for repair are associated with high risk of death out to 30 years. Survival outcomes are improving, but further efforts need to minimize staged approach and risks associated with LVOTO relief procedures.
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Affiliation(s)
- J Cole Miller
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Romie N Velani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Wade D Miller
- University of South Carolina School of Medicine, Greenville, South Carolina
| | - Amanda S Thomas
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Fawwaz R Shaw
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Lazaros Kochilas
- Children's Healthcare of Atlanta Cardiology, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
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Batsis M, Dryer R, Scheel AM, Basu M, Figueroa J, Clarke S, Shaw FR, Wolf MJ, Beshish AG. Early Functional Status Change After Cardiopulmonary Resuscitation in a Pediatric Heart Center: A Single-Center Retrospective Study. Pediatr Cardiol 2023; 44:1674-1683. [PMID: 37587236 DOI: 10.1007/s00246-023-03251-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023]
Abstract
Children with cardiac disease are at significantly higher risk for in-hospital cardiac arrest (CA) compared with those admitted without cardiac disease. CA occurs in 2-6% of patients admitted to a pediatric intensive care unit (ICU) and 4-6% of children admitted to the pediatric cardiac-ICU. Treatment of in-hospital CA with cardiopulmonary resuscitation (CPR) results in return of spontaneous circulation in 43-64% of patients and survival rate that varies from 20 to 51%. We aimed to investigate the change in functional status of survivors who experienced an in-hospital CA using the functional status scale (FSS) in our heart center by conducting a retrospective study of all patients 0-18 years who experienced CA between June 2015 and December 2020 in a free-standing university-affiliated quaternary children's hospital. Of the 165 CA patients, 61% (n = 100) survived to hospital discharge. The non-survivors had longer length from admission to CA, higher serum lactate levels peri-CA, and received higher number of epinephrine doses. Using FSS, of the survivors, 26% developed new morbidity, and 9% developed unfavorable outcomes. There was an association of unfavorable outcomes with longer CICU-LOS and number of epinephrine doses given. Sixty-one-percent of CA patients survived to hospital discharge. Of the survivors, 26% developed new morbidity and 91% had favorable outcomes. Future multicenter studies are needed to help better identify modifiable risk factors for development of poor outcomes and help improve outcomes of this fragile patient population.
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Affiliation(s)
- Maria Batsis
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, 2835 Brandywine Road, suite 400, Atlanta, GA, 30341, USA
| | - Rebecca Dryer
- Emory University School of Medicine, Atlanta, GA, USA
| | - Amy M Scheel
- Emory University School of Medicine, Atlanta, GA, USA
| | - Mohua Basu
- Qualitative Analysis, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Shanelle Clarke
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, 2835 Brandywine Road, suite 400, Atlanta, GA, 30341, USA
| | - Fawwaz R Shaw
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Michael J Wolf
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, 2835 Brandywine Road, suite 400, Atlanta, GA, 30341, USA
| | - Asaad G Beshish
- Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, 2835 Brandywine Road, suite 400, Atlanta, GA, 30341, USA.
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Patel PM, Zapata D, Qu W, Callahan M, Rao N, Kelleman M, Kanter KR, Chai PJ, Shaw FR, Shashidharan S, Rosenblum JM. Bioprosthetic Pulmonary Valve Dysfunction in Congenital Heart Disease. Ann Thorac Surg 2023; 115:641-648. [PMID: 35031286 DOI: 10.1016/j.athoracsur.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 11/21/2021] [Accepted: 12/10/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND We aim to identify the incidence and timing of dysfunction and failure of stented bioprosthetic valves in the pulmonary position in congenital heart disease patients. METHODS A total of 482 congenital heart disease patients underwent 484 stented bioprosthetic pulmonary valve implantations between 2008 and 2018. There were 164 porcine valves (Porcine) and 320 bovine pericardial valves (Pericardial) implanted. Primary endpoints were survival, valve dysfunction, and valve failure. RESULTS Pericardial valves were implanted in older patients (22.0, interquartile range [IQR] 14-33 vs 16.0, IQR 11-23 years, P < 0.001). Five-year survival (96.7% vs 97.9%) for the Pericardial and Porcine groups, respectively, were similar, P > 0.05. Forty-six (34%) Porcine and 75 (27%) Pericardial group patients met criteria for valve dysfunction at a median echocardiographic follow-up time of 7.43 years (IQR 4.1-9.5 years) and 3.26 years (IQR 1.7-4.7 years), respectively. More Pericardial group patients suffered from at least mild late PR while late median peak gradient was higher in the Porcine group, P < .001 for both. Risk factors for valve dysfunction included decreasing patient age for the entire cohort (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.00-1.04, P = .015) and lack of anticoagulation at discharge for the Porcine group (HR 3.06, 95% CI 1.03-9.10, P = .044) but not the Pericardial group. Five-year cumulative incidence of dysfunction was 39% for the Pericardial group and 17% for the Porcine group. CONCLUSIONS Porcine stented and bovine pericardial stented valves can be implanted in the pulmonary position in all age groups safely. However, despite similar rates of valve failure, bovine pericardial stented valves have a higher incidence of valve dysfunction at mid-term follow-up.
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Affiliation(s)
- Parth M Patel
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia.
| | - David Zapata
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia
| | - William Qu
- Emory University School of Medicine, Atlanta, Georgia
| | - Mia Callahan
- Emory University School of Medicine, Atlanta, Georgia
| | - Nikita Rao
- Children's Hospital of Atlanta, Atlanta, Georgia
| | - Michael Kelleman
- Department of Biostatistics, Rollins School of Public Health, Atlanta, Georgia
| | - Kirk R Kanter
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia; Children's Hospital of Atlanta, Atlanta, Georgia
| | - Paul J Chai
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia; Children's Hospital of Atlanta, Atlanta, Georgia
| | - Fawwaz R Shaw
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia; Children's Hospital of Atlanta, Atlanta, Georgia
| | - Subhadra Shashidharan
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia; Children's Hospital of Atlanta, Atlanta, Georgia
| | - Joshua M Rosenblum
- Division of Thoracic and Cardiovascular Surgery, Emory University School of Medicine, Atlanta, Georgia; Emory University School of Medicine, Atlanta, Georgia; Children's Hospital of Atlanta, Atlanta, Georgia
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Wright LK, Gajarski RJ, Phelps C, Hoffman TM, Lytrivi ID, Magnetta DA, Shaw FR, Thompson C, Weisert M, Nandi D. Worsening racial disparity in waitlist mortality for pediatric heart transplant candidates since the 2016 Pediatric Heart Allocation Policy revision. Pediatr Transplant 2022; 27:e14412. [PMID: 36329630 DOI: 10.1111/petr.14412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/10/2022] [Accepted: 09/26/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The US Pediatric Heart Allocation Policy (PHAP) was revised in March 2016, with the goal of reducing waitlist mortality. We evaluated the hypothesis that these changes, which increased status exceptions, have worsened racial disparities in waitlist outcomes. METHODS Children in the Pediatric Heart Transplant Study database listed for first heart transplant from January 2012 - June 2020 were included and stratified by listing before (Era 1) or after (Era 2) the PHAP revision. RESULTS A total of 4,089 children were listed during the study period. Compared with white children (n = 2648), non-white children (n = 1441) were more likely to have an underlying diagnosis of cardiomyopathy in both eras. Waitlist mortality was similar in white and non-white children in Era 1, but comparatively worse for non-white children in Era 2. In multivariable analysis controlling for diagnosis, age, and severity markers, non-white children had a significantly higher waitlist mortality only in Era 2 (Era 1: sHR 1.22 [95%CI 0.90 - 1.66] vs. Era 2: sHR 1.57 [95%CI 1.17 - 2.10]). CONCLUSIONS Widening racial disparities in waitlist mortality may be an unintended consequence of the 2016 PHAP revision. Additional analyses may inform the degree to which this policy vs. unrelated changes in care differentially contribute to these disparities.
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Affiliation(s)
- Lydia K Wright
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Robert J Gajarski
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christina Phelps
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Timothy M Hoffman
- University of North Carolina Children's Hospital, Chapel Hill, NC, USA
| | - Irene D Lytrivi
- Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center New York, New York, New York, USA
| | - Defne A Magnetta
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | | | - Molly Weisert
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Deipanjan Nandi
- Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH, USA
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Rosenblum JM, Kanter KR, Shashidharan S, Shaw FR, Chai PJ. Cardiac surgery in children with trisomy 13 or trisomy 18: How safe is it? JTCVS Open 2022; 12:364-371. [PMID: 36590710 PMCID: PMC9801274 DOI: 10.1016/j.xjon.2022.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/04/2022] [Accepted: 09/21/2022] [Indexed: 01/04/2023]
Abstract
Objective Surgery for heart defects in children with trisomy 13 or 18 is controversial. We analyzed our 20-year experience. Methods Since 2002, we performed 21 operations in 19 children with trisomy 13 (n = 8) or trisomy 18 (n = 11). Age at operation was 4 days to 12 years (median, 154 days). Principal diagnosis was ventricular septal defect in 10 patients, tetralogy of Fallot in 7 patients, arch hypoplasia in 1 patient, and patent ductus arteriosus in 1 patient. Results The initial operation was ventricular septal defect closure in 9 patients, tetralogy of Fallot repair in 7 patients, pulmonary artery banding in 1 patient, patent ductus arteriosus ligation in 1 patient, and aortic arch/coarctation repair in 1 patient. There were no operative or hospital deaths. Median postoperative intensive care and hospital stays were 189 hours (interquartile range, 70-548) and 14 days (interquartile range, 8.0-37.0), respectively, compared with median hospital stays in our center for ventricular septal defect repair of 4.0 days and tetralogy of Fallot repair of 5.0 days. On median follow-up of 17.4 months (interquartile range, 6.0-68), 1 patient was lost to follow-up after 5 months. Two patients had reoperation without mortality. There have been 5 late deaths (4 with trisomy 18, 1 with trisomy 13) predominately due to respiratory failure from 4 months to 9.4 years postoperatively. Five-year survival was 66.6% compared with 24% in a group of unoperated patients with trisomy 13 or 18. Conclusions Cardiac operation with an emphasis on complete repair can be performed safely in carefully selected children with trisomy 13 or trisomy 18. Hospital resource use measured by postoperative intensive care and hospital stays is considerably greater compared with nontrisomy 13 and 18.
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Affiliation(s)
- Joshua M. Rosenblum
- Address for reprints: Joshua M. Rosenblum, MD, PhD, Pediatric Cardiac Surgery, Emory University School of Medicine, 1405 Clifton Rd, NE, Atlanta, GA 30322.
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Gil D, Aljiffry A, Dryer R, Rao N, Figueroa J, Downey L, Shaw FR, Beshish AG. Extubation delays and the associated prostaglandin and opiate dose following coarctation of the aorta repair. Progress in Pediatric Cardiology 2022. [DOI: 10.1016/j.ppedcard.2022.101574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Beshish AG, Fundora MP, Aronoff E, Rao N, Kelleman MS, Shaw FR, Maher KO, Wolf M. Prevalence, Risk Factors, and Etiology of Extubation Failure in Pediatric Patients After Cardiac Surgery. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0041-1742253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractIn this article, our primary objective was to investigate the prevalence and etiology of extubation failure (EF) in patients following cardiac surgery for congenital heart disease. Secondarily, we examined the association of different risk factors with EF. This was single-center retrospective study in a 27-bed cardiac intensive care unit at a quaternary children's hospital. All patients between 0 and 18 years of age who underwent congenital cardiac surgery from January 2008 to September 2019 were included. During the study period, among 8,750 surgical encounters, 257 (2.9%) failed extubation, defined as reintubation within 48 hours from extubation. EF patients were younger, smaller, more likely to have genetic syndromes, higher Society of Thoracic Surgeons and the European Association for Cardio-Thoracic Surgery (STAT) mortality scores, single-ventricle physiology, longer cardiopulmonary bypass (CPB) and cross-clamp (XC) times, longer mechanical ventilation (MV) duration, and higher mortality (p <0.05). In a univariate analysis, EF patients when compared to matched controls by age, gender, and STAT score, and genetic syndrome, particularly heterotaxy, were associated with increased odds of EF (p <0.05). In a multivariable logistic regression of the entire cohort, the presence of any genetic syndrome was associated with higher odds of EF (p <0.05). In a subgroup of neonates, a univariate analysis was performed and multivariable analysis was attempted, but both did not achieve statistical significance. In summary, EF after congenital cardiac surgery is associated with younger age, lower weight, single-ventricle physiology, longer CPB and XC times, longer duration of MV, and genetic syndromes. Patients failing extubation have increased morbidity and mortality. Recognition of these risk factors may provide clinicians the ability to identify patients at high risk allowing for timely intervention to limit adverse outcomes.
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Affiliation(s)
- Asaad G. Beshish
- Division of Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Michael P. Fundora
- Division of Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Elizabeth Aronoff
- Emory University School of Medicine, Atlanta, Georgia, United States
| | - Nikita Rao
- Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Michael S. Kelleman
- Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Fawwaz R. Shaw
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Kevin O. Maher
- Division of Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Michael Wolf
- Division of Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, United States
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Lamb EP, Shaw FR, Fleming MD. Investigation of the Diagnostic Precision and Utility of Sentinel Lymph Node Biopsy in the Treatment of Patients with Merkel Cell Carcinoma. Am Surg 2018. [DOI: 10.1177/000313481808400507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Elena P. Lamb
- Department of Surgical Oncology Fox Chase Cancer Center Philadelphia, Pennsylvania
| | - Fawwaz R. Shaw
- Department of Surgery West Virginia University Children's Hospital Morgantown, West Virginia
| | - Martin D. Fleming
- Division of Surgical Oncology The University of Tennessee Health Science Center Memphis, Tennessee
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Lamb EP, Shaw FR, Fleming MD. Investigation of the Diagnostic Precision and Utility of Sentinel Lymph Node Biopsy in the Treatment of Patients with Merkel Cell Carcinoma. Am Surg 2018; 84:e173-e175. [PMID: 30454322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Elena P Lamb
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Abstract
Total anomalous pulmonary venous connection (TAPVC) is predominantly a neonatal congenital cardiac diagnosis in which the pulmonary veins fail to return to the left atrium. The presence or absence of obstruction defines the clinical presentation, and in the setting of obstructed pulmonary veins, this diagnosis represents a true surgical emergency. Improvements in perioperative care and refinement of surgical techniques continue to allow for improved survival and decreased morbidity. A description of the surgical anatomy and key concepts in the perioperative and surgical management of TAPVC are presented in this review.
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Affiliation(s)
- Fawwaz R Shaw
- 1 West Virginia University School of Medicine, Morgantown, WV, USA
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Abstract
Total anomalous pulmonary venous connection (TAPVC) is predominantly a neonatal congenital cardiac diagnosis in which the pulmonary veins fail to return to the left atrium. The presence or absence of obstruction defines the clinical presentation, and in the setting of obstructed pulmonary veins, this diagnosis represents a true surgical emergency. Improvements in perioperative care and refinement of surgical techniques continue to allow for improved survival and decreased morbidity. A description of the surgical anatomy and key concepts in the perioperative and surgical management of TAPVC are presented in this review.
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Affiliation(s)
- Fawwaz R. Shaw
- West Virginia University School of Medicine, Morgantown, WV, USA
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Pelletier AL, Thomas J, Shaw FR. Vision loss in older persons. Am Fam Physician 2009; 79:963-970. [PMID: 19514694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Family physicians have an essential role in assessing, identifying, treating, and preventing or delaying vision loss in the aging population. Approximately one in 28 U.S. adults older than 40 years is visually impaired. Vision loss is associated with depression, social isolation, falls, and medication errors, and it can cause disturbing hallucinations. Adults older than 65 years should be screened for vision problems every one to two years, with attention to specific disorders, such as diabetic retinopathy, refractive error, cataracts, glaucoma, and age-related macular degeneration. Vision-related adverse effects of commonly used medications, such as amiodarone or phosphodiesterase inhibitors, should be considered when evaluating vision problems. Prompt recognition and management of sudden vision loss can be vision saving, as can treatment of diabetic retinopathy, refractive error, cataracts, glaucoma, and age-related macular degeneration. Aggressive medical management of diabetes, hypertension, and hyperlipidemia; encouraging smoking cessation; reducing ultraviolet light exposure; and appropriate response to medication adverse effects can preserve and protect vision in many older persons. Antioxidant and mineral supplements do not prevent age-related macular degeneration, but may play a role in slowing progression in those with advanced disease.
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Affiliation(s)
- Allen L Pelletier
- Department of Family Medicine, Medical College of Georgia, Augusta, GA 30912-3500, USA.
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Masia NA, Shaw FR. Reevaluating traditional hospital care as a sustainable business. Healthc Strateg 1998; 2:1-4. [PMID: 10345272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Affiliation(s)
- N A Masia
- Health Care Advisory Board, Washington, DC, USA
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Wasti SS, Shaw FR, Smith CT. Detection of residues of Rabon in manure of Rhode Island red hens. J Econ Entomol 1970; 63:1355-1356. [PMID: 5475206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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