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Miller-Tate H, Fichtner S, Davis JA, Alvarado C, Conroy S, Bigelow AM, Wright L, Galantowicz M, Cua CL. Utility of the NEONATE Score at an Institution that Routinely Performs the Hybrid Procedure for Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2023; 44:1684-1690. [PMID: 37632588 DOI: 10.1007/s00246-023-03223-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/26/2023] [Indexed: 08/28/2023]
Abstract
NEONATE score > 17 has been proposed as a risk factor for interstage mortality/cardiac transplant (IM/T) for patients with single ventricle physiology. Hybrid procedure is assigned 6 points, the highest possible score for that surgical variable. Most centers reserve the hybrid procedure for high-risk patients. Goal of this study was to evaluate the NEONATE score at a center that routinely performs the hybrid procedure. Retrospective chart review of patients undergoing the hybrid procedure was performed (2008-2021). Demographics and variables used for the NEONATE score were collected. Maximization of Youden's J Statistic used to determine cohort-specific optimal threshold for patients undergoing comprehensive Stage II procedure (H-CSII) versus those with IM/T (H-IM/T). Total of 120 patients met inclusion criteria (H-CSII = 105, H-IM/T = 15). Gestational age was median 39 weeks (IQR 38, 39) and birth weight was 3.18 kg (2.91, 3.57). No patient was discharged with opiates or required post-operative extracorporeal circulatory support. Optimal threshold, as selected by maximizing Youden's J Statistic, was 22. Score > 22 had a positive predictive value of 0.33 (95% CI 0.12-0.62), negative predictive values of 0.90 (95% CI 0.83-0.95), and accuracy of 0.83 (95% CI 0.75-0.90) for IM/T. At a center that routinely performs the hybrid procedure, value of > 22 had the highest accuracy. This suggests that the hybrid procedure is not necessarily intrinsically a risk-factor for IM/T, but rather patient selection for the hybrid procedure may play a larger role at centers that do not routinely perform this procedure.
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Affiliation(s)
- Holly Miller-Tate
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Samantha Fichtner
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Jo Ann Davis
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Chance Alvarado
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
- Biostatistics Resource, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, 43205, USA
- The Ohio Perinatal Research Network, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA
- Center for Biostatistics, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
| | - Sara Conroy
- Biostatistics Resource, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, 43205, USA
- The Ohio Perinatal Research Network, Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA
- Center for Biostatistics, The Ohio State University, Wexner Medical Center, Columbus, OH, 43210, USA
| | - Amee M Bigelow
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Lydia Wright
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Mark Galantowicz
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
- Department of Pediatrics, Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA.
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Reddy RK, Zyblewski SC, Chowdhury SM, Godown J, Bradley SM, Brown DW, Duncan RK, Brown TN, Bates KE, Minich LL, Costello JM. Association of Digoxin Use With Transplant-Free Interstage Survival in Infants Palliated With a Stage 1 Hybrid Procedure. J Am Heart Assoc 2023; 12:e029521. [PMID: 37804192 PMCID: PMC10757543 DOI: 10.1161/jaha.123.029521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 09/06/2023] [Indexed: 10/09/2023]
Abstract
Background Digoxin prescription in patients with single-ventricle physiology after stage 1 palliation is associated with reduced interstage death. Prior literature has primarily included patients having undergone the Norwood procedure. We sought to determine if digoxin prescription at discharge in infants following hybrid stage 1 palliation was associated with improved transplant-free interstage survival. Methods and Results A retrospective multicenter cohort analysis was conducted using data from the National Pediatric Cardiology Quality Improvement Collaborative registry data from 2008 to 2021. Infants with functional single ventricles and aortic arch obstruction discharged home after the hybrid stage 1 palliation hospitalization were included. Patients were excluded if they had supraventricular tachycardia or conversion to Norwood operation. The primary outcome was transplant-free survival. Multivariable logistic regression analysis including a propensity score for digoxin use identified associations between digoxin use and interstage death or transplant. Of 259 included infants from 45 sites, 158 (61%) had hypoplastic left heart syndrome. Forty-nine percent had a gestational age ≤38 weeks, 18% had a birth weight <2.5 kg, and 58% had a preoperative risk factor. Of the 259 subjects, 129 (50%) were discharged on digoxin. Interstage death or transplant occurred in 30 (23%) patients in the no-digoxin group compared with 18 (14%) in the digoxin group (P=0.06). With multivariate analysis, discharge digoxin prescription was associated with a lower risk of interstage death or transplant (adjusted odds ratio, 0.48 [95% CI, 0.24-0.93]; P=0.03). Conclusions In infants with single-ventricle physiology who underwent hybrid stage 1 palliation, digoxin prescription at hospital discharge was associated with improved interstage transplant-free survival.
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Affiliation(s)
- Reshma K. Reddy
- Division of Pediatric Cardiology, Department of PediatricsShawn Jenkins Children’s Hospital, Medical University of South CarolinaCharlestonSC
| | - Sinai C. Zyblewski
- Division of Pediatric Cardiology, Department of PediatricsShawn Jenkins Children’s Hospital, Medical University of South CarolinaCharlestonSC
| | - Shahryar M. Chowdhury
- Division of Pediatric Cardiology, Department of PediatricsShawn Jenkins Children’s Hospital, Medical University of South CarolinaCharlestonSC
| | - Justin Godown
- Division of Pediatric Cardiology, Department of PediatricsMonroe Carell Jr. Children’s Hospital, Vanderbilt University Medical CenterNashvilleTN
| | - Scott M. Bradley
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Shawn Jenkins Children’s HospitalMedical University of South Carolina Shawn Jenkins Children’s HospitalCharlestonSC
| | - David W. Brown
- Department of CardiologyBoston Children’s Hospital, Harvard Medical SchoolBostonMA
| | - Rachel K. Duncan
- Division of Pediatric Cardiology, Department of PediatricsMonroe Carell Jr. Children’s Hospital, Vanderbilt University Medical CenterNashvilleTN
| | - Tyler N. Brown
- Division of Pediatric Cardiology, Department of PediatricsCincinnati Children’s Hospital Medical Center, University of Cincinnati College of MedicineCincinnatiOH
| | - Katherine E. Bates
- Division of Pediatric Cardiology, Department of PediatricsC.S. Mott Children’s Hospital, University of Michigan Medical SchoolAnn ArborMI
| | - L. LuAnn Minich
- Division of Pediatric Cardiology, Primary Children’s HospitalUniversity of UtahSalt Lake CityUT
| | - John M. Costello
- Division of Pediatric Cardiology, Department of PediatricsShawn Jenkins Children’s Hospital, Medical University of South CarolinaCharlestonSC
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Czosek RJ, Spar DS, Anderson JB, Khoury PR, Webster G. Predictors and Outcomes of Arrhythmia on Stage I Palliation of Single Ventricle Patients. JACC Clin Electrophysiol 2022; 8:1136-1144. [DOI: 10.1016/j.jacep.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
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Post-operative arrhythmias in patients with hypoplastic left heart syndrome and anatomic variants: incidence, type, and course. Cardiol Young 2021; 31:1412-1418. [PMID: 33685535 DOI: 10.1017/s1047951121000299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Arrhythmias are common in the post-operative course of patients with hypoplastic left heart syndrome. We sought to determine the types, incidence, risk factors, and impact of arrhythmias in patients with HLHS and anatomic variants. METHODS We performed a retrospective chart review of 120 consecutive patients with HLHS and anatomical variants, who had single-ventricle palliation at our institution from January, 2006 to December, 2016. RESULTS A total of thirty-one patients (26%) had 37 episodes of arrhythmias over a median follow-up period of 3.5 years. Of the 37 episodes, 12 (32.4%) were ectopic atrial tachycardia, 9 (24.3%) were paroxysmal supraventricular tachycardia, 4 (10.8%) were junctional ectopic tachycardia, 5 (13.6%) were sinus node dysfunction, 3 (8.1%) were heart block, 2 (5.4%) were atrial flutter, and 2 (5.4%) were ventricular tachycardia. Twenty-four (65%) of the arrhythmias occurred at post-stage 1 surgery. Most (64.8%) of the arrhythmias were resolved. Arrhythmias that occurred at post-stage 1 surgery were more likely to resolve compared to post-stages 2 or 3 (p = 0.006). No anatomical, surgical, or clinical variables were associated with arrhythmia except for age (OR per unit decrease in age at stage 1 palliation: 1.12 (95% CI 1.003, 1.250); p = 0.0439). Arrhythmias were not associated with length of hospital stay or mortality. CONCLUSION Arrhythmias are common in patients with HLHS and anatomic variants, with EAT and PSVT being the most common types. Arrhythmias were associated with younger age at surgery, but did not affect mortality or length of hospital stay.
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Alphonso N, Angelini A, Barron DJ, Bellsham-Revell H, Blom NA, Brown K, Davis D, Duncan D, Fedrigo M, Galletti L, Hehir D, Herberg U, Jacobs JP, Januszewska K, Karl TR, Malec E, Maruszewski B, Montgomerie J, Pizzaro C, Schranz D, Shillingford AJ, Simpson JM. Guidelines for the management of neonates and infants with hypoplastic left heart syndrome: The European Association for Cardio-Thoracic Surgery (EACTS) and the Association for European Paediatric and Congenital Cardiology (AEPC) Hypoplastic Left Heart Syndrome Guidelines Task Force. Eur J Cardiothorac Surg 2020; 58:416-499. [DOI: 10.1093/ejcts/ezaa188] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Nelson Alphonso
- Queensland Pediatric Cardiac Service, Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Annalisa Angelini
- Department of Cardiac, Thoracic Vascular Sciences and Public health, University of Padua Medical School, Padua, Italy
| | - David J Barron
- Department of Cardiovascular Surgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Katherine Brown
- Paediatric Intensive Care, Heart and Lung Division, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Deborah Davis
- Department of Anesthesiology, Thomas Jefferson University, Philadelphia, PA, USA
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Daniel Duncan
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
| | - Marny Fedrigo
- Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Lorenzo Galletti
- Unit of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - David Hehir
- Division of Cardiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Katarzyna Januszewska
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | | | - Edward Malec
- Division of Pediatric Cardiac Surgery, University Hospital Muenster, Westphalian-Wilhelm’s-University, Muenster, Germany
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - James Montgomerie
- Department of Anesthesia, Birmingham Children’s Hospital, Birmingham, UK
| | - Christian Pizzaro
- Nemours Cardiac Center, A.I. Du Pont Hospital for Children, Wilmington, DE, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dietmar Schranz
- Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
| | - Amanda J Shillingford
- Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Malkar M, Kannankeril PJ, Radbill AE, Fish FA. Catheter ablation of orthodromic reciprocating tachycardia and atrioventricular nodal reentrant tachycardia in children with hypoplastic left heart syndrome. J Cardiovasc Electrophysiol 2020; 31:2043-2048. [PMID: 32542917 DOI: 10.1111/jce.14619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Experience with catheter ablation of orthodromic reciprocating tachycardia (ORT) and atrioventricular nodal reentrant tachycardia (AVNRT) in young children with hypoplastic left heart syndrome (HLHS) is limited. We report the feasibility, safety, and outcomes of catheter ablation of ORT and AVNRT in children with HLHS. METHODS AND RESULTS This was a retrospective review of patients with HLHS who underwent catheter ablation for reentrant supraventricular tachycardias (excluding atrial tachycardias) between 2005 and 2017 at a single center. Descriptive data including demographics, clinical history, procedural data, and outcomes were recorded. Ten children with HLHS underwent eleven catheter ablation procedures. Median age and weight at ablation were 2.7 years (range: 0.1-10.5) and 11.4 kg (range: 3.6-30.4), respectively. Tachycardia mechanism was AVNRT in four, ORT in five (two with preexcitation), and both in one. Acute procedural success was 100% and there was no spontaneous recurrence of tachycardia orpreexcitationin median 92 months (range: 21-175 months) follow-up. Five patients underwent subsequent EP studies at catheterization (intracardiac) or after surgery (via epicardial wires): three were noninducible, one after AVNRT ablation had inducible atrial tachycardia, and one after initial ORT ablation had inducible ORT at fenestration closure and underwent successful repeat ablation. Thus, long-term freedom from clinical tachycardia was 100% and from inducible AVNRT or ORT was 80%. CONCLUSION Transcatheter ablation for ORT and AVNRT in children with HLHS can be performed with excellent acute and long-term success without major complications.
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Affiliation(s)
- Manish Malkar
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Prince J Kannankeril
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew E Radbill
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Frank A Fish
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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