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Stern JA, Tou SP, Barker PC, Hill KD, Lodge AJ, Mathews KG, Keene BW. Hybrid cutting balloon dilatation for treatment of cor triatriatum sinister in a cat. J Vet Cardiol 2013; 15:205-10. [DOI: 10.1016/j.jvc.2013.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 03/20/2013] [Accepted: 03/25/2013] [Indexed: 11/29/2022]
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Crews KA, Kaiser SL, Walczak RJ, Jaquiss RD, Lodge AJ. Bridge to Transplant With Extracorporeal Membrane Oxygenation Followed by HeartWare Ventricular Assist Device in a Child. Ann Thorac Surg 2013; 95:1780-2. [DOI: 10.1016/j.athoracsur.2012.09.088] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Revised: 09/12/2012] [Accepted: 09/28/2012] [Indexed: 10/26/2022]
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Turek JW, Andersen ND, Lawson DS, Bonadonna D, Turley RS, Peters MA, Jaggers J, Lodge AJ. Outcomes before and after implementation of a pediatric rapid-response extracorporeal membrane oxygenation program. Ann Thorac Surg 2013; 95:2140-6; discussion 2146-7. [PMID: 23506632 DOI: 10.1016/j.athoracsur.2013.01.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/11/2013] [Accepted: 01/27/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Rapid-response extracorporeal membrane oxygenation (RR-ECMO) has been implemented at select centers to expedite cannulation for patients placed on ECMO during extracorporeal cardiopulmonary resuscitation (ECPR). In 2008, we established such a program and used it for all pediatric venoarterial ECMO initiations. This study was designed to compare outcomes before and after program implementation. METHODS Between 2003 and 2011, 144 pediatric patients were placed on venoarterial ECMO. Records of patients placed on ECMO before (17 ECPR and 62 non-ECPR) or after (14 ECPR and 51 non-ECPR) RR-ECMO program implementation were retrospectively compared. RESULTS The peak performance of the ECMO team was assessed by measuring ECMO initiation times for the ECPR patient subgroup (n = 31). There was a shift toward more ECPR initiations achieved in less than 40 minutes (24% pre-RR-ECMO versus 43% RR-ECMO; p = 0.25) and fewer requiring more than 60 minutes (47% pre-RR-ECMO versus 21% RR-ECMO; p = 0.14) after program implementation, although these changes did not reach statistical significance. After multivariable risk adjustment, RR-ECMO was associated with a 52% reduction in neurologic complications for all patients (adjusted odds ratio, 0.48; 95% confidence interval, 0.23 to 0.98; p = 0.04), but the risk of in-hospital death remained unchanged (adjusted odds ratio, 0.99; 95% confidence interval, 0.50 to 1.99; p = 0.99). CONCLUSIONS Implementation of a pediatric RR-ECMO program for venoarterial ECMO initiation was associated with reduced neurologic complications but not improved survival during the first 3 years of program implementation. These data suggest that development of a coordinated system for rapid ECMO deployment may benefit both ECPR and non-ECPR patients, but further efforts are required to improve survival.
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Hill KD, Lodge AJ, Forsha D, Fleming GA, Green AS, Rhodes JF. A strategy for atrial septal defect closure in small children that eliminates long-term wall erosion risk. Catheter Cardiovasc Interv 2012; 81:654-9. [DOI: 10.1002/ccd.24500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 05/20/2012] [Indexed: 11/09/2022]
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Chen XJ, Smith PB, Jaggers J, Lodge AJ. Bioprosthetic pulmonary valve replacement: contemporary analysis of a large, single-center series of 170 cases. J Thorac Cardiovasc Surg 2012; 146:1461-6. [PMID: 23122698 DOI: 10.1016/j.jtcvs.2012.09.081] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 08/10/2012] [Accepted: 09/13/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The present study was designed to compare stented porcine and bovine pericardial valves used for pulmonary valve replacement to better define valve performance and postoperative quality of life. METHODS A retrospective review of all patients who underwent pulmonary valve replacement with a stented bioprosthesis from 1992 to 2008 was conducted. The medical records, imaging results, and quality of life questionnaires were analyzed. Differences in reintervention by valve type were determined using Cox proportional hazards models, controlling for subject age. RESULTS A total of 170 consecutive pulmonary valve replacements (73 stented porcine, group 1; 97 bovine pericardial, group 2) were reviewed. No significant differences were seen in patient age or implanted valve size between the groups. Surgical mortality was 1.2%. The median follow-up was 48.2 months and was longer for group 2. No significant difference was seen in the risk of reintervention by valve type (hazard ratio, 0.64; 95% confidence interval, 0.18-2.34; P = .51). After 39 months of follow-up, pulmonary stenosis and pulmonary insufficiency that was moderate or worse were more common in patients who had undergone pulmonary valve replacement at younger than 15 years (pulmonary stenosis, 30.9% vs 10.0%, P = .003; pulmonary insufficiency, 46.2% vs 3.8%, P < .001), regardless of valve type. All patients performed well mentally and physically on the quality of life surveys. CONCLUSIONS The present large series of stented bioprosthetic pulmonary valve replacements has demonstrated good results, particularly in adults, at intermediate follow-up. Freedom from reintervention was similar for the porcine and pericardial valves, and our finding did not clearly demonstrate the superiority of 1 type of valve. However, the stented bioprosthetic valves were less durable in younger patients.
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Chen DF, Jaquiss RD, Lodge AJ, Carboni MP. 82-P. Hum Immunol 2012. [DOI: 10.1016/j.humimm.2012.07.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Andersen ND, DiBernardo LR, Linardic CM, Camitta MGW, Lodge AJ. Recurrent inflammatory myofibroblastic tumor of the heart. Circulation 2012; 125:2379-81. [PMID: 22586293 DOI: 10.1161/circulationaha.111.066191] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tabbutt S, Ghanayem N, Ravishankar C, Sleeper LA, Cooper DS, Frank DU, Lu M, Pizarro C, Frommelt P, Goldberg CS, Graham EM, Krawczeski CD, Lai WW, Lewis A, Kirsh JA, Mahony L, Ohye RG, Simsic J, Lodge AJ, Spurrier E, Stylianou M, Laussen P. Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 2012; 144:882-95. [PMID: 22704284 DOI: 10.1016/j.jtcvs.2012.05.019] [Citation(s) in RCA: 240] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 03/21/2012] [Accepted: 05/09/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial. METHODS Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality. RESULTS Analysis included 549 subjects prospectively enrolled from 15 centers; 30-day and hospital mortality were 11.5% (63/549) and 16.0% (88/549), respectively. Independent risk factors for both 30-day and hospital mortality included lower birth weight, genetic abnormality, extracorporeal membrane oxygenation (ECMO) and open sternum on the day of the Norwood procedure. In addition, longer duration of deep hypothermic circulatory arrest was a risk factor for 30-day mortality. Shunt type at the end of the Norwood procedure was not a significant risk factor for 30-day or hospital mortality. Independent risk factors for postoperative renal failure (n = 46), sepsis (n = 93), increased length of ventilation, and hospital length of stay among survivors included genetic abnormality, lower center/surgeon volume, open sternum, and post-Norwood operations. CONCLUSIONS Innate patient factors, ECMO, open sternum, and lower center/surgeon volume are important risk factors for postoperative mortality and/or morbidity during the Norwood hospitalization.
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Forsha D, Rhodes JF, Williams DA, Lodge AJ, Li JS. A Rare Coronary Collateral in Pulmonary Atresia and Intact Septum With Coronary Sinusoids. World J Pediatr Congenit Heart Surg 2012; 3:255-9. [DOI: 10.1177/2150135111430515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A neonate with pulmonary atresia and intract ventricular septum, ventriculocoronary sinusoids, bilateral coronary ostial atresia, and a rare collateral vessel between the descending thoracic aorta and the coronary system is described. The clinical course in this infant included extracorporeal life support and coil occlusion of the collateral in order to manage multiple ischemic events.
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Jaquiss RDB, Lodge AJ. Pediatric Ventricular Assist Devices: The Future (as of 2011). World J Pediatr Congenit Heart Surg 2012; 3:82-6. [PMID: 23804689 DOI: 10.1177/2150135111423277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the last decade, there have been enormous advances in the field of pediatric-specific mechanical circulatory support. In the past, small children requiring bridge to transplant or recovery were limited to extracorporeal membrane oxygenation. Now, in various stages of development, there are several devices that offer the promise of the same quality of support enjoyed by older teenagers and adolescents, with the potential to substantially reduce transplant waiting list mortality and optimize transplant outcomes. Advances have been driven by both industry and, for the first time, by funding from the US National Institutes of Health.
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Piacentino V, Troupes CD, Ganapathi AM, Blue LJ, Mackensen GB, Swaminathan M, Felker GM, Stafford-Smith M, Lodge AJ, Rogers JG, Milano CA. Clinical impact of concomitant tricuspid valve procedures during left ventricular assist device implantation. Ann Thorac Surg 2011; 92:1414-8; discussion 1418-9. [PMID: 21958790 DOI: 10.1016/j.athoracsur.2011.05.084] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 05/12/2011] [Accepted: 05/16/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND Almost 50% of patients referred for implantable left ventricular assist device (LVAD) have significant tricuspid regurgitation (TR). Preoperative TR is associated with negative outcomes but the clinical benefit of concomitant tricuspid valve procedures has not been extensively studied. METHODS One hundred fifteen patients, undergoing implantable LVADs, were identified as having significant TR by echocardiography prior to their surgical procedure. Patients underwent either LVAD alone (n = 81) versus LVAD plus concomitant tricuspid procedures (n = 34) (29 annuloplasty ring repairs and 5 bioprosthetic replacements.) Preoperative characteristics and hemodynamics, as well as TR severity and clinical outcomes were retrospectively determined from chart and database review and compared for the two groups. RESULTS Preoperative characteristics and hemodynamics were similar for the two groups. Postoperative TR was markedly reduced for the group undergoing concomitant procedures versus LVAD alone. A temporary right ventricular assist device was required for only one of the 34 cases in which concomitant tricuspid procedures were performed; for patients undergoing LVAD alone, 8 of 81 required right ventricular assist devices. Mean duration of postoperative inotrope utilization was increased for the LVAD alone group versus the group with concomitant tricuspid procedures (10.0 vs 8.0 days, respectively, p = 0.04). The incidence of postoperative renal dysfunction was increased for the LVAD alone group (39%) versus concomitant procedures (21%) (p = 0.05). The LVAD alone group also had a greater mean postimplant length of hospitalization versus the concomitant procedures group (26.0 vs 19.0 days, p = 0.02). Finally, there was a trend toward improved survival for the group with concomitant tricuspid procedures versus LVAD alone. CONCLUSIONS For patients with significant TR undergoing implantable LVAD procedures, concomitant tricuspid procedures are associated with improved early clinical outcomes.
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Turner II, Turek JW, Jaggers J, Herlong JR, Lawson DS, Lodge AJ. Anomalous Aortic Origin of a Coronary Artery: Preoperative Diagnosis and Surgical Planning. World J Pediatr Congenit Heart Surg 2011; 2:340-5. [DOI: 10.1177/2150135111406938] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Anomalous aortic origin of a coronary artery (AAOCA), the anomalous coronary artery arises from an inappropriate coronary sinus and travels between the aorta and pulmonary artery. Proper surgical management depends upon correct diagnosis and accurate characterization of the origin and course of the coronary artery. Transthoracic echocardiography (TTE) has been the mainstay for diagnosis, but magnetic resonance imaging (MRI) and computed tomographic angiography (CTA) have been increasingly utilized. In this study, we report the largest series of surgically repaired AAOCA and accuracy of preoperative diagnostic studies. Methods: A review of 53 consecutive patients (mean age 13.9 years, range 4-65 years) undergoing repair of an AAOCA from 1995 to 2009 was performed. In all, 40 patients were identified with an anomalous right coronary artery (ARCA) from the left sinus of Valsalva, 13 patients had an anomalous left coronary artery (ALCA) arising from the opposite sinus. Symptoms of angina or syncope were present in 58% and 46% of cases with ARCA and ALCA, respectively. Results of preoperative diagnostic testing were compared to actual surgical findings to determine the accuracy of the tests. Results: Lack of an intramural course was observed intraoperatively in 7 cases (5 ARCA and 2 ALCA). Preoperative TTE accurately predicted whether the AAOCA was intramural or extramural in 49 (92.5%) of 53 cases. Magnetic resonance imaging was predictive in 5 (83.3%) of 6 patients and CTA in 11 (64.7%) of 17. Survival was 100%. Complications occurred in 4 (7.5%) of 53 patients (mean follow-up 29 months). Patency was confirmed in 97.7% with TTE, and 23 (95.8%) of 24 patients had a negative postoperative functional study. Conclusions: Transthoracic echocardiography was found to be very accurate at defining the presence or absence of an intramural course in AAOCA. Both MRI and CTA can provide additional information but may not be as accurate as TTE.
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Pasquali SK, Sun JL, d'Almada P, Jaquiss RDB, Lodge AJ, Miller N, Kemper AR, Lannon CM, Li JS. Center variation in hospital costs for patients undergoing congenital heart surgery. Circ Cardiovasc Qual Outcomes 2011; 4:306-12. [PMID: 21505154 DOI: 10.1161/circoutcomes.110.958959] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenital heart disease consumes significant health care resources; however, there are limited data regarding factors affecting resource utilization. The purpose of this study was to evaluate variation between centers in total hospital costs for 4 congenital heart operations of varying complexity and associated factors. METHODS AND RESULTS The Premier Database was used to evaluate total cost in children undergoing isolated atrial septal defect (ASD) repair, ventricular septal defect (VSD) repair, tetralogy of Fallot (TOF) repair, or arterial switch operation (ASO) from 2001 to 2007. Mixed models were used to evaluate the impact of center on total hospital costs adjusting for patient and center characteristics and length of stay. A total of 2124 patients were included: 719 ASD (19 centers), 792 VSD (20 centers), 420 TOF (17 centers), and 193 ASO (13 centers). Total cost increased with complexity of operation from median $12 761 (ASD repair) to $55 430 (ASO). In multivariable analysis, models that accounted for center effects versus those that did not performed significantly better for all 4 surgeries (all P≤0.01). The proportion of total cost variation explained by center was 19% (ASD repair), 11% (VSD repair), 6% (TOF repair), and 3% (ASO). Higher-volume centers had significantly lower hospital costs for ASD and VSD repair but not for TOF repair and ASO. CONCLUSIONS Total hospital costs varied significantly by center for all congenital heart surgeries evaluated, even after adjustment for patient and center characteristics and length of stay. Differences among centers were most prominent for lower complexity procedures.
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Piacentino V, Williams ML, Depp T, Garcia-Huerta K, Blue L, Lodge AJ, Mackensen GB, Swaminathan M, Rogers JG, Milano CA. Impact of tricuspid valve regurgitation in patients treated with implantable left ventricular assist devices. Ann Thorac Surg 2011; 91:1342-6; discussion 1346-7. [PMID: 21457940 DOI: 10.1016/j.athoracsur.2011.01.053] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 01/14/2011] [Accepted: 01/20/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND The progression of tricuspid valve regurgitation (TR) and the impact of preoperative TR on postoperative outcomes in patients having left ventricular assist device (LVAD) implantation has not been studied. METHODS One hundred seventy-six consecutive implantable LVAD procedures were retrospectively reviewed. A total of 137 patients comprised the final study group with complete preimplant characteristics, before and after echocardiogram assessment of TR, and outcomes data. Patients were divided into two groups: insignificant TR (iTR) consisting of those with preimplant TR grades of none, trace, and mild; and significant TR (sTR) consisting of those with moderate and severe TR grades. RESULTS Relative to patients with iTR, patients with sTR were younger (53.6±12.8 versus 58.4±10.0 years, p=0.02) and more commonly had nonischemic cardiomyopathies (69% versus 38%, p<0.001). The preimplant incidence of iTR and sTR was 51% and 49%. Immediately after the LVAD implant procedure, TR did not significantly change. At late follow-up (156±272 days), 32% had moderate or severe TR. Also, 41% of the original sTR group persisted with moderate or severe TR. Relative to patients with iTR, patients with sTR required longer postimplant intravenous inotropic support (8.5 versus 5.0 days, p=0.02), more commonly required a temporary right ventricular assist device, and had a longer postimplant length of hospital stay (27.0 versus 20.0 days, p=0.03). There was also a trend toward decreased survival for sTR versus iTR (log rank=0.05). CONCLUSIONS Tricuspid regurgitation is not reduced immediately after LVAD implantation. Significant TR is associated with longer postimplant inotropic support and length of hospital stay.
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Hornik CP, Hartman ME, Markert ML, Lodge AJ, Cheifetz IM, Turner DA. Successful extracorporeal membrane oxygenation for respiratory failure in an infant with DiGeorge anomaly, following thymus transplantation. Respir Care 2011; 56:866-70. [PMID: 21333090 DOI: 10.4187/respcare.01051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report the first successful use of venovenous extracorporeal membrane oxygenation (ECMO) for refractory respiratory failure in an infant with DiGeorge anomaly, following thymus transplantation. A 23-month-old female with complete immune-incompetent DiGeorge anomaly 65 days after allogenic thymus transplantation was treated in our pediatric intensive care unit for acute respiratory failure secondary to bacterial sepsis. She subsequently developed acute hypercarbic respiratory failure unresponsive to conventional medical therapy. She was successfully managed with venovenous ECMO for 4 days, with complete resolution of her respiratory symptoms. This case demonstrates the complex decision making process regarding initiation of ECMO in patients with severe immunodeficiency.
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Trivedi B, Smith PB, Barker PC, Jaggers J, Lodge AJ, Kanter RJ. Arrhythmias in patients with hypoplastic left heart syndrome. Am Heart J 2011; 161:138-44. [PMID: 21167346 DOI: 10.1016/j.ahj.2010.09.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 09/29/2010] [Indexed: 01/31/2023]
Abstract
BACKGROUND Mortality between stage I and II palliation for hypoplastic left heart syndrome (HLHS) has been associated with arrhythmias. The stage-related proportion, associations, and clinical impact of arrhythmias in patients with HLHS have not been evaluated. In addition, arrhythmia subtypes have not been described in this patient group. METHODS We performed a retrospective analysis of all patients at Duke University Medical Center who received one or more palliative stages for HLHS from September 2000 to October 2008. RESULTS Overall, 49 (57%) of 86 patients had 63 arrhythmias. The majority of arrhythmias occurred between stage I and II, with 44 (51%) of 86 patients manifesting a new arrhythmia. Arrhythmias occurring in this interval tended to be associated with a higher mortality compared with arrhythmias occurring after stage II (odds ratio = 3.2 [95% CI 0.84-12.0], P = .09). Overall mortality was similar in patients with and without arrhythmias (P = .99). Supraventricular tachycardia was the most common arrhythmia (16/63; 25%), but persistent bradycardias (sinus node dysfunction or high-grade atrioventricular block) had the worst clinical outcome with 73% mortality (8/11). There was no association between arrhythmia occurrence and degree of tricuspid regurgitation, left ventricular hypertension, genetic syndrome, type of stage I operation, or need for extracorporeal membrane oxygenation. CONCLUSIONS A large proportion of patients with HLHS experience serious arrhythmias requiring therapy, especially between stage I and II. Persistent bradycardia following stage I is associated with a high mortality rate. Considering all arrhythmia patients, overall mortality was not different compared with the arrhythmia-free group.
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Pasquali SK, Hall M, Li JS, Peterson ED, Jaggers J, Lodge AJ, Marino BS, Goodman DM, Shah SS. Corticosteroids and outcome in children undergoing congenital heart surgery: analysis of the Pediatric Health Information Systems database. Circulation 2010; 122:2123-30. [PMID: 21060075 PMCID: PMC3013053 DOI: 10.1161/circulationaha.110.948737] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Children undergoing congenital heart surgery often receive corticosteroids with the aim of reducing the inflammatory response after cardiopulmonary bypass; however, the value of this approach is unclear. METHODS AND RESULTS The Pediatric Health Information Systems Database was used to evaluate outcomes associated with corticosteroids in children (0 to 18 years of age) undergoing congenital heart surgery at 38 US centers from 2003 to 2008. Propensity scores were constructed to account for potential confounders: age, sex, race, prematurity, genetic syndrome, type of surgery (Risk Adjustment in Congenital Heart Surgery [RACHS-1] category), center, and center volume. Multivariable analysis, adjusting for propensity score and individual covariates, was performed to evaluate in-hospital mortality, postoperative length of stay, duration of ventilation, infection, and use of insulin. A total of 46 730 children were included; 54% received corticosteroids. In multivariable analysis, there was no difference in mortality among corticosteroid recipients and nonrecipients (odds ratio, 1.13; 95% confidence interval, 0.98 to 1.30). Corticosteroids were associated with longer length of stay (least square mean difference, 2.18 days; 95% confidence interval, 1.62 to 2.74 days), greater infection (odds ratio, 1.27; 95% confidence interval, 1.10 to 1.46), and greater use of insulin (odds ratio, 2.45; 95% confidence interval, 2.24 to 2.67). There was no difference in duration of ventilation. In analysis stratified by RACHS-1 category, no significant benefit was seen in any group, and the association of corticosteroids with increased morbidity was most prominent in RACHS-1 categories 1 through 3. CONCLUSION In this observational analysis of children undergoing congenital heart surgery, we were unable to demonstrate a significant benefit associated with corticosteroids and found that corticosteroids may be associated with increased morbidity, particularly in lower-risk patients.
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Lee MS, Kozitza R, Mudrick D, Williams M, Lodge AJ, Harrison JK, Glower DD. Intraoperative device closure of postinfarction ventricular septal defects. Ann Thorac Surg 2010; 89:e48-50. [PMID: 20494012 DOI: 10.1016/j.athoracsur.2010.03.081] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 02/16/2010] [Accepted: 03/22/2010] [Indexed: 10/19/2022]
Abstract
Postinfarction ventricular septal defects (VSDs) are associated with high mortality and typically these are treated urgently with surgery for exclusion patch repair. Percutaneous closure of postinfarction VSDs using occlusion devices is feasible in some patients, but in some cases device deployment may not be possible due to VSD anatomy or valvular apparatus interference. We report the novel technique of deploying Amplatzer VSD devices in the operating room under direct vision through a right atriotomy with and without aortotomy in 2 patients with large inferobasal VSDs after myocardial infarction.
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Daneshmand MA, Rajagopal K, Lima B, Khorram N, Blue LJ, Lodge AJ, Hernandez AF, Rogers JG, Milano CA. Left Ventricular Assist Device Destination Therapy Versus Extended Criteria Cardiac Transplant. Ann Thorac Surg 2010; 89:1205-9; discussion 1210. [DOI: 10.1016/j.athoracsur.2009.12.058] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 12/17/2009] [Accepted: 12/18/2009] [Indexed: 10/19/2022]
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Rajagopal K, Rogers JG, Lodge AJ, Gaca JG, McCann RL, Milano CA, Hughes GC. Two-stage total cardioaortic replacement for end-stage heart and aortic disease in Marfan syndrome: case report and review of the literature. J Heart Lung Transplant 2010; 28:958-63. [PMID: 19716050 DOI: 10.1016/j.healun.2009.05.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 04/15/2009] [Accepted: 05/06/2009] [Indexed: 11/18/2022] Open
Abstract
A 24-year-old man with Marfan syndrome underwent mitral valve repair for prolapse at age 13. He sustained an acute type A aortic dissection at age 20 and underwent aortic root/ascending aortic replacement with a mechanical valved conduit. He initially did well after the latter procedure, but end-stage heart disease developed 4 years later, apparently secondary to primary cardiomyopathy. Pre-transplant evaluation revealed residual chronic dissection with aneurysmal dilatation of the distal ascending aorta, transverse arch, and descending thoracic aorta. He underwent combined orthotopic heart transplantation (OHT) and total arch replacement (stage I elephant trunk procedure). Subsequently, he underwent extent II thoracoabdominal aneurysm repair, leaving no residual aortic disease. The 2 procedures resulted in total cardioaortic replacement, thus definitively managing his cardiomyopathy and aortic disease resulting from Marfan syndrome. The operative strategies employed represent a novel approach in this clinical setting. This report emphasizes that patients with this disease should not be denied potentially life-saving OHT on the basis of concomitant aortic disease, but rather should be treated in centers offering expertise in both areas of surgical therapy.
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Pal JD, Piacentino V, Cuevas AD, Depp T, Daneshmand MA, Hernandez AF, Felker GM, Lodge AJ, Rogers JG, Milano CA. Impact of Left Ventricular Assist Device Bridging on Posttransplant Outcomes. Ann Thorac Surg 2009; 88:1457-61; discussion 1461. [DOI: 10.1016/j.athoracsur.2009.07.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 07/07/2009] [Accepted: 07/10/2009] [Indexed: 11/16/2022]
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Rajagopal K, Lima B, Petersen RP, Mesis RG, Daneshmand MA, Lemaire A, Felker GM, Hernandez AF, Rogers JG, Lodge AJ, Milano CA. Infectious Complications in Extended Criteria Heart Transplantation. J Heart Lung Transplant 2008; 27:1217-21. [DOI: 10.1016/j.healun.2008.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 06/30/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022] Open
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Drinker LR, Camitta MGW, Herlong JR, Miller S, Lodge AJ, Jaggers J, Barker PCA. Use of the monoplane intracardiac imaging probe in high-risk infants during congenital heart surgery. Echocardiography 2008; 25:999-1003. [PMID: 18771552 DOI: 10.1111/j.1540-8175.2008.00719.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
UNLABELLED Imaging options are limited in high-risk infants with small or abnormal oropharyngeal anatomy during congenital heart surgery. METHODS All cases in which the monoplane intracardiac echo probe was used for transesophageal intraoperative imaging over a 15-month period at a single institution were reviewed. RESULTS Eleven patients underwent intraoperative imaging using the intracardiac probe. Patient weight ranged from 1.96 kg to 4 kg. Adequate images of the anatomy relevant to the surgical repair were obtained in all cases. No adverse events related to probe use occurred. CONCLUSION Transesophageal echocardiography using the monoplane intracardiac echo probe provides safe and effective imaging in patients who are not candidates for standard transesophageal echocardiography.
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Lodge AJ, Wells WJ, Backer CL, O'Brien JE, Austin EH, Bacha EA, Yeh T, DeCampli WM, Lavin PT, Weinstein S. A Novel Bioresorbable Film Reduces Postoperative Adhesions After Infant Cardiac Surgery. Ann Thorac Surg 2008; 86:614-21. [DOI: 10.1016/j.athoracsur.2008.04.103] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 04/23/2008] [Accepted: 04/24/2008] [Indexed: 10/21/2022]
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