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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Restrepo H. Complex neonatal congenital heart surgery in Nevada. J Card Surg 2022; 37:3209-3213. [DOI: 10.1111/jocs.16749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Affiliation(s)
- William N. Evans
- Congenital Heart Center Nevada Las Vegas Nevada USA
- Department of Pediatrics, Division of Pediatric Cardiology Kirk Kerkorian School of Medicine at University of Nevada Las Vegas Las Vegas Nevada USA
| | - Ruben J. Acherman
- Congenital Heart Center Nevada Las Vegas Nevada USA
- Department of Pediatrics, Division of Pediatric Cardiology Kirk Kerkorian School of Medicine at University of Nevada Las Vegas Las Vegas Nevada USA
| | - Michael L. Ciccolo
- Congenital Heart Center Nevada Las Vegas Nevada USA
- Department of Surgery Kirk Kerkorian School of Medicine at University of Nevada Las Vegas Las Vegas Nevada USA
| | - Juan Lehoux
- Congenital Heart Center Nevada Las Vegas Nevada USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada Las Vegas Nevada USA
- Department of Pediatrics, Division of Pediatric Cardiology Kirk Kerkorian School of Medicine at University of Nevada Las Vegas Las Vegas Nevada USA
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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Galindo A, Rothman A, Mayman GA, Restrepo H. Stage-1 Hybrid Palliation for High-Risk 2-Ventricle Patients with Ductal-Dependent Systemic Circulation in the Era of High Prenatal Detection. World J Pediatr Congenit Heart Surg 2021; 12:754-759. [PMID: 34846971 DOI: 10.1177/21501351211044417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We reviewed our center's prenatal detection and surgical experience with high-risk, 2-ventricle patients, with complex congenital heart disease that underwent stage-1 hybrid palliation. METHODS We retrospectively identified those born between March 2008 and March 2021 with 2-ventricle hearts, complex congenital cardiovascular malformations, and ductal-dependent systemic circulation that underwent stage-1 hybrid palliation consisting of surgical bilateral pulmonary artery banding and interventional catheterization placed ductus arteriosus stents. RESULTS We identified 30 patients. Of the 30, 19 (63%) were male. For the 30, median gestational age was 35 weeks (29-39 weeks), and median birth weight was 2.2 kg (0.6-4.5 kg). Of the 30, 1 was transferred from an adjacent state, and 29 were born in Nevada. Of the 29 born in Nevada, overall statewide prenatal detection was 18 of 29 (62%); however, for 2008 to 2011 the prenatal detection rate was 3 of 10 (30%) and 15 of 19 (79%) for 2012 to 2021, P = .03. For the last 5 years, prenatal detection for Nevada-born patients was 8 of 8 (100%). Two full-term newborns, without a prenatal diagnosis, presented postnatally in extremis. For the 30 patients, there were 0 stage-1 hybrid palliation mortalities, 1 subsequent repair mortality, and 3 late nonsurgical deaths. CONCLUSIONS Stage-1 hybrid palliation may result in excellent surgical outcomes for high-risk, 2-ventricle patients. Additionally, high rates of population-wide prenatal detection are possible for high-risk congenital heart disease, allowing prenatal planning and possibly reducing postnatal extremis presentations.
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Affiliation(s)
- William N Evans
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Ruben J Acherman
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Michael L Ciccolo
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Juan Lehoux
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA
| | - Alvaro Galindo
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Abraham Rothman
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Gary A Mayman
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Humberto Restrepo
- 20567Congenital Heart Center Nevada, Las Vegas, NV, USA.,212548Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA
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Evans WN, Acherman RJ, Ciccolo ML, Lehoux J, Galindo A, Rothman A, Mayman GA, Restrepo H. Common arterial trunk in the era of high prenatal detection rates: Results of neonatal palliation and primary repair. J Card Surg 2021; 36:4090-4094. [PMID: 34462970 DOI: 10.1111/jocs.15964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We reviewed our center's experience with common arterial trunk. METHODS We included those with common arterial trunk in Nevada with estimated delivery dates or birth dates between June 2006 and May 2021. We excluded patients with functionally univentricular hearts. RESULTS We identified a total of 39: 32 prenatally and 7 postnatally. Of the 32 prenatally detected, 2 had elective termination, 2 had fetal demise, and 28 were live-born. Of the 7 postnatally diagnosed, 6 had prenatal care without a fetal echocardiogram, and 1 had no prenatal care. Overall, live-born prenatal detection was 28/34 (82%). Prenatal detection for 2006-2009 was 2/6 (33%) and for 2010-2021 was 26/28 (93%) p = .049. Of the 35 live-born infants, 1 died preoperatively, and 34 underwent neonatal surgery. Of the 34, 8 had palliation (birth weight 1.9±0.7 kg, range 0.8-2.6 kg), and 26 had a primary repair (birth weight 3.0±0.3 kg, range 2.6-4.0 kg) p = .0004. For all 34 neonatal surgical procedures, there were 2 (5.9%) deaths; however, there were no subsequent surgical or interventional catheterization mortalities. CONCLUSIONS In Nevada, current state-wide, general population prenatal detection of the common arterial trunk was more than 90%. By employing a combination of neonatal palliation and primary repair, surgical mortality was less than 6% in a cohort that included those with birth weights less than 2.5 kg, truncal valve surgery, and interrupted aortic arches.
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Affiliation(s)
- William N Evans
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Ruben J Acherman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Michael L Ciccolo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Juan Lehoux
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA
| | - Alvaro Galindo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Abraham Rothman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Gary A Mayman
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Humberto Restrepo
- Congenital Heart Center Nevada, Las Vegas, Nevada, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, USA
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