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Mikulski MF, Iyer S, Well A, Mery CM, Owens WR, Glass LD, Castleberry CD, Fraser CD. Successful explantation of children from the Berlin Heart EXCOR® ventricular assist device: A systematic review. Artif Organs 2024; 48:444-455. [PMID: 38419587 DOI: 10.1111/aor.14727] [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] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/10/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The Berlin Heart EXCOR® (BHE) can bridge children with severe heart failure to transplantation, but some are successfully weaned and spared transplantation. This study seeks to identify characteristics of children amenable to successful explantation with BHE support. METHODS Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines were used. Five databases were screened for original, English articles measuring BHE support in patients <18 years old based on title and abstract. Exclusion criteria were applied: full-text availability, <10 total pediatric BHE patients, zero successful explantations from BHE, nonprimary literature, adult and pediatric results that could not be separated, and studies with overlapping patient information. Studies were analyzed with descriptive statistics. RESULTS From 41 857 potential studies, 14 were analyzed with data from 58 hospitals on four continents from 1990 to 2020. There were 984 BHE patients. The most common diagnosis was dilated cardiomyopathy (n = 318, 32.3%), followed by congenital heart disease (n = 249, 25.3%). There were 85 (8.6%) children explanted with favorable outcomes. The underlying diagnosis was known in 44 (51.8%) cases: 14 (8.4%) of 166 cardiomyopathies, 17 (48.6%) of 35 myocarditis, and 12 (16.7%) of 72 with congenital heart disease were explanted. When the type of support was known, the rate of LVAD patients explanted was 21.3% (n = 19/89) and 2.4% (n = 1/42) of BiVAD patients were explanted. CONCLUSION Explantation from BHE is not uncommon at 8.6%, but significant variation exists in the explantation data reported. Myocarditis and LVAD support may be populations suitable for weaning. Standardization of reporting measures and prospective registries may help identify patients suitable for this alternative to transplant and help develop weaning protocols.
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Affiliation(s)
- Matthew F Mikulski
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Texas, USA
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Swati Iyer
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Texas, USA
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Texas, USA
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Texas, USA
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - W Richard Owens
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Texas, USA
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Lauren D Glass
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Texas, USA
- Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Chesney D Castleberry
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Texas, USA
- Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Texas, USA
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
- Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, Texas, USA
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Mikulski MF, Well A, Shmorhun D, Mery CM, Fenrich AL, Fraser CD. Impact of electrophysiologists at daily multidisciplinary report in a paediatric cardiac care unit. Cardiol Young 2024:1-7. [PMID: 38577782 DOI: 10.1017/s1047951124000738] [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] [Indexed: 04/06/2024]
Abstract
BACKGROUND Paediatric cardiac electrophysiologists are essential in CHD inpatient care, but their involvement is typically limited to consultation with individual patients. In our integrated heart centre, an electrophysiologist reviews all cardiac inpatient telemetry over the preceding 24 hours and participates in daily multidisciplinary morning report. This study investigates the impact of the strategy of consistent, formalised electrophysiologist presence at multidisciplinary morning report. METHODS This is a single-centre, prospective, observational study of electrophysiologist participation in patient encounters during heart centre multidisciplinary morning report from 10/20/2021 to 10/31/2022. Multidisciplinary morning report includes discussion of all intensive care and non-intensive care cardiac patients. An encounter was defined as reporting on one patient for one day. Electrophysiologists were initially blinded to observations. RESULTS Two electrophysiologists were observed over 215 days encompassing 6413 patient encounters. Electrophysiologists made comments on 581(9.1%) encounters in 234 unique patients with diverse diagnoses, equating to a median of 3[interquartile range:1-4] encounters per day. These included identifications of arrhythmias and describing electrocardiographic findings. Recommendation to change management occurred in 282(48.5%) encounters, most commonly regarding medications (n = 142, 24.4%) or pacemaker management (n = 48, 8.3%). Of the 581 encounters, there were 61(10.5%) in which they corrected another physician's interpretation of rhythm or electrocardiogram. CONCLUSION Routine electrophysiologist involvement in multidisciplinary morning report provides significant, frequent, and timely input in patient management by identifying precise rhythm-related diagnoses and allowing nuanced, patient-specific medication and pacemaker management of all cardiac patients, not just those consulted. Electrophysiologist presence at multidisciplinary morning report is a vital resource and this practice should be considered at integrated paediatric cardiac centres.
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Affiliation(s)
- Matthew F Mikulski
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Daniel Shmorhun
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Arnold L Fenrich
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center & UT Health Austin, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Mikulski MF, Linero A, Stromberg D, Affolter JT, Fraser CD, Mery CM, Lion RP. Analysis of haemodynamics surrounding blood transfusions after the arterial switch operation: a pilot study utilising real-time telemetry high-frequency data capture. Cardiol Young 2024:1-8. [PMID: 38450505 DOI: 10.1017/s104795112400009x] [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] [Indexed: 03/08/2024]
Abstract
BACKGROUND Packed red blood cell transfusions occur frequently after congenital heart surgery to augment haemodynamics, with limited understanding of efficacy. The goal of this study was to analyse the hemodynamic response to packed red blood cell transfusions in a single cohort, as "proof-of-concept" utilising high-frequency data capture of real-time telemetry monitoring. METHODS Retrospective review of patients after the arterial switch operation receiving packed red blood cell transfusions from 15 July 2020 to 15 July 2021. Hemodynamic parameters were collected from a high-frequency data capture system (SickbayTM) continuously recording vital signs from bedside monitors and analysed in 5-minute intervals up to 6 hours before, 4 hours during, and 6 hours after packed red blood cell transfusions-up to 57,600 vital signs per packed red blood cell transfusions. Variables related to oxygen balance included blood gas co-oximetry, lactate levels, near-infrared spectroscopy, and ventilator settings. Analgesic, sedative, and vasoactive infusions were also collected. RESULTS Six patients, at 8.5[IQR:5-22] days old and weighing 3.1[IQR:2.8-3.2]kg, received transfusions following the arterial switch operation. There were 10 packed red blood cell transfusions administered with a median dose of 10[IQR:10-15]mL/kg over 169[IQR:110-190]min; at median post-operative hour 36[IQR:10-40]. Significant increases in systolic and mean arterial blood pressures by 5-12.5% at 3 hours after packed red blood cell transfusions were observed, while renal near-infrared spectroscopy increased by 6.2% post-transfusion. No significant changes in ventilation, vasoactive support, or laboratory values related to oxygen balance were observed. CONCLUSIONS Packed red blood cell transfusions given after the arterial switch operation increased arterial blood pressure by 5-12.5% for 3 hours and renal near-infrared spectroscopy by 6.2%. High-frequency data capture systems can be leveraged to provide novel insights into the hemodynamic response to commonly used therapies such as packed red blood cell transfusions after paediatric cardiac surgery.
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Affiliation(s)
- Matthew F Mikulski
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Antonio Linero
- Department of Statistics and Data Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Daniel Stromberg
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Jeremy T Affolter
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Richard P Lion
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Dawson-Gore CC, Well A, Wallace S, Teisberg E, Born C, Carberry K, Gottlieb E, Holt DB, Fraser CD, Mery CM. Evaluating variation in pre-operative evaluation and planning for children undergoing atrial or ventricular septal defect repair. Cardiol Young 2024; 34:164-170. [PMID: 37309178 DOI: 10.1017/s1047951123001336] [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] [Indexed: 06/14/2023]
Abstract
BACKGROUND CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points. METHODS From interviews with staff of an integrated congenital heart centre, an initial process map was constructed. A retrospective chart review of patients with isolated surgical atrial septal defect and ventricular septal defect repair from 7/1/2018 through 11/1/2020 informed revisions of the process map. The map was assessed for points of consistency and variability. RESULTS Thirty-two surgical atrial septal defect/ventricular septal defect repair patients were identified. Ten (31%) were reviewed by interventional cardiology before surgical review. Of these, 6(60%) had a failed catheter-based closure and 4 (40%) were deemed inappropriate for catheter-based closure. Thirty (94%) were reviewed in case conference, all attended surgical clinic, and none were admitted prior to surgery. The process map from interviews alone identified surgery rescheduling as a point of major variability; however, chart review revealed this was not as prominent a source of variability as pre-operative interventional cardiology review. CONCLUSIONS Significant variation in the pre-operative evaluation and planning process for surgical atrial septal defect/ventricular septal defect patients was identified. If such process variation is widespread through CHD care, it may contribute to variations in outcome and cost previously documented within CHD surgery. Future research will focus on determining whether the variation is warranted or unwarranted, associated health outcomes and cost variation attributed to these variations in care processes.
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Affiliation(s)
- Catherine C Dawson-Gore
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Surgery School of Medicine, University of Colorado, Anschutz Medical Campus, AuroraCO, USA
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, AustinTX, USA
- The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, AustinTX, USA
| | - Scott Wallace
- The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, AustinTX, USA
| | - Elizabeth Teisberg
- The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, AustinTX, USA
| | | | - Kathleen Carberry
- The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, AustinTX, USA
| | - Erin Gottlieb
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, AustinTX, USA
| | - Dudley Byron Holt
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, AustinTX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, AustinTX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, AustinTX, USA
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, AustinTX, USA
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Fraser CD, Mikulski MF, Venardos NM, Mery CM, Well A. The journey of becoming a congenital heart surgeon: Too long, too costly, too unpredictable. J Thorac Cardiovasc Surg 2024; 167:312-321.e4. [PMID: 37385526 DOI: 10.1016/j.jtcvs.2023.05.046] [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: 02/28/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE The pathway to become a congenital heart surgeon (CHS) is challenging and unpredictable. Previous voluntary manpower surveys have shed partial light on this problem but have not included all trainees. We believe that this arduous journey merits more attention. METHODS To examine the real-life challenges of recent participants in Accreditation Council for Graduate Medical Education-accredited CHS training programs, we conducted phone interviews with all graduates of approved programs from 2021 to 2022. This institutional review board approved survey focused on issues including preparation, length of training, debt burden, and employment. RESULTS All 22 (100%) graduates during the study period were interviewed. Age at fellowship completion was a median 37 years (range, 33-45 years). Pathways to fellowship included traditional general surgery with adult cardiac (43%), abbreviated general surgery ("4 + 3," 19%) and integrated-6 (38%). Time spent on any pediatric related rotation before CHS fellowship was a median 4 months (range, 1-10 months). During CHS fellowship, graduates reported medians of 100 (range, 75-170) total cases and 8 (range, 0-25) neonatal cases as the primary surgeon. Debt burden at completion was a median of $179,000 (range, $0-$550,000). Maximal financial compensation during training before and during CHS fellowship were medians of $65,000 (range, $50,000-$100,000) and $80,000 (range, $65,000-$165,000), respectively. Six (27.3%) are currently in roles in which they cannot practice independently (5 [22.7%] faculty instructors, 1 [4.5%] CHS clinical fellowship). Median salary in first job is $450,000 (range, $80,000-$700,000). CONCLUSIONS Graduates of CHS fellowships are old, and training is highly variable. Aptitude screening and pediatric-focused preparation are minimal. Debt burden is onerous. Further attention to refining training paradigms and compensation are justified.
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Affiliation(s)
- Charles D Fraser
- Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Tex; Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Tex.
| | - Matthew F Mikulski
- Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Tex; Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Tex
| | - Neil M Venardos
- Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Tex; Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Tex
| | - Carlos M Mery
- Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Tex; Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Tex
| | - Andrew Well
- Division of Pediatric and Congenital Cardiothoracic Surgery, Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Tex; Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, Tex
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Mizrahi M, Well A, Gottlieb EA, Stewart E, Lucke A, Fraser CD, Mery CM, Beckerman Z. Trisomy 18: disparities of care and outcomes in the State of Texas between 2009 and 2019. Cardiol Young 2023; 33:2328-2333. [PMID: 36776116 DOI: 10.1017/s1047951123000215] [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] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To perform a statewide characteristics and outcomes analysis of the Trisomy 18 (T18) population and explore the potential impact of associated congenital heart disease (CHD) and congenital heart surgery. STUDY DESIGN Retrospective review of the Texas Hospital Inpatient Discharge Public Use Data File between 2009 and 2019, analysing discharges of patients with T18 identified using ICD-9/10 codes. Discharges were linked to analyse patients. Demographic characteristics and available outcomes were evaluated. The population was divided into groups for comparison: patients with no documentation of CHD (T18NoCHD), patients with CHD without congenital heart surgery (T18CHD), and patients who underwent congenital heart surgery (T18CHS). RESULTS One thousand one hundred fifty-six eligible patients were identified: 443 (38%) T18NoCHD, 669 (58%) T18CHD, and 44 (4%) T18CHS. T18CHS had a lower proportion of Hispanic patients (n = 9 (20.45%)) compared to T18CHD (n = 315 (47.09%)), and T18NoCHD (n = 219 (49.44%)) (p < 0.001 for both). Patients with Medicare/Medicaid insurance had a 0.42 odds ratio (95%CI: 0.20-0.86, p = 0.020) of undergoing congenital heart surgery compared to private insurance. T18CHS had a higher median total days in-hospital (47.5 [IQR: 12.25-113.25] vs. 9 [IQR: 3-24] and 2 [IQR: 1-5], p < 0.001); and a higher median number of admissions (n = 2 [IQR: 1-4]) vs. 1 [IQR: 1-2] and 1 [IQR: 1-1], (p < 0.001 for both). However, the post-operative median number of admissions for T18CHS was 0 [IQR: 0-2]. After the first month of life, T18CHS had freedom from in-hospital mortality similar to T18NoCHD and superior to T18CHD. CONCLUSIONS Short-term outcomes for T18CHS patients are encouraging, suggesting a freedom from in-hospital mortality that resembles the T18NoCHD. The highlighted socio-economic differences between the groups warrant further investigation. Development of a prospective registry for T18 patients should be a priority for better understanding of longer-term outcomes.
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Affiliation(s)
- Michelle Mizrahi
- Department of Pediatrics, University of Illinois College of Medicine in Chicago and UI Health, Chicago, IL, USA
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Erin A Gottlieb
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Eileen Stewart
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ashley Lucke
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ziv Beckerman
- Department of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
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Well A, Lamari-Fisher A, Taylor K, Ulack C, Lee R, Affolter JT, Colucci J, Van Diest H, Carberry K, Johnson G, Fraser CD, Mery CM. Experiences and insights from partners of individuals with single-ventricle CHD: a pilot qualitative research study. Cardiol Young 2023; 33:2016-2020. [PMID: 36510796 DOI: 10.1017/s1047951122003882] [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] [Indexed: 12/14/2022]
Abstract
INTRODUCTION With advances in care, an increasing number of individuals with single-ventricle CHD are surviving into adulthood. Partners of individuals with chronic illness have unique experiences and challenges. The goal of this pilot qualitative research study was to explore the lived experiences of partners of individuals with single-ventricle CHD. METHODS Partners of patients ≥18 years with single-ventricle CHD were recruited and participated in Experience Group sessions and 1:1 interviews. Experience Group sessions are lightly moderated groups that bring together individuals with similar circumstances to discuss their lived experiences, centreing them as the experts. Formal inductive qualitative coding was performed to identify salient themes. RESULTS Six partners of patients participated. Of these, four were males and four were married; all were partners of someone of the opposite sex. Themes identified included uncertainty about their partners' future health and mortality, becoming a lay CHD specialist, balancing multiple roles, and providing positivity and optimism. Over time, they took on a role as advocates for their partners and as repositories of medical history to help navigate the health system. Despite the uncertainties, participants described championing positivity and optimism for the future. CONCLUSIONS In this first-of-its-kind pilot study, partners of individuals with single-ventricle CHD expressed unique challenges and experiences in their lives. There is a tacit need to design strategies to help partners cope with those challenges. Further larger-scale research is required to better understand the experiences of this unique population.
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Affiliation(s)
- Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX, USA
- Value Institute for Health and Care, Dell Medical School and McCombs School of Business at The University of Texas at Austin, Austin, TX, USA
| | - Alexandra Lamari-Fisher
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Psychiatry and Behavioral Sciences, Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - Kate Taylor
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
| | - Christopher Ulack
- Value Institute for Health and Care, Dell Medical School and McCombs School of Business at The University of Texas at Austin, Austin, TX, USA
| | - Rachel Lee
- Value Institute for Health and Care, Dell Medical School and McCombs School of Business at The University of Texas at Austin, Austin, TX, USA
| | - Jeremy T Affolter
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - Jose Colucci
- Design Institute for Health, Dell Medical School and College of Fine Arts at The University of Texas at Austin, Austin, TX, USA
| | - Heather Van Diest
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Health Social Work, Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - Kathleen Carberry
- Value Institute for Health and Care, Dell Medical School and McCombs School of Business at The University of Texas at Austin, Austin, TX, USA
| | - Gregory Johnson
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX, USA
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Well A, Dawson C, Johnson G, Patt H, Fraser CD, Mery CM, Beckerman Z. Hospitalisations of children and adults with Hypoplastic Left Heart Syndrome in Texas from 2009 to 2019. Cardiol Young 2023; 33:1819-1827. [PMID: 36220311 DOI: 10.1017/s1047951122003146] [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] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Hypoplastic Left Heart Syndrome accounts for a significant proportion of CHD morbidity and mortality, despite improvements in care and improved survival. This study evaluates number of, reasons for, and trends in discharges of patients with hypoplastic left heart syndrome over 11 years in Texas. METHODS The Texas Inpatient Discharge Dataset Public Use File captures almost all discharges in Texas and was reviewed from 2009 to 2019. Discharges of patients ≥5 years of age and diagnosis codes for Hypoplastic Left Heart Syndrome were included. The admitting and principle diagnoses were categorised and all discharges were evaluated for procedures performed. Descriptive and univariate statistical analyses were performed. RESULTS A total of 1024 discharges were identified with a 16.9% annual increase over the study period. Median length of stay was 4 [IQR: 2-8] and there were 17 (1.7%) in-hospital mortalities with no differences across age groups. Seven (17.1%) discharges of patients 25+ years were uninsured, higher than other age groups (p < 0.001). The most common admitting diagnosis was CHD and 224 (21.9%) of discharges included a procedure, including 23 heart transplants. Discharges occurred from 67 different hospitals with 4 (6.0%) representing 71.4% of all discharges. CONCLUSIONS Discharges of Hypoplastic Left Heart Syndrome have increased rapidly, particularly in the older age groups and were spread over a large number of hospitals. Further work is needed to understand the interplay between Hypoplastic Left Heart Syndrome and other conditions and care experiences that occur within the general population, which will become more common as this population ages and grows.
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Affiliation(s)
- Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Catherine Dawson
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Gregory Johnson
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Hanoch Patt
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ziv Beckerman
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
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Mikulski MF, Well A, Shmorhun D, Fraser CD, Mery CM, Fenrich AL. Pacemaker Management and In-Hospital Outcomes in Neonatal Congenital Atrioventricular Block. JACC Clin Electrophysiol 2023; 9:1977-1986. [PMID: 37354188 DOI: 10.1016/j.jacep.2023.05.003] [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] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Neonatal congenital atrioventricular block (nCAVB) is rare, causes bradycardia, confers high mortality, and frequently requires pacing. In-hospital outcomes and pacemaker management in nCAVB are limited. OBJECTIVES The purpose of this study was to analyze pacing and outcomes of nCAVB with and without congenital heart disease (CHD) using a multicenter database. METHODS A Pediatric Health Information System database review from January 1, 2004, to June 30, 2022. Patients <31 days of age with a nCAVB International Classification of Diseases-9th/10th Revision diagnosis code and no cardiac surgeries except pacemaker were included. Pacing and in-hospital mortality were analyzed using univariate and multivariable logistic statistics and competing risk and event-free survival models. RESULTS Of 1,146 patients with nCAVB, 659 (57.5%) were girls and 506 (44.2%) were premature. Among the 326 (28.4%) with CHD, 134 (41.1%) underwent pacemaker insertion as initial intervention and 56 (17.2%) had temporary pacing wires. In-hospital mortality occurred in 118 (36.2%), with increased adjusted odds with temporary pacing wires placed at 0 to 1 or 2 to 7 days of age relative to no wires, and with decreased odds among pacemakers placed at 2 to 7 or 8+ days of age relative to no pacemaker. Of 820 (71.6%) without CHD, 334 (40.7%) underwent pacemaker insertion as the initial intervention and 81 (9.9%) had temporary pacing wires. In-hospital mortality occurred in 69 (8.4%) with increased adjusted odds in prematurity and decreased odds among pacemaker placement at 2 to 7 days of age relative to no pacemaker. CONCLUSIONS Over 18.5 years, in-hospital mortality occurred in 36.2% of nCAVB patients with CHD and 8.4% with non-CHD. Associations with increased in-hospital mortality included CHD and prematurity and decreased with pacemaker placement. Prospective registries are needed to better characterize and standardize management of this rare but high-mortality disease.
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Affiliation(s)
- Matthew F Mikulski
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas, USA; Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA.
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas, USA; Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Daniel Shmorhun
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas, USA; Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas, USA; Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas, USA; Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Arnold L Fenrich
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas, USA; Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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Mikulski MF, Well A, Mery CM, Johnson G, Gottlieb EA, Fraser CD, Beckerman Z. Outcomes of thoracic aortic interventions in Marfan syndrome in the state of Texas over 11 years. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad128. [PMID: 37584655 PMCID: PMC10438956 DOI: 10.1093/icvts/ivad128] [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] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/01/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Marfan syndrome is a heritable connective tissue disorder with significant aortopathy and conveys substantial cardiovascular morbidity. This study characterizes the mortality and morbidities of thoracic aortic interventions (TAI) in the Marfan syndrome population in the state of Texas from 2009 to 2019. METHODS A retrospective review of the Texas Inpatient Discharge Dataset from 1 January 2009 to 31 December 2019. Discharges from acute care hospitals with a Marfan syndrome diagnosis by the International Classification of Diseases 9/10 codes and a procedure code for TAI were analysed utilizing descriptive, univariate and multivariable regression statistics. RESULTS There were 4641 Marfan syndrome discharges identified, of whom 644 (13.9%) underwent TAI. Thoracic or thoraco-abdominal aortic dissection or rupture was noted in 223 (34.6%). Thirty-three (5.1%) had a concomitant coronary artery intervention. There were 30 (4.7%) in-hospital mortalities, 126 (19.6%) diagnoses of acute renal failure (ARF), 52 (8.1%) had mechanical ventilation >96 h and the median length of stay was 10 [interquartile range (IQR) 7-16] days. After adjustment, concomitant coronary artery intervention was associated with in-hospital mortality [odds ratio (OR) 3.69 [IQR 1.15-11.90], P = 0.029] and ARF (OR 2.66 [IQR 1.19-5.94], P = 0.017). Aortic dissections/ruptures were associated with ARF (OR 1.73 [IQR 1.14-2.63], P = 0.010), ventilation >96 h (OR 2.19 [IQR 1.21-3.97], P = 0.010), and 15% longer length of stay (95% confidence interval 2.4-29.1%, P = 0.038). CONCLUSIONS TAI are frequent among the hospitalized Marfan Syndrome population. Concomitant coronary intervention is associated with increased risk of death and aortic dissections/ruptures are associated with increased morbidity. The high prevalence of aortic dissections/ruptures points to a potential target for improving imaging surveillance, adherence to treatment guidelines and preventative management of Marfan syndrome aortopathy.
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Affiliation(s)
- Matthew F Mikulski
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Andrew Well
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Carlos M Mery
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Gregory Johnson
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Erin A Gottlieb
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Charles D Fraser
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
| | - Ziv Beckerman
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children’s Medical Center, Austin, TX, USA
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Mery CM, Well A, Taylor K, Carberry K, Colucci J, Ulack C, Zeiner A, Mizrahi M, Stewart E, Dillingham C, Cook T, Hartounian A, McCullum E, Affolter JT, Van Diest H, Lamari-Fisher A, Chang S, Wallace S, Teisberg E, Fraser CD. Examining the Real-Life Journey of Individuals and Families Affected by Single-Ventricle Congenital Heart Disease. J Am Heart Assoc 2023; 12:e027556. [PMID: 36802928 PMCID: PMC10111463 DOI: 10.1161/jaha.122.027556] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background The lifetime journey of patients with single-ventricle congenital heart disease is characterized by long-term challenges that are incompletely understood and still unfolding. Health care redesign requires a thorough understanding of this journey to create and implement solutions that improve outcomes. This study maps the lifetime journey of individuals with single-ventricle congenital heart disease and their families, identifies the most meaningful outcomes to them, and defines significant challenges in the journey. Methods and Results This qualitative research study involved experience group sessions and 1:1 interviews of patients, parents, siblings, partners, and stakeholders. Journey maps were created. The most meaningful outcomes to patients and parents and significant gaps in care were identified across the life journey. A total of 142 participants from 79 families and 28 stakeholders were included. Lifelong and life-stage specific journey maps were created. The most meaningful outcomes to patients and parents were identified and categorized using a "capability (doing the things in life you want to), comfort (experience of physical/emotional pain/distress), and calm (experiencing health care with the least impact on daily life)" framework. Gaps in care were identified and classified into areas of ineffective communication, lack of seamless transitions, lack of comprehensive support, structural deficiencies, and insufficient education. Conclusions There are significant gaps in care during the lifelong journey of individuals with single-ventricle congenital heart disease and their families. A thorough understanding of this journey is a critical first step in developing initiatives to redesign care around their needs and priorities. This approach can be used for people with other forms of congenital heart disease and other chronic conditions. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04613934.
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Affiliation(s)
- Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX.,Department of Surgery and Perioperative Care The University of Texas at Austin Dell Medical School Austin TX
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX.,Department of Surgery and Perioperative Care The University of Texas at Austin Dell Medical School Austin TX.,Value Institute for Health and Care The University of Texas at Austin Dell Medical School and McCombs School of Business Austin TX
| | - Kate Taylor
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX.,Department of Surgery and Perioperative Care The University of Texas at Austin Dell Medical School Austin TX
| | - Kathleen Carberry
- Value Institute for Health and Care The University of Texas at Austin Dell Medical School and McCombs School of Business Austin TX
| | - José Colucci
- Design Institute for Health The University of Texas at Austin Dell Medical School and College of Fine Arts Austin TX
| | - Christopher Ulack
- Value Institute for Health and Care The University of Texas at Austin Dell Medical School and McCombs School of Business Austin TX
| | - Adam Zeiner
- Design Institute for Health The University of Texas at Austin Dell Medical School and College of Fine Arts Austin TX
| | - Michelle Mizrahi
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX.,Department of Surgery and Perioperative Care The University of Texas at Austin Dell Medical School Austin TX
| | - Eileen Stewart
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX.,Department of Pediatrics The University of Texas at Austin Dell Medical School Austin TX
| | - Christine Dillingham
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX
| | - Taylor Cook
- Design Institute for Health The University of Texas at Austin Dell Medical School and College of Fine Arts Austin TX
| | - Arotin Hartounian
- Design Institute for Health The University of Texas at Austin Dell Medical School and College of Fine Arts Austin TX
| | - Elizabeth McCullum
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX.,Department of Surgery and Perioperative Care The University of Texas at Austin Dell Medical School Austin TX
| | - Jeremy T Affolter
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX.,Department of Pediatrics The University of Texas at Austin Dell Medical School Austin TX
| | - Heather Van Diest
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX.,Department of Health Social Work The University of Texas at Austin Dell Medical School Austin TX
| | - Alexandra Lamari-Fisher
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX.,Department of Psychiatry and Behavioral Sciences The University of Texas at Austin Dell Medical School Austin TX
| | - Stacey Chang
- Design Institute for Health The University of Texas at Austin Dell Medical School and College of Fine Arts Austin TX
| | - Scott Wallace
- Value Institute for Health and Care The University of Texas at Austin Dell Medical School and McCombs School of Business Austin TX
| | - Elizabeth Teisberg
- Value Institute for Health and Care The University of Texas at Austin Dell Medical School and McCombs School of Business Austin TX
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease UT Health Austin/Dell Children's Medical Center Austin TX.,Department of Surgery and Perioperative Care The University of Texas at Austin Dell Medical School Austin TX
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12
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Mikulski MF, Well A, Subramanian S, Colman K, Fraser CD, Mery CM, Lion RP. Pericardial Effusions After the Arterial Switch Operation: A PHIS Database Review. World J Pediatr Congenit Heart Surg 2023; 14:148-154. [PMID: 36883788 PMCID: PMC10041572 DOI: 10.1177/21501351221146153] [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] [Indexed: 03/09/2023]
Abstract
Background: Pericardial effusion (PCE) is a significant complication after pediatric cardiac surgery. This study investigates PCE development after the arterial switch operation (ASO) and its short-term and longitudinal impacts. Methods: A retrospective review of the Pediatric Health Information System database. Patients with dextro-transposition of the great arteries who underwent ASO from January 1, 2004, to March 31, 2022, were identified. Patients with and without PCE were analyzed with descriptive, univariate, and multivariable regression statistics. Results: There were 4896 patients identified with 300 (6.1%) diagnosed with PCE. Thirty-five (11.7%) with PCE underwent pericardiocentesis. There were no differences in background demographics or concomitant procedures between those who developed PCE and those who did not. Patients who developed PCE more frequently had acute renal failure (N = 56 (18.7%) vs N = 603(13.1%), P = .006), pleural effusions (N = 46 (15.3%) vs N = 441 (9.6%), P = .001), mechanical circulatory support (N = 26 (8.7%) vs N = 199 (4.3%), P < .001), and had longer postoperative length of stay (15 [11-24.5] vs 13 [IQR: 9-20] days). After adjustment for additional factors, pleural effusions (OR = 1.7 [95% CI: 1.2-2.4]), and mechanical circulatory support (OR = 1.81 [95% CI: 1.15-2.85]) conferred higher odds of PCE. There were 2298 total readmissions, of which 46 (2%) had PCE, with no difference in median readmission rate for patients diagnosed with PCE at index hospitalization (median 0 [IQR: 0-1] vs 0 [IQR: 0-0], P = .208). Conclusions: PCE occurred after 6.1% of ASO and was associated with pleural effusions and mechanical circulatory support. PCE is associated with morbidity and prolonged length of stay; however, there was no association with in-hospital mortality or readmissions.
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Affiliation(s)
- Matthew F Mikulski
- Department of Surgery and Perioperative Care, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Andrew Well
- Department of Surgery and Perioperative Care, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Sujata Subramanian
- Department of Surgery and Perioperative Care, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Kathleen Colman
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Charles D Fraser
- Department of Surgery and Perioperative Care, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Carlos M Mery
- Department of Surgery and Perioperative Care, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Richard P Lion
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Mikulski MF, Well A, Beckerman Z, Fraser CD, Bebbington MW, Moise KJ. Open and endoscopic fetal myelomeningocele surgeries display similar in-hospital safety profiles in a large, multi-institutional database. Am J Obstet Gynecol MFM 2023; 5:100854. [PMID: 36587805 DOI: 10.1016/j.ajogmf.2022.100854] [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] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Open intrauterine fetal myelomeningocele repair has demonstrated decreased ventriculoperitoneal shunting and improved motor outcomes despite maternal and fetal risks. Few data directly compare the safety of open vs endoscopic approaches. OBJECTIVE This study aimed to analyze in-hospital maternal and fetal outcomes of pregnant patients undergoing open vs endoscopic fetal myelomeningocele repair using a large, multi-center database. STUDY DESIGN This was a review of the Pediatric Health Information System database from October 1, 2015, to December 31, 2021. All patients who underwent open or endoscopic fetal myelomeningocele repair according to the International Classification of Diseases, Tenth Revision, were identified. Demographics, gestational age, and outcomes were analyzed. Descriptive and univariate statistics were used. RESULTS A total of 378 pregnant patients underwent fetal myelomeningocele repair. The approach was endoscopic in 143 cases (37.8%) and open in 235 cases (62.2%). Overall postprocedural outcomes included no maternal in-hospital mortalities or intensive care unit admissions, a median length of stay of 4 days (interquartile range, 4-5), 14 cases (3.7%) of surgical and postoperative complications, 6 cases (1.6%) of intrauterine infections, 12 cases (3.2%) of obstetrical complications (including preterm premature rupture of membranes), 3 cases (0.8%) of intrauterine fetal demise, and 16 cases (4.2%) of preterm delivery. Compared with an open approach, the endoscopic approach occurred at a later gestational age (25 weeks [interquartile range, 24-25] vs 24 weeks [interquartile range, 24-25]; P<.001) and had an increased rate of intrauterine infection (6 [4.2%] cases vs 0 [0%] case; P=.002). There was no difference between approaches in the rates of surgical complications, obstetrical complications, intrauterine fetal demise, or preterm deliveries. CONCLUSION Compared with an open approach, endoscopic fetal myelomeningocele repair displays a comparable rate of fetal complications, including intrauterine fetal demise and preterm delivery, and a similar in-hospital maternal safety profile despite an association with increased intrauterine infection.
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Affiliation(s)
- Matthew F Mikulski
- Departments of Surgery and Perioperative Care (Drs Mikulski, Well, Beckerman, and Fraser).
| | - Andrew Well
- Departments of Surgery and Perioperative Care (Drs Mikulski, Well, Beckerman, and Fraser)
| | - Ziv Beckerman
- Departments of Surgery and Perioperative Care (Drs Mikulski, Well, Beckerman, and Fraser); Department of Surgery, Duke University School of Medicine, Durham NC (Dr Beckerman)
| | - Charles D Fraser
- Departments of Surgery and Perioperative Care (Drs Mikulski, Well, Beckerman, and Fraser)
| | - Michael W Bebbington
- Women's Health (Drs Bebbington and Moise), The University of Texas at Austin Dell Medical School, Austin, TX
| | - Kenneth J Moise
- Women's Health (Drs Bebbington and Moise), The University of Texas at Austin Dell Medical School, Austin, TX
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Mikulski M, Well A, Shmorhun D, Estevez S, Fraser CD, Mery CM, Fenrich AL. PACEMAKER MANAGEMENT AND OUTCOMES OF NEONATAL CONGENITAL ATRIOVENTRICULAR BLOCK: A REVIEW OF THE PEDIATRIC HEALTH INFORMATION SYSTEM DATABASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01993-9] [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: 03/06/2023]
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Agrawal H, Lamari-Fisher A, Hasbani K, Philip S, Fraser CD, Mery CM. Decision making in anomalous aortic origin of a coronary artery. Expert Rev Cardiovasc Ther 2023; 21:177-191. [PMID: 36846957 DOI: 10.1080/14779072.2023.2184799] [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] [Indexed: 03/01/2023]
Abstract
INTRODUCTION There are many uncertainties surrounding anomalous aortic origin of a coronary artery (AAOCA) including the pathophysiology of sudden cardiac death, how to best risk stratify patients, how to best evaluate patients, who would benefit from exercise restriction, who should undergo surgical intervention, and which operation to perform. AREAS COVERED The goal of this review is to provide a comprehensive but succinct overview of AAOCA to help clinicians with the difficult task of navigating optimal evaluation and treatment of an individual patient with AAOCA. EXPERT OPINION Beginning in year 2012, some of our authors proposed an integrated, multi-disciplinary working group which has become the standard management strategy for patients diagnosed with AAOCA. A multi-disciplinary team with a focus on shared decision-making with the patients/families is likely necessary to optimize outcomes. Long-term follow-up and research are needed to improve our understanding of AAOCA.
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Affiliation(s)
- Hitesh Agrawal
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Alexandra Lamari-Fisher
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Keren Hasbani
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Stephanie Philip
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Charles D Fraser
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Carlos M Mery
- Department of Pediatrics, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
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Well A, Fenrich A, Shmorhun D, Stromberg D, Lavinghousez P, Beckerman Z, Fraser CD, Mery CM. Arrhythmias Requiring ECMO in Infants Without Structural Congenital Heart Disease. Pediatr Cardiol 2022; 43:914-921. [PMID: 35037091 DOI: 10.1007/s00246-021-02803-x] [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: 07/09/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
Arrhythmias account for 55 per 100,000 patient evaluations in pediatric emergency departments. Most arrhythmias in children are amenable to medical management or cardioversion. Rarely, arrhythmias lead to significant hemodynamic instability requiring extracorporeal membrane oxygenation (ECMO) support. This study seeks to evaluate children under 1 year of age with a structurally normal heart requiring ECMO for an arrhythmia. This is a retrospective review of the Extracorporeal Life Support Organization Registry. All patients less than 1 year of age between 2009 and 2019 with a diagnosis of arrhythmia and without a diagnosis of structural heart malformation were included. Demographics, clinical characteristics, and outcomes were assessed with descriptive statistics and univariate and multivariable analyses. A total of 140 eligible patients were identified from the dataset. The most common arrhythmia was supraventricular tachycardia (SVT) in 70 (50%) patients. ECMO complications occurred in 106 (76.3%) patients and survival to discharge was achieved in 120 (85.7%) patients. In-hospital mortality was associated with neuromuscular blockade prior to ECMO [aOR 10.0 (95% CI 2.95-41.56), p < 0.001], neurologic ECMO complication [aOR 28.1 (95% CI 6.6-155.1), p < 0.001], and race with white race being protective [aOR 0.13, (95% CI 0.02-0.21), p = 0.002]. Similar survival and complication rates were found in subgroup analysis of SVT arrhythmias alone. Arrhythmias necessitating ECMO support in infants without structural congenital heart disease is a rare occurrence. However, survival to hospital discharge is favorable at greater than 85%. Given the favorable survival, earlier and more aggressive utilization of ECMO may result in improved outcomes.
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Affiliation(s)
- Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA.
- Department of Surgery and Perioperative Care at the University of Texas at Austin Dell Medical School, Austin, TX, USA.
| | - Arnold Fenrich
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics at the University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Daniel Shmorhun
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics at the University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Daniel Stromberg
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics at the University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Preston Lavinghousez
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics at the University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ziv Beckerman
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care at the University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care at the University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
- Department of Surgery and Perioperative Care at the University of Texas at Austin Dell Medical School, Austin, TX, USA
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Well A, Morgan J, Affolter J, Stewart E, Gottlieb E, Fraser CD, Mery CM. OUTCOMES AFTER NORWOOD OPERATION ARE NOT ASSOCIATED WITH FAMILY DISTANCE FROM OPERATING CENTER. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02410-x] [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: 11/29/2022]
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18
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Giuliano K, Scheel P, Etchill E, Fraser CD, Suarez-Pierre A, Hsu S, Wittstein IS, Kasper EK, Florido R, Tandri H, Calkins H, Choi CW, Sharma K, Kilic A, Gilotra NA. Heart transplantation outcomes in arrhythmogenic right ventricular cardiomyopathy: a contemporary national analysis. ESC Heart Fail 2022; 9:988-997. [PMID: 35132806 PMCID: PMC8934952 DOI: 10.1002/ehf2.13687] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/27/2021] [Accepted: 10/09/2021] [Indexed: 01/06/2023] Open
Abstract
Aims Heart failure is an increasingly recognized later stage manifestation of arrhythmogenic right ventricular cardiomyopathy (ARVC) that can require heart transplantation (HT) to appropriately treat. We aimed to study contemporary ARVC HT outcomes in a national registry. Methods and results The United Network for Organ Sharing registry was queried for HT recipients from 1/1994 through 2/2020. ARVC patients were compared with non‐ARVC dilated, restrictive, and hypertrophic cardiomyopathy HT patients (HT for ischaemic and valvular disease was excluded from analysis). Post‐HT survival was assessed using Kaplan–Meier estimates. A total of 189 of 252 (75%) waitlisted ARVC patients (median age 48 years, 65% male) underwent HT, representing 0.3% of the total 65 559 HT during the study time period. Annual frequency of HT for ARVC increased significantly over time. ARVC patients had less diabetes (5% vs. 17%, P < 0.001), less cigarette use (15% vs. 23%, P < 0.001), lower pulmonary artery and pulmonary capillary wedge pressures, and lower cardiac output than the 33 659 non‐ARVC patients (P < 0.001). Ventricular assist device use was significantly lower in ARVC patients (8% vs. 32%, P < 0.001); 1 and 5 year post‐HT survival was 97% and 93% for ARVC vs. 95% and 82% for non‐ARVC HT recipients (P < 0.001). On adjusted multivariable Cox regression, ARVC had decreased risk of post‐HT death compared with non‐ARVC aetiologies (hazard ratio 0.48, 95% confidence interval 0.28–0.82, P = 0.008). Patients with ARVC also had lower risk of death or graft failure than non‐ARVC patients (hazard ratio 0.51, 95% confidence interval 0.32–0.81, P = 0.004). Conclusions In the largest series of HT in ARVC, we found that HT is increasingly performed in ARVC, with higher survival compared with other cardiomyopathy aetiologies. The right ventricular predominant pathophysiology may require unique considerations for heart failure management, including HT.
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Affiliation(s)
- Katherine Giuliano
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul Scheel
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric Etchill
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles D Fraser
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Steven Hsu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ilan S Wittstein
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward K Kasper
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Roberta Florido
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harikrishna Tandri
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chun W Choi
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kavita Sharma
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ahmet Kilic
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nisha A Gilotra
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Mikulski MF, Well A, Beckerman Z, Fraser CD. A 15mm Mechanical Aortic Prosthesis in a Small Infant. JTCVS Tech 2022; 12:157-158. [PMID: 35403061 PMCID: PMC8987377 DOI: 10.1016/j.xjtc.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/12/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
| | | | | | - Charles D. Fraser
- Address for reprints: Charles D. Fraser, Jr, MD, Dell Children's Medical Center, 4900 Mueller Blvd, Suite 3S.003, Austin, TX 78723.
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Karnik S, Smith PA, Ogiwara E, Fraser CD, Frazier OH, Kurita N, Fraser KH, Wang Y. Hemocompatibility Assessment Platform Drive System Design: Trade-off between Motor Performance and Hemolysis. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:5539-5542. [PMID: 34892379 DOI: 10.1109/embc46164.2021.9630400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Left ventricular assist devices (LVADs) have long been used to treat adults with heart failure, but LVAD options for pediatric patients with heart failure are lacking. Despite the urgent need for long-term, implantable pediatric LVADs, design challenges such as hemolysis, pump thrombosis, and bleeding persist. We have developed a Hemocompatibility Assessment Platform (HAP) to identify blood trauma from individual LVAD components. A HAP would aid in refining pump components before in vivo testing, thereby preventing unnecessary animal sacrifice and reducing development time and cost. So that the HAP does not confound hemolysis data, the HAP drive system consists of an enlarged air-gap motor coupled to a magnetic levitation system. Although it is known that an enlarged air gap motor will have diminished performance, while the larger gap in the motor will cause less blood damage, the trade-offs are not fully characterized. Therefore, in this study we evaluated these trade-offs to determine an optimal rotor diameter for the HAP drive motor. The motor performance was characterized with an experimental method by determining the torque constant for the HAP drive motor with varied rotor diameters. The torque threshold was set as 10 mNm to achieve a nominal current of 3.5A. Hemolysis in the HAP drive motor gap was estimated by calculating scalar shear stress generated in the HAP motor gap analytically and numerically. A design criterion of 30 Pa was selected for scalar shear stress to achieve minimal hemolysis and platelet activation in the HAP drive system.Clinical Relevance- We evaluated a Hemocompatibility Assessment Platform for developing LVAD prototypes that can best balance motor performance and hemocompatibility. This design method can assist with optimizing the drive system during the research stage and illustrates how motor geometry can be tuned to reduce blood trauma.
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21
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Well A, Mizrahi M, Johnson G, Patt H, Fraser CD, Mery CM, Beckerman Z. Aortic dissection and ruptures in adult congenital heart disease in Texas from 2009 to 2019. Eur J Cardiothorac Surg 2021; 61:309-317. [PMID: 34633038 DOI: 10.1093/ejcts/ezab416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/17/2021] [Revised: 07/28/2021] [Accepted: 08/12/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Acute thoracic aortic dissection and rupture (TADR) has an incidence of 5-7 per 100 000-person years. Today, most children with congenital heart disease (CHD) survive to become adults with congenital heart disease (ACHD). This study evaluates TADR in patients with ACHD in a large, hospitalized patient population over 11 years to evaluate the incidence, risk factors and outcomes associated with TADR. METHODS This was a retrospective review of the Texas Inpatient Discharge Data Set from 1 January 2009 to 31 December 2019. All non-trauma discharges of patients ≥18 years were included. ACHD discharges were identified by International Classification of Diseases, 9th edition (ICD-9)/10 diagnosis codes. TADR were identified using 2 definitions: TADR1 is an ICD-9/10 code for TADR, and TADR2 is TADR1 with an ICD-9/10 procedure code for aortic intervention. Descriptive, univariate and logistic regression statistics were used. RESULTS A total of 22 154 664 eligible discharges were identified, of which 12 584 (0.06%) were TADR1 and a subgroup of 5699 (0.03%) were TADR2. CHD was more prevalent in TADR1 (0.2% vs 0.05%; P < 0.001) and TADR2 (0.3% vs 0.04%; P < 0.001). Adjusting for known TADR risk factors, CHD had an odds ratio of 1.69 (95% confidence interval: 1.09-2.63; P = 0.020) for TADR1 and an odds ratio of 1.69 (95% confidence interval: 0.99-2.88; P = 0.056) for TADR2. No in-hospital deaths were found in patients with CHD with TADR. CONCLUSIONS ACHD discharges had a higher frequency of TADR versus the general population (0.9-1.2 vs 0.3-0.6 per 1000 discharges). There is an indication that CHD confers an increased adjusted odds of TADR. As the ACHD population continues to grow in number as well as age, it will be important to continue to assess the risk of TADR from CHD and how traditional risk factors impact this risk.
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Affiliation(s)
- Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA.,Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Michelle Mizrahi
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA.,Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Gregory Johnson
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA.,Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Hanoch Patt
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA.,Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA.,Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA.,Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Ziv Beckerman
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA.,Department of Surgery and Perioperative Care, University of Texas at Austin Dell Medical School, Austin, TX, USA
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Fraser CD. Commentary: Very nice study…what are we to do with it? J Thorac Cardiovasc Surg 2021; 163:209-210. [PMID: 34023156 DOI: 10.1016/j.jtcvs.2021.04.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Hospital, Austin, Tex; Division of Cardiovascular Surgery, University of Texas-Dell Medical School, Austin, Tex.
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Fraser CD, Martínez-Bravo LE. Risk stratification and surgery for anomalous aortic origin of a coronary artery: Onward through the fog. J Thorac Cardiovasc Surg 2021; 161:1584-1586. [PMID: 33707036 DOI: 10.1016/j.jtcvs.2019.06.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School, Dell Children's Medical Center, Austin, Tex.
| | - Luis E Martínez-Bravo
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School, Dell Children's Medical Center, Austin, Tex; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
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Knudson SA, Gottlieb EA, Johnson G, Fraser CD, Beckerman Z. Acquired Sinus of Valsalva Fistula and Turner Syndrome. Ann Thorac Surg 2021; 112:e275-e277. [PMID: 33524357 DOI: 10.1016/j.athoracsur.2020.11.066] [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: 10/04/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
A 21-year old female with a history of Turner syndrome presented with a diastolic heart murmur, dizziness, dyspnea, and intermittent chest pain. Preoperative imaging revealed a fistula from the right sinus of Valsalva into the right atrium. Turner syndrome is associated with both aortopathy and congenital heart malformations. Acquired sinus of Valsalva fistula is a rare disorder and has not been previously reported in association with Turner syndrome.
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Affiliation(s)
- Sean A Knudson
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas
| | - Erin A Gottlieb
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas; Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, Texas
| | - Gregory Johnson
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas; Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, Texas
| | - Ziv Beckerman
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, Texas; Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, Texas.
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Lui C, Fraser CD, Suarez-Pierre A, Zhou X, Higgins RSD, Zehr KJ, Choi CW, Kilic A. Evaluation of Extracorporeal Membrane Oxygenation Therapy as a Bridging Method. Ann Thorac Surg 2020; 112:68-74. [PMID: 33098881 DOI: 10.1016/j.athoracsur.2020.08.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/01/2020] [Revised: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND With the implementation of the new heart allocation system, heart transplantation teams are prompted to reevaluate management of patients requiring mechanical circulatory support. The purpose of our study is to compare the outcomes of patients supported with extracorporeal membrane oxygenation (ECMO) before transplantation. METHODS The United Network for Organ Sharing database was queried for all adult patients (aged 18 years or more) who required support with ECMO before heart transplantation from 2001 to 2018. Patients were stratified into patients who did not require ECMO before transplantation, who were weaned off ECMO before transplantation, who were bridged immediately to transplantation from ECMO, and who were bridged to a left ventricular assist device (LVAD) before transplantation. Demographics and outcomes including 1-year survival, postoperative stroke, postoperative renal failure requiring dialysis, episodes of rejection, and graft failure were compared. RESULTS Overall, 29,370 patients did not require ECMO before transplantation, 101 patients were weaned off ECMO before transplantation, 118 were bridged from ECMO directly to transplantation, and 55 patients were successfully bridged from ECMO to LVAD before transplantation. Kaplan-Meier survival estimates found a statistically significant decrease in 1-year survival for patients who were bridged from ECMO to transplantation compared with patients who were bridged to LVAD before subsequent transplantation (P < .001). CONCLUSIONS Our study suggests bridging ECMO patients to an LVAD before transplantation will result in improved 1-year survival compared with patients bridged to immediate transplantation. With the new heart allocation system, continued evaluation of outcomes is required to inform management strategies.
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Affiliation(s)
- Cecillia Lui
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles D Fraser
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alejandro Suarez-Pierre
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xun Zhou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S D Higgins
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kenton J Zehr
- Heart and Vascular Institute, Detroit Medical Center, Detroit, Michigan
| | - Chun W Choi
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Suarez-Pierre A, Lui C, Zhou X, Fraser CD, Ferrigno AS, Etchill E, Giuliano K, Higgins RS, Choi CW, Kilic A. Conditional Survival in Heart Transplantation: An Organ Procurement and Transplantation Network Database Analysis. Ann Thorac Surg 2020; 110:1339-1347. [DOI: 10.1016/j.athoracsur.2020.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 12/23/2019] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
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Jacobs JP, Fraser CD, Tweddell JS, Jacobs ML. Commentary: The challenge of postoperative diaphragmatic paralysis in patients with functionally univentricular circulation: A data-driven strategy. J Thorac Cardiovasc Surg 2020; 160:1297-1299. [PMID: 32900478 DOI: 10.1016/j.jtcvs.2020.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Fla.
| | - Charles D Fraser
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
| | - James S Tweddell
- Department of Cardiothoracic Surgery, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marshall L Jacobs
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md
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Fraser CD. Commentary: I guess I'm just confused…isn't this information sobering? J Thorac Cardiovasc Surg 2020; 160:775-776. [DOI: 10.1016/j.jtcvs.2020.02.020] [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] [Received: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 11/30/2022]
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Chacon-Portillo MA, Mossad EB, Zea-Vera R, Beckerman Z, Binsalamah ZM, Adachi I, Mery CM, Imamura M, Heinle JS, Fraser CD. Sickle Cell-Related Complications in Patients Undergoing Cardiopulmonary Bypass. World J Pediatr Congenit Heart Surg 2020; 11:565-571. [PMID: 32853076 DOI: 10.1177/2150135120926991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We aimed to describe our experience with patients with sickle cell trait (SCT) and undergoing surgery on cardiopulmonary bypass (CPB). METHODS Data on all patients with SCT or sickle-α thalassemia who underwent surgery on CPB were collected (1996-2017). RESULTS Overall, 46 patients were included, 37 (80%) had SCT and 9 (20%) had sickle-α thalassemia. A total of 4 (9%) developed a potential sickle cell-related complication. Patients with sickle cell-related complications were significantly older (median 14 years vs 14 months, P = .037) and heavier (median 54 kg vs 9 kg, P = .041). Complications occurred, although without statistical significance, in patients who underwent longer median CPB times (249 minutes vs 137 minutes, P = .069), lower median temperature (31.7 °C vs 33.3 °C, P = .094), and a higher percentage underwent deep hypothermic circulatory arrest (50% vs 7%, P = .053). A total of 30 (65%) patients underwent exchange transfusion (ET) pre-bypass. Patients who underwent ET were significantly older (median 4 years vs 7 months, P = .003) and heavier (median 16 kg vs 6 kg, P = .015) than patients who did not undergo ET. The incidence of complications was comparable between patients who underwent ET (10%) and those who did not (6%). CONCLUSIONS In this retrospective, single-center study, it has been shown that cardiac surgery requiring CPB in patients with SCT and sickle-α thalassemia had a low risk for sickle cell-associated complications. In this cohort of patients, older age, longer CPB times, lower median temperature, and the utilization of deep hypothermic circulatory arrest appear to play an important role in the development of complications.
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Affiliation(s)
- Martin A Chacon-Portillo
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Emad B Mossad
- Division of Pediatric Cardiovascular Anesthesia, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Ziv Beckerman
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Ziyad M Binsalamah
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Iki Adachi
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
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Fraser CD. Commentary: Coronary origins after the arterial switch operation: Let's think of it like anomalous aortic origin of the coronaries. J Thorac Cardiovasc Surg 2020; 161:1406-1407. [PMID: 32792154 DOI: 10.1016/j.jtcvs.2020.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, The University of Texas - Dell Medical School, Dell Children's Hospital, Austin, Tex.
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Fraser CD, Ravekes W, Thibault D, Scully B, Chiswell K, Giuliano K, Hill KD, Jacobs JP, Jacobs ML, Kutty S, Vricella L, Hibino N. Diaphragm Paralysis After Pediatric Cardiac Surgery: An STS Congenital Heart Surgery Database Study. Ann Thorac Surg 2020; 112:139-146. [PMID: 32763270 DOI: 10.1016/j.athoracsur.2020.05.175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/27/2020] [Revised: 05/08/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Previous single-center studies of diaphragm paralysis (DP) after pediatric cardiac surgery report incidence of 0.3% to 12.8% and associate DP with respiratory complications, prolonged ventilation and length of stay, and mortality. To better define incidence and associations between DP and various procedures and outcomes, we performed a multicenter study. METHODS The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried to identify children who experienced DP after cardiac surgery (2010-2018; 126 centers). Baseline characteristics and postoperative outcomes were compared between patients with and without DP as well as between patients who underwent plication and those who did not. Associations between center volume and center rates of DP and use of plication were also explored. RESULTS A total of 2214 of 191,463 (1.2%) patients experienced DP. Postoperative DP portended worse outcomes, including mortality (5.6% vs 3.5%; P < .001), major morbidity (37.2% vs 10.7%; P < .001), tracheostomy (7.1% vs 0.9%; P < .001), prolonged mechanical ventilation (38.0% vs 7.8%; P < .001), and 30-day readmission (22.0% vs 10.6%; P < .001). A total of 1105 of 2214 (49.9%) patients with DP underwent plication. Patients who underwent plication were younger, were smaller, had more risk factors, and underwent more complex surgeries. Plication rates varied widely across centers. There was no correlation between center volume and center risk-adjusted rates of DP (r = .05, P = .5), nor frequency of plication (r = .08, P = .4). CONCLUSIONS DP complicating pediatric heart surgery is rare but portends significantly worse outcomes. One-half of patients underwent plication. Center-level risk-adjusted rates of DP and plication are not associated with case volume. Significant variability in plication practices suggests a target for quality improvement.
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Affiliation(s)
- Charles D Fraser
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
| | - William Ravekes
- Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Dylan Thibault
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Brandi Scully
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Karen Chiswell
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Katherine Giuliano
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kevin D Hill
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Jeffrey P Jacobs
- Division of Thoracic and Cardiovascular Surgery, University of Florida Congenital Heart Center, Gainesville, Florida
| | - Marshall L Jacobs
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Shelby Kutty
- Division of Pediatric Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Luca Vricella
- Division of Pediatric Cardiac Surgery, University of Chicago, Chicago, Illinois
| | - Narutoshi Hibino
- Division of Pediatric Cardiac Surgery, University of Chicago, Chicago, Illinois
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Mizrahi M, Mery CM, Hasbani K, Fraser CD, Beckerman Z. Anomalous Aortic Origin of a Coronary Artery: Surgical Emergency? Ann Thorac Surg 2020; 110:e257-e259. [PMID: 32240646 DOI: 10.1016/j.athoracsur.2020.02.052] [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: 01/18/2020] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 11/26/2022]
Abstract
Anomalous aortic origin of a coronary artery is a congenital condition associated with sudden cardiac death. There are no current recommendations for the acute management and urgency for this patient population. This manuscript describes and discusses two patients who presented with an acute coronary event and needed emergent intervention despite initial clinical stabilization and improvement.
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Affiliation(s)
- Michelle Mizrahi
- Coronary Anomalies Program, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, Austin, Texas; Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, Texas
| | - Carlos M Mery
- Coronary Anomalies Program, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, Austin, Texas; Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, Texas
| | - Keren Hasbani
- Coronary Anomalies Program, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, Austin, Texas; Department of Pediatrics, University of Texas Dell Medical School, Austin, Texas
| | - Charles D Fraser
- Coronary Anomalies Program, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, Austin, Texas; Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, Texas
| | - Ziv Beckerman
- Coronary Anomalies Program, Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children's Medical Center, Austin, Texas; Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin, Texas.
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Beckerman Z, Martínez-Bravo LE, Johnson G, Holt B, Fraser CD. Rare Presentation of Endocarditis and Mycotic Brain Aneurysm. Ann Thorac Surg 2020; 109:e179-e181. [DOI: 10.1016/j.athoracsur.2019.06.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/14/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
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Doan TT, Zea-Vera R, Agrawal H, Mery CM, Masand P, Reaves-O’Neal DL, Noel CV, Qureshi AM, Sexson-Tejtel SK, Fraser CD, Molossi S. Myocardial Ischemia in Children With Anomalous Aortic Origin of a Coronary Artery With Intraseptal Course. Circ Cardiovasc Interv 2020; 13:e008375. [DOI: 10.1161/circinterventions.119.008375] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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] [Indexed: 11/16/2022]
Abstract
Background:
Intraseptal anomalous aortic origin of a coronary artery is considered a benign condition. However, there have been case reports of patients with myocardial ischemia, arrhythmia, and sudden cardiac death. The purpose of this study was to determine the clinical presentation, myocardial perfusion on provocative stress testing, and management of children with anomalous aortic origin of a coronary artery with an intraseptal course in a prospective cohort.
Methods:
Patients with anomalous aortic origin of a coronary artery and intraseptal course were prospectively enrolled from December 2012 to May 2019, evaluated, and managed following a standardized algorithm. Myocardial perfusion was assessed using stress imaging. Fractional flow reserve was performed in patients with myocardial hypoperfusion on noninvasive testing. Exercise restriction, β-blockers, and surgical intervention were discussed with the families.
Results:
Eighteen patients (female 6, 33.3%), who presented with no symptoms (10, 55.6%), nonexertional (4, 22.2%), and exertional symptoms (4, 22.2%), were enrolled at a median age of 12.4 years (0.3–15.9). Perfusion imaging was performed in 14/18 (77.8%) and was abnormal in 7/14 (50%); fractional flow reserve was positive in 5/8 (62.5%). All 4 patients with exertional symptoms and 3/10 (30%) with no or nonexertional symptoms had myocardial hypoperfusion. Coronary artery bypass grafting was performed in a 4-year-old patient; β-blocker and exercise restriction were recommended in 4 patients not suitable for surgery. One patient had nonexertional chest pain and 17 were symptom-free at median follow-up of 2.5 years (0.2–7.1).
Conclusions:
Up to 50% of patients with intraseptal anomalous aortic origin of a coronary artery had inducible myocardial hypoperfusion during noninvasive provocative testing. Long-term follow-up is necessary to understand the natural history of this rare anomaly.
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Affiliation(s)
- Tam T. Doan
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
| | - Rodrigo Zea-Vera
- Texas Children’s Hospital and General Surgery Residency Program (R.Z.V.), Baylor College of Medicine, Houston
| | - Hitesh Agrawal
- Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis (H.A.)
| | - Carlos M. Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School, Dell Children’s Medical Center, The University of Texas at Austin (C.M.M., C.D.F.)
| | - Prakash Masand
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
- Section of Pediatric Radiology (P.M.), Baylor College of Medicine, Houston
| | - Dana L. Reaves-O’Neal
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
| | - Cory V. Noel
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
| | - Athar M. Qureshi
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
| | - S. Kristen Sexson-Tejtel
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
| | - Charles D. Fraser
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School, Dell Children’s Medical Center, The University of Texas at Austin (C.M.M., C.D.F.)
| | - Silvana Molossi
- Coronary Anomalies Program (T.T.D., P.M., D.L.R.-O., C.V.N., A.M.Q., S.K.S.-T., S.M.), Baylor College of Medicine, Houston
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Fraser CD. Commentary: TEE in TOF Surgery: Looking for the Pearls. Semin Thorac Cardiovasc Surg 2020; 32:290-291. [PMID: 32087241 DOI: 10.1053/j.semtcvs.2020.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/13/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Charles D Fraser
- Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Texas.
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Goeddel LA, Fraser CD, Daly RJ, Sciortino CM, Sheinberg RB. A Bullet in the Aortic Root: Utility of Transesophageal Echocardiography in Penetrating Thoracic Trauma. Anesth Analg 2020; 129:e69-e72. [PMID: 31425202 DOI: 10.1213/ane.0000000000002440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lee A Goeddel
- From the Department of Anesthesiology and Critical Care Medicine
| | - Charles D Fraser
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rodrigo J Daly
- From the Department of Anesthesiology and Critical Care Medicine
| | - Christopher M Sciortino
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Molossi S, Agrawal H, Mery CM, Krishnamurthy R, Masand P, Sexson Tejtel SK, Noel CV, Qureshi AM, Jadhav SP, McKenzie ED, Fraser CD. Outcomes in Anomalous Aortic Origin of a Coronary Artery Following a Prospective Standardized Approach. Circ Cardiovasc Interv 2020; 13:e008445. [DOI: 10.1161/circinterventions.119.008445] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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] [Indexed: 12/25/2022]
Abstract
Background:
Anomalous aortic origin of a coronary artery (CA) is the second leading cause of sudden cardiac death in young athletes. Management is controversial and longitudinal follow-up data are sparse. We aim to evaluate outcomes in a prospective study of anomalous aortic origin of CA patients following a standardized algorithm.
Methods:
Patients with anomalous aortic origin of a CA were followed prospectively from December 2012 to April 2017. All patients were evaluated following a standardized algorithm, and data were reviewed by a dedicated multidisciplinary team. Assessment of myocardial perfusion was performed using stress imaging. High-risk patients (high-risk anatomy—anomalous left CA from the opposite sinus, presence of intramurality, abnormal ostium—and symptoms or evidence of myocardial ischemia) were offered surgery or exercise restriction (if deemed high risk for surgical intervention). Univariate and multivariable analyses were used to determine predictors of high risk.
Results:
Of 201 patients evaluated, 163 met inclusion criteria: 116 anomalous right CA (71%), 25 anomalous left CA (15%), 17 single CA (10%), and 5 anomalous circumflex CA (3%). Patients presented as an incidental finding (n=80, 49%), with exertional (n=31, 21%) and nonexertional (n=32, 20%) symptoms and following sudden cardiac arrest/shock (n=5, 3%). Eighty-two patients (50.3%) were considered high risk. Predictors of high risk were older age at diagnosis, black race, intramural course, and exertional syncope. Most patients (82%) are allowed unrestrictive sports activities. Forty-seven patients had surgery (11 anomalous left CA and 36 anomalous right CA), 3 (6.4%) remained restricted from sports activities. All patients are alive at a median follow-up of 1.6 (interquartile range, 0.7–2.8) years.
Conclusions:
In this prospective cohort of patients with anomalous aortic origin of a CA, most have remained free of exercise restrictions. Development of a multidisciplinary team has allowed a consistent approach and may have implications in risk stratification and long-term prognosis.
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Affiliation(s)
- Silvana Molossi
- Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Hitesh Agrawal
- Invasive Cardiac Imaging and Interventional Catheterization Laboratory, Le Bonheur Children’s Hospital, The University of Tennessee Health Sciences Center, Memphis (H.A.)
| | - Carlos M. Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children’s Medical Center, Austin (C.M.M., C.D.F.)
| | - Rajesh Krishnamurthy
- Division of Pediatric Radiology, Nationwide Children’s Hospital, Columbus, OH (R.K.)
| | - Prakash Masand
- Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston
- Section of Pediatric Radiology (P.M., S.P.J.), Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - S. Kristen Sexson Tejtel
- Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Cory V. Noel
- Seattle Children’s Pediatric Cardiology of Alaska, Seattle Children’s Hospital, Anchorage (C.V.N.)
| | - Athar M. Qureshi
- Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Siddharth P. Jadhav
- Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston
- Section of Pediatric Radiology (P.M., S.P.J.), Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - E. Dean McKenzie
- Coronary Anomalies Program, The Lillie Frank Abercrombie Section of Pediatric Cardiology (S.M., P.M., S.K.S.T., A.M.Q., S.P.J., E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery (E.D.M.), Texas Children’s Hospital, Baylor College of Medicine, Houston
| | - Charles D. Fraser
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children’s Medical Center, Austin (C.M.M., C.D.F.)
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Fraser CD. Commentary: Overpromised, understudied: The slippery slope of pediatric cardiac device development. J Thorac Cardiovasc Surg 2020; 160:e221-e222. [PMID: 31987622 DOI: 10.1016/j.jtcvs.2019.10.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Charles D Fraser
- University of Texas Dell Medical School, Dell Children's Medical Center, Austin, Tex.
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Fraser CD, Chacon-Portillo MA, Well A, Zea-Vera R, Binsalamah Z, Adachi I, Mery CM, Heinle JS. Twenty-Three-Year Experience With the Arterial Switch Operation: Expectations and Long-Term Outcomes. Semin Thorac Cardiovasc Surg 2020; 32:292-299. [PMID: 31958553 DOI: 10.1053/j.semtcvs.2020.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 11/26/2019] [Accepted: 01/12/2020] [Indexed: 11/11/2022]
Abstract
We aimed to describe the short- and long-term outcomes of patients after an arterial switch operation (ASO) at a single institution during a 23-year period. A retrospective chart review of all patients <18 months of age who underwent an ASO between January 1995 and March 2018 at Texas Children's Hospital, Houston, TX was performed. Primary endpoints include mortality and reintervention. Perioperative mortality was defined as mortality occurring in-hospital and/or <30 days after surgery. Survival and freedom-from-reintervention were analyzed using Kaplan-Meier method, log-rank tests, and Cox regression models. The cohort included 394 patients. Diagnoses included 204 patients (52%) with intact ventricular septum, 137 (35%) with a ventricular septal defect, 17 (4%) with a ventricular septal defect and left ventricular outflow tract obstruction (LVOTO), and 36 (9%) with Taussig-Bing anomaly. Median age at surgery was 8 days (range: 1 day to 17 months) and median weight was 3.4 (range: 0.8-12.0) kg. Overall perioperative mortality was 1.3% (n = 5), 0.3% (n = 1) since 1999. Overall survival at 5, 10, and 15 years was 98.2%, 97.8%, and 97.8%, respectively. Perioperative morality was associated with prematurity (P = 0.012), <2.5 kg (P< 0.001), and longer circulatory arrest (P = 0.024) after univariate analysis. Reintervention was associated with a longer cross-clamp time (P < 0.001), <2.5 kg (P = 0.009), LVOTO resection (P = 0.047), and genetic syndrome (P= 0.011) after multivariable analysis. Current ASO expectations should include a perioperative mortality risk of <1% and good long-term survival. Reinterventions are more frequent in patients <2.5 kg, concomitant LVOTO resection, a genetic syndrome, and longer cross-clamp time.
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Affiliation(s)
- Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Texas.
| | - Martin A Chacon-Portillo
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Texas
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ziyad Binsalamah
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Olive MK, Fraser CD, Kutty S, McKenzie ED, Hammel JM, Krishnamurthy R, Dodd NA, Maskatia SA. Infundibular sparing versus transinfundibular approach to the repair of tetralogy of Fallot. CONGENIT HEART DIS 2020; 14:1149-1156. [DOI: 10.1111/chd.12863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/10/2019] [Accepted: 11/18/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Mary K. Olive
- Department of Pediatrics, Section of Pediatric Cardiology Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Ann Arbor Michigan
| | - Charles D. Fraser
- Department of Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease University of Texas Dell Medical School, Dell Children’s Medical Center Austin Texas
| | - Shelby Kutty
- Department of Pediatrics Taussig Congenital Heart Center, Johns Hopkins University Baltimore Maryland
| | - Emmett D. McKenzie
- Section of Congenital Heart Surgery Texas Children’s Hospital, Baylor College of Medicine Houston Texas
| | - James M. Hammel
- Section of Cardiovascular Surgery University of Nebraska College of Medicine Omaha Nebraska
| | - Rajesh Krishnamurthy
- Section of Diagnostic Radiology Nationwide Children’s Hospital, Ohio State University Columbus Ohio
| | - Nicolas A. Dodd
- Section of Pediatric Radiology Texas Children’s Hospital, Baylor College of Medicine Houston Texas
| | - Shiraz A. Maskatia
- Section of Pediatric Cardiology Stanford University Palo Alto California
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Liu RH, Fraser CD, Zhou X, Beaulieu RJ, Reifsnyder T. Complete versus partial excision of infected arteriovenous grafts: Does remnant graft material impact outcomes? J Vasc Surg 2020; 71:174-179. [DOI: 10.1016/j.jvs.2019.03.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
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Fraser CD, Kovler ML, Liu RH, Beaulieu RJ, Reifsnyder T. Contemporary Outcomes following Redo Autogenous Infrainguinal Bypass. Ann Vasc Surg 2019; 66:537-542. [PMID: 31678127 DOI: 10.1016/j.avsg.2019.10.070] [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] [Received: 07/21/2019] [Revised: 10/13/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Revascularization after lower extremity bypass failure poses many challenges. Despite nearly 7 decades of experience with lower extremity revascularization, there is little data on the success of redo bypass particularly when autogenous conduit is utilized. The purpose of this study is to review outcomes of redo infrainguinal bypass constructed solely of autogenous vein. METHODS All patients who underwent redo infrainguinal bypass at a single institution by a single surgeon were retrospectively reviewed. Bypasses were categorized into 3 groups: femoral-popliteal, femoral-distal, and popliteal-distal bypasses. Since the repeat bypasses were all done for limb salvage, freedom from above or below knee amputation (FFA) was primary outcome, which was defined as the number of days from redo bypass to subsequent amputation or the most recent follow-up. RESULTS From 2006 to 2016, 100 limbs underwent redo bypass. Fifty-nine (59.0%) limbs had undergone one previous bypass while 41 (41.0%) had undergone 2 or more. The redo configurations consisted of 23 (23.0%) femoral-popliteal, 70 (70.0%) femoral-distal, and 7 (7.0%) popliteal-distal bypasses. Ninety-seven (97.0%) underwent redo using autologous vein grafts including 41 (95.5%) of those who had 2 or more previous bypasses. The 3 patients who ultimately underwent prosthetic bypass had bilateral great and small saphenous veins and bilateral basilic and cephalic veins previously harvested. Nine (9.0%) limbs were subsequently amputated: 2 (2.0%) above knee and 7 (7.0%) below knee amputations. Of these, all had had 2 or more previous bypasses and 2 of the 3 patients who ultimately received prosthetic bypasses were in this group. In patients with one previous bypass, FFA was 775 days (IQR: 213-1,626 days). In patients with 2 or more previous bypasses, FFA was 263 days (IQR: 106-1,148 days). No patients with femoral-popliteal bypasses suffered amputation while 7 (10.0%) of the femoral-distal and 2 (28.6%) of the popliteal-distal bypasses suffered subsequent amputations (P = 0.067). CONCLUSIONS Redo infrainguinal bypass is effective in salvaging threatened lower extremities. Furthermore, once a patient is deemed a bypass candidate, revascularization with autologous vein can be achieved. A significant FFA rate is achieved with redo bypass, although patients with more distal disease are harder to salvage.
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Affiliation(s)
- Charles D Fraser
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.
| | - Mark L Kovler
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Rui Han Liu
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | | | - Thomas Reifsnyder
- Division of Vascular Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, MD
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Lui C, Suarez-Pierre A, Zhou X, Crawford TC, Fraser CD, Giuliano K, Hsu S, Higgins RS, Zehr KJ, Whitman GJ, Choi CW, Kilic A. Effects of Systemic and Device-Related Complications in Patients Bridged to Transplantation With Left Ventricular Assist Devices. J Surg Res 2019; 246:207-212. [PMID: 31605947 DOI: 10.1016/j.jss.2019.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 02/18/2019] [Revised: 06/24/2019] [Accepted: 08/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of left ventricular assist devices (LVADs) as a bridge to heart transplantation has increased rapidly over the last 2 decades. We aim to explore the effect of pretransplant systemic and device-related complications on posttransplant survival for patients bridged with LVADs. MATERIALS AND METHODS The United Network of Organ Sharing (Organ Procurement and Transplantation Network) database was queried for all adult heart transplant recipients (aged ≥ 18 y) transplanted from April 1, 2015, to June 31, 2018. Device-related complications included thrombosis, device infection, device malfunction, life-threatening arrhythmia, and other device complications. Systemic complications included a new dialysis need or ventilator dependence between the time of listing and transplantation, transfusion, or systemic infection requiring treatment with intravenous antibiotics within 2 wk of transplantation. RESULTS A total of 2131 patients were identified as requiring LVAD support before transplantation. LVAD patients had high rates of preoperative systemic complications (53%) and high rates of device-related complications (42.7% experienced at least one device-related complication). Kaplan-Meier analysis revealed a significantly decreased 1-y survival for LVAD patients bridged to transplantation who experienced a pretransplant systemic complication (P = 0.041). Interestingly, preoperative device-related complications had no effect on 1-y posttransplantation survival (P = 0.93). Multivariate Cox modeling revealed that systemic complications were associated with a significantly increased risk of posttransplant mortality for LVAD patients (hazard ratio 1.45; P = 0.033). CONCLUSIONS Recipients who suffered a systemic complication while awaiting heart transplantation experienced higher short-term mortality rates. Device-related complications do not appear to impact posttransplantation outcomes.
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Affiliation(s)
- Cecillia Lui
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Alejandro Suarez-Pierre
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xun Zhou
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd C Crawford
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles D Fraser
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine Giuliano
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Steven Hsu
- Department of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S Higgins
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kenton J Zehr
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Glenn J Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chun W Choi
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Lui C, Fraser CD, Zhou X, Suarez-Pierre A, Kilic A, Zehr KJ, Higgins RS. Racial Disparities in Patients Bridged to Heart Transplantation With Left Ventricular Assist Devices. Ann Thorac Surg 2019; 108:1122-1126. [DOI: 10.1016/j.athoracsur.2019.03.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/01/2019] [Accepted: 03/25/2019] [Indexed: 01/25/2023]
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Crawford TC, Leary PJ, Fraser CD, Suarez-Pierre A, Magruder JT, Baumgartner WA, Zehr KJ, Whitman GJ, Masri SC, Sheikh F, De Marco T, Maron BA, Sharma K, Gilotra NA, Russell SD, Houston BA, Ramu B, Tedford RJ. Impact of the New Pulmonary Hypertension Definition on Heart Transplant Outcomes: Expanding the Hemodynamic Risk Profile. Chest 2019; 157:151-161. [PMID: 31446063 DOI: 10.1016/j.chest.2019.07.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [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: 03/09/2019] [Revised: 07/11/2019] [Accepted: 07/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND At the recent 6th World Symposium on Pulmonary Hypertension (PH), the definition of PH was redefined to include lower pulmonary artery pressures in the setting of elevated pulmonary vascular resistance (PVR). However, the relevance of this change to subjects with PH due to left-heart disease as well as the preoperative assessment of heart transplant (HT) recipients is unknown. METHODS The United Network for Organ Sharing database was queried to identify adult recipients who underwent primary HT from 1996 to 2015. Recipients were subdivided into those with mean pulmonary artery pressure (mPAP) < 25 mm Hg and ≥ 25 mm Hg. Exploratory univariable analysis was undertaken to identify candidate risk factors associated with 30-day and 1-year survival (conditional on 30-day survival) in recipients with mPAP < 25 mm Hg, and subsequently, parsimonious multivariable Cox proportional hazards models were constructed to assess the independent association with PVR. RESULTS Over the study period, 32,465 patients underwent HT, including 12,257 (38%) with mPAP < 25 mm Hg. The median age was 55 years (interquartile range, 47-62) and the median PVR was 1.5 Wood units (WU) (interquartile range, 1-2.2) in recipients with mPAP < 25 mm Hg. After controlling for confounders, PVR was independently associated with increased risk for 30-day mortality (hazard ratio, 1.16; 95% CI, 1.05-1.27; P < .01), but not conditional 1-year mortality (hazard ratio, 1.03; 95% CI, 0.94-1.12; P = .55). PVR ≥ 3 WU was associated with an absolute 1.9% increase in 30-day mortality in those with mPAP < 25 mm Hg, a similar risk to recipients with PVR ≥ 3 WU and mPAP ≥ 25 mm Hg. CONCLUSIONS Elevated PVR remains associated with a significant increase in the hazard for 30-day mortality after cardiac transplantation, even in the setting of lower pulmonary artery pressures. These data support the validity of the new definition of pulmonary hypertension.
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Affiliation(s)
- Todd C Crawford
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peter J Leary
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington Medicine, Seattle, WA
| | - Charles D Fraser
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - J Trent Magruder
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - William A Baumgartner
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenton J Zehr
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Glenn J Whitman
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - S Carolina Masri
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington Medicine, Seattle, WA
| | - Farooq Sheikh
- Advanced Heart Failure program, Mechanical Circulatory Support, and Cardiac Transplantation, MedStar Washington Hospital Center, Washington, DC
| | - Teresa De Marco
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Bradley A Maron
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston VA Health Care System, Boston, MA
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stuart D Russell
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Bhavadharini Ramu
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
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Suarez‐Pierre A, Lui C, Zhou X, Fraser CD, Crawford TC, Choi CW, Whitman GJ, Higgins RS, Kilic A. Discrepancies in access and institutional risk tolerance in heart transplantation: A national open cohort study. J Card Surg 2019; 34:994-1003. [DOI: 10.1111/jocs.14179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alejandro Suarez‐Pierre
- Department of Surgery, Division of Cardiac SurgeryJohns Hopkins University School of Medicine Baltimore Maryland
| | - Cecillia Lui
- Department of Surgery, Division of Cardiac SurgeryJohns Hopkins University School of Medicine Baltimore Maryland
| | - Xun Zhou
- Department of Surgery, Division of Cardiac SurgeryJohns Hopkins University School of Medicine Baltimore Maryland
| | - Charles D. Fraser
- Department of Surgery, Division of Cardiac SurgeryJohns Hopkins University School of Medicine Baltimore Maryland
| | - Todd C. Crawford
- Department of Surgery, Division of Cardiac SurgeryJohns Hopkins University School of Medicine Baltimore Maryland
| | - Chun W. Choi
- Department of Surgery, Division of Cardiac SurgeryJohns Hopkins University School of Medicine Baltimore Maryland
| | - Glenn J. Whitman
- Department of Surgery, Division of Cardiac SurgeryJohns Hopkins University School of Medicine Baltimore Maryland
| | - Robert S. Higgins
- Department of Surgery, Division of Cardiac SurgeryJohns Hopkins University School of Medicine Baltimore Maryland
| | - Ahmet Kilic
- Department of Surgery, Division of Cardiac SurgeryJohns Hopkins University School of Medicine Baltimore Maryland
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Suarez-Pierre A, Lui C, Zhou X, Crawford TC, Fraser CD, Giuliano K, Hsu S, Higgins RS, Zehr KJ, Whitman GJ, Choi CW, Kilic A. Early Outcomes After Heart Transplantation in Recipients Bridged With a HeartMate 3 Device. Ann Thorac Surg 2019; 108:467-473. [DOI: 10.1016/j.athoracsur.2019.01.084] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/27/2018] [Accepted: 01/29/2019] [Indexed: 01/06/2023]
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Suarez-Pierre A, Zhou X, Gonzalez JE, Rizwan M, Fraser CD, Lui C, Malas MB, Abularrage CJ, Black JH. Association of preoperative spinal drain placement with spinal cord ischemia among patients undergoing thoracic and thoracoabdominal endovascular aortic repair. J Vasc Surg 2019; 70:393-403. [DOI: 10.1016/j.jvs.2018.10.112] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/22/2018] [Indexed: 11/24/2022]
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