1
|
Olds A, Gray WH, Bojko M, Weaver C, Cleveland JD, Bowdish ME, Wells WJ, Starnes VA, Kumar SR. Surgical pulmonary arterioplasty at bidirectional cavopulmonary anastomosis leads to favorable pulmonary hemodynamics at final stage palliation. JTCVS OPEN 2024; 18:180-192. [PMID: 38690435 PMCID: PMC11056446 DOI: 10.1016/j.xjon.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/18/2024] [Accepted: 02/02/2024] [Indexed: 05/02/2024]
Abstract
Objective Pulmonary arterioplasty (PA plasty) at bidirectional cavopulmonary anastomosis (BDCA) is associated with increased morbidity, but outcomes to final stage palliation are unknown. We sought to determine the influence of PA plasty on pulmonary artery growth and hemodyamics at Fontan. Methods We retrospectively reviewed clinical data and outcomes for BDCA patients from 2006 to 2018. PA plasty was categorized by extent (type 1-4), as previously described. Outcomes included pulmonary artery reintervention and mortality before final palliation. Results Five hundred eighty-eight patients underwent BDCA. One hundred seventy-nine patients (30.0%) underwent concomitant PA plasty. Five hundred seventy (97%) patients (169 [94%] PA plasty) survived to BDCA discharge. One hundred forty out of 570 survivors (25%) required PA/Glenn reintervention before final stage palliation (59 out of 169 [35%]) PA plasty; 81 out of 401 (20%) non-PA plasty; P < .001). Twelve-, 24-, and 36-month freedom from reintervention after BDCA was 80% (95% CI, 74-86%), 75% (95% CI, 69-82%), and 64% (95% CI, 57-73%) for PA plasty, and 95% (95% CI, 93-97%), 91% (95% CI, 88-94%), and 81% (95% CI, 76-85%) for non-PA plasty (P < .001). Prefinal stage mortality was 37 (6.3%) (14 out of 169 PA plasty; 23 out of 401 non-PA plasty; P = .4). Five hundred four (144 PA plasty and 360 non-PA plasty) patients reached final stage palliation (471 Fontan, 26 1.5-ventricle, and 7 2-ventricular repair). Pre-Fontan PA pressure and pulmonary vascular resistance were 10 mm Hg (range, 9-12 mm Hg) and 1.6 mm Hg (range, 1.3-1.9 mm Hg) in PA plasty and 10 mm Hg (range, 8-12 mm Hg) and 1.5 mm Hg (range, 1.3-1.9 mm Hg) in non-PA plasty patients, respectively (P = .29, .6). Fontan hospital mortality, length of stay, and morbidity were similar. Conclusions PA plasty at BDCA does not confer additional mortality risk leading to final palliation. Despite increased pulmonary artery reintervention, there was reliable pulmonary artery growth and favorable pulmonary hemodynamics at final stage palliation.
Collapse
Affiliation(s)
- Anna Olds
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
- Division of Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - W. Hampton Gray
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
- Division of Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Markian Bojko
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
- Division of Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Carly Weaver
- Division of Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - John D. Cleveland
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
- Division of Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Michael E. Bowdish
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Winfield J. Wells
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
- Division of Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Vaughn A. Starnes
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
- Division of Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - S. Ram Kumar
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif
- Division of Cardiac Surgery, Heart Institute, Children's Hospital of Los Angeles, Los Angeles, Calif
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, Calif
| |
Collapse
|
2
|
Yu P, Xiong J, Tong Z, Chen L, Hu L, Liu J, Liu J. Hemodynamic-based virtual surgery design of double-patch repair for pulmonary arterioplasty in tetralogy of Fallot. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 245:108012. [PMID: 38246096 DOI: 10.1016/j.cmpb.2024.108012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Surgical correction of pulmonary artery stenosis (PAS) is essential to the prognosis of patients with tetralogy of Fallot (TOF). The double-patch method of pulmonary arterioplasty is usually applied in case of multiple stenosis in TOF patients' pulmonary artery (PA) and when PAS cannot be relieved by the single-patch method. The surgical planning for the double-patch design remains challenging. The purpose of this study is to investigate the double-patch design with different angulations between the left pulmonary artery (LPA) and the right pulmonary artery (RPA), and to understand postoperative hemodynamic alterations by the application of computer-aided design (CAD) and computational fluid dynamics (CFD) techniques. METHODS The three-dimensional model of the PA was reconstructed based on preoperative computed tomography imaging data obtained from the patient with TOF. Three postoperative models with different designs of double-patch were created by "virtual surgery" using the CAD technique. Double-Patch 120 Model was created with double patches implanted in the main pulmonary artery (MPA) and the PA bifurcation and without changing the spatial position of PA. The angulation between the LPA and the RPA was defined as θ, which equaled to 120° in Pre-Operative Model and Double-Patch 120 Model. Based on Double-Patch 120 Model, Double-Patch 110 Model and Double-Patch 130 Model were generated with θ equaled to 110° and 130°, respectively. Combined with CFD, the differences of velocity streamlines, wall shear stress (WSS), flow distribution ratio (FDR), and energy loss (EL) were compared to analyze postoperative pulmonary flow characteristics. RESULTS The values of velocity and WSS decreased significantly after virtual surgery. Obvious vortices and swirling flows were observed downstream of the stenosis of RPA and LPA in Pre-Operative Model, while fewer vortices developed along the anterior wall of the expanded lumens of RPA, especially in Double-Patch 110 Model. With the relief of PAS, two relatively higher WSS regions were observed at the posterior walls of RPA and LPA. The maximum WSS values in these regions of Double-Patch 110 Model were lower than those in Double-Patch 120 Model and Double-Patch 130 Model. Furthermore, the FDRs were elevated and the ELs were greatly reduced. It was found that Double-Patch 110 Model with the angulation between the LPA and the RPA equaled to 110° showed relatively better properties of hemodynamics than other models. CONCLUSIONS The angulation between the LPA and the RPA is an important factor that should be integrated in the double-patch design for TOF repair. Virtual surgery based on patient-specific vascular model and computational hemodynamics can be used to provide assistance for individualized surgical planning of double-patch arterioplasty.
Collapse
Affiliation(s)
- Pingping Yu
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jiwen Xiong
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Zhirong Tong
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Lijun Chen
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jinfen Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Jinlong Liu
- Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Institute for Pediatric Congenital Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China; Shanghai Engineering Research Center of Virtual Reality of Structural Heart Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
| |
Collapse
|
3
|
Gao B. Pulmonary Artery Stenosis in Tetralogy of Fallot. Cardiol Rev 2023:00045415-990000000-00172. [PMID: 37966279 DOI: 10.1097/crd.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Tetralogy of Fallot (TOF) is the most common cyanotic congenital cardiac defect. The survival rate after primary complete repair is high (98-100%); however, pulmonary artery stenosis (PAS) is not uncommon after TOF repair, and severe PAS aggravates pulmonary regurgitation, resulting in right ventricle dilation, ventricular arrhythmia, and possibly death. PAS in TOF can be congenital due to hypoplasia or coarctation or can be acquired secondary to a surgical procedure. The latter may be caused by an exogenous conduit implant, compression from the adjacent enlarged ascending aorta, or outflow tract dilation after transannular patch repair. PAS can also be caused by the pulmonary artery plasty strategy itself. Here, the intrinsic mechanisms underlying PAS and pulmonary artery plasty techniques and strategies are reviewed to provide guidance for surgeons.
Collapse
Affiliation(s)
- Botao Gao
- From the Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
4
|
Zheng WC, Buratto E, Caldaroni F, Ishigami S, Konstantinov IE, d'Udekem Y. T-Remodeling of the Pulmonary Artery Bifurcation for Pulmonary Artery Origin Stenosis. World J Pediatr Congenit Heart Surg 2023; 14:716-722. [PMID: 37933694 DOI: 10.1177/21501351231181109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Various surgical techniques are utilized for reconstructing hypoplastic pulmonary arteries (PAs) in patients with conotruncal anomalies and at times, may be susceptible to restenosis and reoperation. We reviewed our experience with a simple technique of T-shaped remodeling of the PA bifurcation. METHODS Between 2005 and 2019, 31 patients underwent T-remodeling of central PAs by a single cardiac surgeon. The PA bifurcation was opened cranially, and the opening was augmented with an oval-shaped patch effectively transforming the V-shaped bifurcation into a T-shaped bifurcation. Both origins of the PAs were enlarged, even in the instance of single PA origin stenosis. RESULTS Median age at time of T-remodeling was 17 months (range: 7 weeks to 14 years). The following cardiac morphologies were observed: tetralogy of Fallot (n = 12, 39%), pulmonary atresia with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (n = 8, 26%), truncus arteriosus (n = 6, 19%), pulmonary atresia with VSD (n = 3, 9.7%), and transposition of the great arteries (n = 2, 6.5%). Thirteen patients (42%) had previous central shunt, and eight patients (26%) had previous modified Blalock-Taussig shunt. There were no operative mortalities. Immediately after T-remodeling, echocardiographic estimates of right ventricle to PA gradient decreased from 42 [interquartile range 28-58] mm Hg to 20 [12-36] mm Hg (P = .03). Freedom from reoperation on the PA bifurcation for the entire cohort was 100% at one year, 88% (95% CI 68%-96%) at five years and 82% (57%-93%) at ten years. CONCLUSIONS T-remodeling for PA origin stenosis is a safe procedure with excellent freedom from reoperation that is easily reproducible and applicable to patients with all cardiac morphologies.
Collapse
Affiliation(s)
- Wayne C Zheng
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Cardiology, Alfred Health, Melbourne, Australia
| | - Edward Buratto
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Federica Caldaroni
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Shuta Ishigami
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Igor E Konstantinov
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Heart Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Division of Cardiovascular Surgery, Children's National Hospital, Washington, DC, USA
- Children's National Heart Institute, Washington, DC, USA
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
5
|
Thomas AJ. Commentary; Native technique versus patch and enlargement techniques in tetralogy of Fallot with hypoplastic branch pulmonary arteries. Eur J Cardiothorac Surg 2022; 62:6711390. [PMID: 36135798 DOI: 10.1093/ejcts/ezac468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/19/2022] [Accepted: 09/21/2022] [Indexed: 11/14/2022] Open
|
6
|
Bonilla-Ramirez C, Aggarwal V, Atyam M, Qureshi AM, Heinle JS, McKenzie ED. Decellularized vs Non-decellularized Allogeneic Pulmonary Artery Patches for Pulmonary Arterioplasty. Semin Thorac Cardiovasc Surg 2022; 35:722-730. [PMID: 35878741 DOI: 10.1053/j.semtcvs.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/11/2022]
Abstract
We studied pulmonary artery size, reinterventions, and panel reactive antibodies in patients with single-ventricle physiology who underwent a pulmonary arterioplasty with decellularized (DAPAP) and non-decellularized allogeneic pulmonary artery patches (non-DAPAP). Retrospective review identified 59 patients with single-ventricle physiology who underwent pulmonary arterioplasty from 2008 to 2017: 28 patients underwent arterioplasty with DAPAP and 31 patients with non-DAPAP. Demographic and operative variables were similar between groups. Among patients who underwent a Norwood procedure, a right ventricle to pulmonary artery shunt was more commonly used in the DAPAP group (12/20, 60%) and a modified Blalock-Taussig shunt was more commonly used in the non-DAPAP group (17/22, 77%). On multivariable analysis, the use of DAPAP was associated with higher pre-Fontan angiography Z-scores in right (estimate = 0.17, standard error = 0.04, P = 0.0005) and left pulmonary arteries (estimate = 0.12, standard error = 0.05, P = 0.01). No areas of calcification, discrete coarctation, or pulmonary dilation were noted in any of the pulmonary arteries. On multivariable analysis, the use of DAPAP was associated with higher freedom from pulmonary artery reinterventions (Hazard ratio = 0.36, 95% confidence interval = 0.13-0.9, P = 0.04). The median value for Class I panel reactive antibodies was 0% (IQR 0, 4) in the DAPAP and 23% (IQR 14, 36) in the non-DAPAP group. The median value for Class II panel reactive antibodies was 15% (IQR 0, 17) in the DAPAP and 21% (IQR 10, 22) in the non-DAPAP group. Pulmonary arterioplasty with DAPAP was associated with higher pre-Fontan pulmonary artery Z-scores and higher freedom from pulmonary artery reinterventions.
Collapse
Affiliation(s)
- Carlos Bonilla-Ramirez
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Manasa Atyam
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX
| | - E Dean McKenzie
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX.
| |
Collapse
|
7
|
Zhu Z, Gao B. Patch Enlargement May Not Be a Good Strategy for Tetralogy of Fallot with Unbalanced Pulmonary Artery Branches. Eur J Cardiothorac Surg 2022; 62:6594491. [PMID: 35640132 DOI: 10.1093/ejcts/ezac326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/16/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To figure out the optimal strategy to manage Tetralogy of Fallot (TOF) with unbalanced pulmonary artery(PA) branches by investigating the different effects of PA plasty on the development of the hypoplastic PA (HPA). METHODS A single center, retrospective analysis was carried out to compare the outcome of different PA plasty methods on the development of HPA in patients of TOF with unbalanced PA branches. Size and balance of the PA branches were used to evaluate the outcome of PA plasty. RESULTS In the NATIVE group, 100% of the HPAs were well-developed and all the PA branches became balanced, while in the PATCH and EXTENSION groups, the percentage of well-developed HPAs was 40% and 33%, respectively, and none of the PA branches were balanced. In addition, HPAs became atretic in 28% of the patients in the patch enlargement group. CONCLUSIONS For TOF with unbalanced PA branches, patch enlargement may not be a good treatment strategy, as it reduces the growth potential of HPA and even causes iatrogenic atresia. Leaving the HPA in the native state without patch enlargement may be a good strategy.
Collapse
Affiliation(s)
- Zhongqun Zhu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, People's Republic of China
| | - Botao Gao
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai 200127, People's Republic of China
| |
Collapse
|
8
|
Preoperative Morphological Prediction of Early Reoperation Risk After Primary Repair in Tetralogy of Fallot: A Contemporary Analysis of 83 Cases. Pediatr Cardiol 2021; 42:1512-1525. [PMID: 34075431 DOI: 10.1007/s00246-021-02635-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
This study was conducted to investigate the pulmonary artery (PA) variations in tetralogy of Fallot (TOF) and preoperative morphological predictors for early reoperation. Eighty-three TOF patients and 20 children with normal PA were included. The TOF group was divided into two subsets according to whether or not reoperation was performed within 3 years postoperatively. Clinical information was obtained, along with computed tomography (CT)-based three-dimensional geometry of the PA. Morphological measurements of the length of the main PA branches, the angles between them, and the cross-sectional area of each segment of the PAs were acquired using computer software. Logistic regression and receiver operating characteristic curves were applied to analysis. The TOF group showed a significantly smaller PA size and irregular PA shape, with lower Nakata and McGoon indices, than the control group. The median bifurcation angle (angle-γ) was greater than 100° in the TOF group, as compared to 66.70° in the control group (P < 0.000). Residual obstruction of the infundibulum or PAs was the main reason for early reoperation in this series. The development of the main PA and left PA was poorer in the reoperation subset than in the non-reoperation subset (P ≤ 0.01). The preoperative angle-γ in the reoperation subset was larger than that in the non-reoperation subset (median, 117.8° vs. 112.0°, P = 0.026). Higher weight (OR = 0.372) and McGoon index (OR = 0.122) were protective factors, while larger angle-γ (> 114.8°, OR = 5.040) and angle-γ normalized by body surface area (BSA) (γ/BSA > 297.9, OR = 18.860) were risk factors. This study provides an intuitive perspective of PA anatomical variations in TOF. Larger preoperative PA bifurcation angle and γ/BSA were morphological risk predictors of postoperative reoperation in patients with TOF.
Collapse
|
9
|
Faerber JA, Huang J, Zhang X, Song L, DeCost G, Mascio CE, Ravishankar C, O'Byrne ML, Naim MY, Kawut SM, Goldmuntz E, Mercer-Rosa L. Identifying Risk Factors for Complicated Post-operative Course in Tetralogy of Fallot Using a Machine Learning Approach. Front Cardiovasc Med 2021; 8:685855. [PMID: 34368247 PMCID: PMC8339319 DOI: 10.3389/fcvm.2021.685855] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/21/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Tetralogy of Fallot (TOF) repair is associated with excellent operative survival. However, a subset of patients experiences post-operative complications, which can significantly alter the early and late post-operative course. We utilized a machine learning approach to identify risk factors for post-operative complications after TOF repair. Methods: We conducted a single-center prospective cohort study of children <2 years of age with TOF undergoing surgical repair. The outcome was occurrence of post-operative cardiac complications, measured between TOF repair and hospital discharge or death. Predictors included patient, operative, and echocardiographic variables, including pre-operative right ventricular strain and fractional area change as measures of right ventricular function. Gradient-boosted quantile regression models (GBM) determined predictors of post-operative complications. Cross-validated GBMs were implemented with and without a filtering stage non-parametric regression model to select a subset of clinically meaningful predictors. Sensitivity analysis with gradient-boosted Poisson regression models was used to examine if the same predictors were identified in the subset of patients with at least one complication. Results: Of the 162 subjects enrolled between March 2012 and May 2018, 43 (26.5%) had at least one post-operative cardiac complication. The most frequent complications were arrhythmia requiring treatment (N = 22, 13.6%), cardiac catheterization (N = 17, 10.5%), and extracorporeal membrane oxygenation (ECMO) (N = 11, 6.8%). Fifty-six variables were used in the machine learning analysis, of which there were 21 predictors that were already identified from the first-stage regression. Duration of cardiopulmonary bypass (CPB) was the highest ranked predictor in all models. Other predictors included gestational age, pre-operative right ventricular (RV) global longitudinal strain, pulmonary valve Z-score, and immediate post-operative arterial oxygen level. Sensitivity analysis identified similar predictors, confirming the robustness of these findings across models. Conclusions: Cardiac complications after TOF repair are prevalent in a quarter of patients. A prolonged surgery remains an important predictor of post-operative complications; however, other perioperative factors are likewise important, including pre-operative right ventricular remodeling. This study identifies potential opportunities to optimize the surgical repair for TOF to diminish post-operative complications and secure improved clinical outcomes. Efforts toward optimizing pre-operative ventricular remodeling might mitigate post-operative complications and help reduce future morbidity.
Collapse
Affiliation(s)
- Jennifer A Faerber
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Jing Huang
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, PA, United States.,Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Xuemei Zhang
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Lihai Song
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Grace DeCost
- School of Public Health, Brown University, Providence, RI, United States
| | - Christopher E Mascio
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Chitra Ravishankar
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Michael L O'Byrne
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.,Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, PA, United States
| | - Maryam Y Naim
- Departments of Anesthesiology, Critical Care Medicine and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Steven M Kawut
- Departments of Medicine and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Elizabeth Goldmuntz
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Laura Mercer-Rosa
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| |
Collapse
|
10
|
Danton MHD. Tangled up in blue: the complexities of pulmonary artery augmentation. Eur J Cardiothorac Surg 2021; 60:1102-1103. [PMID: 34269386 DOI: 10.1093/ejcts/ezab265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mark H D Danton
- Department of Paediatric Cardiac Surgery, Royal Hospital for Children, Glasgow, Institute of Cardiovascular and Medical Sciences, University of Glasgow
| |
Collapse
|
11
|
Murin P, Weixler VHM, Kuschnerus K, Romanchenko O, Lorenzen V, Nordmeyer J, Cho MY, Sigler M, Photiadis J. Pulmonary artery augmentation using decellularized equine pericardium (Matrix Patch™): initial single-centre experience. Eur J Cardiothorac Surg 2021; 60:1094-1101. [PMID: 34270732 DOI: 10.1093/ejcts/ezab183] [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] [Received: 10/25/2020] [Revised: 01/31/2021] [Accepted: 03/09/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to report our initial experience when using Matrix Patch™ a cell-free equine-derived pericardium for the augmentation of branch pulmonary arteries (PAs) in children. METHODS Between September 2016 and September 2019, Matrix Patch was used for the augmentation of branch PAs in 96 patients and implanted in 147 separate locations. The median age at implantation was 3.2 years (interquartile range: 0.9-8.4), and 33% of patients were infants. The patch was used mainly in redo surgeries (89.6%). Intra-procedural feasibility and reinterventions were analysed. Primary end points were death or patch-related reoperation/stent implantation. Explanted patches were stained for recellularization/calcification, or to reveal proliferation/inflammation. RESULTS A total of 81 patients, who received patches in 119 separate locations, were followed within a median of 20 months (interquartile range: 10.2-30.2). Patients with early reoperation/stent implantation were excluded from follow-up. No patch-related death was noted. Survival at last follow-up was 88% (95% CI: 78.8-93.7%). Overall probability of freedom from reoperation/stent implantation per location, 12 and 24 months after initial surgery was 85.8% (95% CI: 76.2-91.7%) and 78.7 (95% CI: 65.9-87.2%), respectively. At 20 months, superficial proliferation with discrete macrophage activity was seen in explants; however, no signs of calcification are observed. CONCLUSIONS The initial experience with the Matrix Patch in PAs showed comparable results to other xenogeneic patch materials. Long-term follow-up data are needed to prove the desired durability of the patch in different locations.
Collapse
Affiliation(s)
- Peter Murin
- Department of Congenital Heart Surgery-Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Viktoria H M Weixler
- Department of Congenital Heart Surgery-Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Kira Kuschnerus
- Department of Congenital Heart Surgery-Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Olga Romanchenko
- Department of Congenital Heart Surgery-Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Victoria Lorenzen
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease-Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Mi-Young Cho
- Department of Congenital Heart Surgery-Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August University Göttingen, Göttingen, Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery-Pediatric Heart Surgery, German Heart Center Berlin, Berlin, Germany
| |
Collapse
|
12
|
Choi ES, Kim DH, Kwon BS, Park CS, Yun TJ. Growth of the Branch Pulmonary Arteries After Employing 'Shunt-Only' Strategy for Neonates With Pulmonary Atresia or Stenosis. Semin Thorac Cardiovasc Surg 2021; 33:1095-1102. [PMID: 33971299 DOI: 10.1053/j.semtcvs.2021.03.047] [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] [Received: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/11/2022]
Abstract
We sought to determine the impact of juxtaductal stenosis (JDS) on branch pulmonary artery (PA) growth after systemic-to-pulmonary shunt (SPS) placement without pulmonary arterioplasty (ie the 'shunt-only' strategy). This was a retrospective review of 91 patients, 54 (59.3%) with pulmonary atresia and 27 (29.7%) with a functionally single ventricle, who underwent neonatal SPS placement without pulmonary arterioplasty between 2008 and 2017. The median age and body weight at SPS procedure were 16 day's (interquartile range [IQR], 11-22) and 3.10 kg (IQR: 2.85-3.40), respectively. All patients had pre-SPS computed tomography (CT) followed by post-SPS CT at a median interval of 5.8 months' (IQR: 4.5-7.2). The ratio of the diameters of the juxtaductal PA over the non-SPS-side hilar PA (JD and/or PA) on preoperative CT-a surrogate for JDS severity-was 0.93 (IQR: 0.67-1.09). The median diameter (Z) of the SPS-side and non-SPS-side PA on postoperative CT were 1.0 (IQR: -0.07-1.73) and 0.99 (IQR: -0.45-1.70), respectively. The pulmonary artery index (Nakata index) increased significantly from 124.0 ± 50.2 mm2/m2 to 240.8 ± 88.7 mm2/m2 (P < .001). Unplanned surgical interventions on the non-SPS-side PA were performed on 7 patients. Logistic regression identified lower preoperative JD and/or PA as a risk factor for unplanned intervention on the non-SPS-side PA (odds ratio, 1.27 per 0.1 decrease; 95% confidence interval, 1.10-2.16, P = 0.025). PA growth on the non-SPS side is generally adequate without pulmonary arterioplasty among patients with JDS. However, unplanned interventions for the non-SPS-side PA are caveats for 'shunt-only' strategy in neonates with significant JDS.
Collapse
Affiliation(s)
- Eun Seok Choi
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong-Hee Kim
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bo Sang Kwon
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chun Soo Park
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Jin Yun
- Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
13
|
Comparison of Management Strategies for Neonates With Symptomatic Tetralogy of Fallot. J Am Coll Cardiol 2021; 77:1093-1106. [PMID: 33632484 DOI: 10.1016/j.jacc.2020.12.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neonates with tetralogy of Fallot and symptomatic cyanosis (sTOF) require early intervention. OBJECTIVES This study sought to perform a balanced multicenter comparison of staged repair (SR) (initial palliation [IP] and subsequent complete repair [CR]) versus primary repair (PR) treatment strategies. METHODS Consecutive neonates with sTOF who underwent IP or PR at ≤30 days of age from 2005 to 2017 were retrospectively reviewed from the Congenital Cardiac Research Collaborative. The primary outcome was death. Secondary outcomes included component (IP, CR, PR) and cumulative (SR): hospital and intensive care unit lengths of stay; durations of cardiopulmonary bypass, anesthesia, ventilation, and inotrope use; and complication and reintervention rates. Outcomes were compared using propensity score adjustment. RESULTS The cohort consisted of 342 patients who underwent SR (IP: surgical, n = 256; transcatheter, n = 86) and 230 patients who underwent PR. Pre-procedural ventilation, prematurity, DiGeorge syndrome, and pulmonary atresia were more common in the SR group (p ≤0.01). The observed risk of death was not different between the groups (10.2% vs 7.4%; p = 0.25) at median 4.3 years. After adjustment, the hazard of death remained similar between groups (hazard ratio: 0.82; 95% confidence interval: 0.49 to 1.38; p = 0.456), but it favored SR during early follow-up (<4 months; p = 0.041). Secondary outcomes favored the SR group in component analysis, whereas they largely favored PR in cumulative analysis. Reintervention risk was higher in the SR group (p = 0.002). CONCLUSIONS In this multicenter comparison of SR or PR for management of neonates with sTOF, adjusted for patient-related factors, early mortality and neonatal morbidity were lower in the SR group, but cumulative morbidity and reinterventions favored the PR group, findings suggesting potential benefits to each strategy.
Collapse
|
14
|
Pewowaruk RJ, Barton GP, Johnson C, Ralphe JC, Francois CJ, Lamers L, Roldán-Alzate A. Stent interventions for pulmonary artery stenosis improve bi-ventricular flow efficiency in a swine model. J Cardiovasc Magn Reson 2021; 23:13. [PMID: 33627121 PMCID: PMC7905680 DOI: 10.1186/s12968-021-00709-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Branch pulmonary artery (PA) stenosis (PAS) commonly occurs in patients with congenital heart disease (CHD). Prior studies have documented technical success and clinical outcomes of PA stent interventions for PAS but the impact of PA stent interventions on ventricular function is unknown. The objective of this study was to utilize 4D flow cardiovascular magnetic resonance (CMR) to better understand the impact of PAS and PA stenting on ventricular contraction and ventricular flow in a swine model of unilateral branch PA stenosis. METHODS 18 swine (4 sham, 4 untreated left PAS, 10 PAS stent intervention) underwent right heart catheterization and CMR at 20 weeks age (55 kg). CMR included ventricular strain analysis and 4D flow CMR. RESULTS 4D flow CMR measured inefficient right ventricular (RV) and left ventricular (LV) flow patterns in the PAS group (RV non-dimensional (n.d.) vorticity: sham 82 ± 47, PAS 120 ± 47; LV n.d. vorticity: sham 57 ± 5, PAS 78 ± 15 p < 0.01) despite the PAS group having normal heart rate, ejection fraction and end-diastolic volume. The intervention group demonstrated increased ejection fraction that resulted in more efficient ventricular flow compared to untreated PAS (RV n.d. vorticity: 59 ± 12 p < 0.01; LV n.d. vorticity: 41 ± 7 p < 0.001). CONCLUSION These results describe previously unknown consequences of PAS on ventricular function in an animal model of unilateral PA stenosis and show that PA stent interventions improve ventricular flow efficiency. This study also highlights the sensitivity of 4D flow CMR biomarkers to detect earlier ventricular dysfunction assisting in identification of patients who may benefit from PAS interventions.
Collapse
MESH Headings
- Animals
- Computed Tomography Angiography
- Disease Models, Animal
- Endovascular Procedures/instrumentation
- Magnetic Resonance Imaging, Cine
- Myocardial Contraction
- Myocardial Perfusion Imaging
- Pulmonary Artery/diagnostic imaging
- Pulmonary Artery/physiopathology
- Recovery of Function
- Stenosis, Pulmonary Artery/diagnostic imaging
- Stenosis, Pulmonary Artery/physiopathology
- Stenosis, Pulmonary Artery/therapy
- Stents
- Sus scrofa
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Dysfunction, Right/therapy
- Ventricular Function, Left
- Ventricular Function, Right
Collapse
Affiliation(s)
- Ryan J Pewowaruk
- Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.
| | - Gregory P Barton
- University of Wisconsin-Madison, Madison, WI, USA
- Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Cody Johnson
- University of Wisconsin-Madison, Madison, WI, USA
| | - J Carter Ralphe
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Division of Cardiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Christopher J Francois
- University of Wisconsin-Madison, Madison, WI, USA
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Luke Lamers
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
- Division of Cardiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- University of Wisconsin-Madison, Madison, WI, USA
- Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
15
|
Pewowaruk R, Hermsen J, Johnson C, Erdmann A, Pettit K, Aesif S, Ralphe JC, Francois CJ, Roldán-Alzate A, Lamers L. Pulmonary artery and lung parenchymal growth following early versus delayed stent interventions in a swine pulmonary artery stenosis model. Catheter Cardiovasc Interv 2020; 96:1454-1464. [PMID: 33063918 PMCID: PMC10831906 DOI: 10.1002/ccd.29326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Compare lung parenchymal and pulmonary artery (PA) growth and hemodynamics following early and delayed PA stent interventions for treatment of unilateral branch PA stenosis (PAS) in swine. BACKGROUND How the pulmonary circulation remodels in response to different durations of hypoperfusion and how much growth and function can be recovered with catheter directed interventions at differing time periods of lung development is not understood. METHODS A total of 18 swine were assigned to four groups: Sham (n = 4), untreated left PAS (LPAS) (n = 4), early intervention (EI) (n = 5), and delayed intervention (DI) (n = 5). EI had left pulmonary artery (LPA) stenting at 5 weeks (6 kg) with redilation at 10 weeks. DI had stenting at 10 weeks. All underwent right heart catheterization, computed tomography, magnetic resonance imaging, and histology at 20 weeks (55 kg). RESULTS EI decreased the extent of histologic changes in the left lung as DI had marked alveolar septal and bronchovascular abnormalities (p = .05 and p < .05 vs. sham) that were less prevalent in EI. EI also increased left lung volumes and alveolar counts compared to DI. EI and DI equally restored LPA pulsatility, R heart pressures, and distal LPA growth. EI and DI improved, but did not normalize LPA stenosis diameter (LPA/DAo ratio: Sham 1.27 ± 0.11 mm/mm, DI 0.88 ± 0.10 mm/mm, EI 1.01 ± 0.09 mm/mm) and pulmonary blood flow distributions (LPA-flow%: Sham 52 ± 5%, LPAS 7 ± 2%, DI 44 ± 3%, EI 40 ± 2%). CONCLUSION In this surgically created PAS model, EI was associated with improved lung parenchymal development compared to DI. Longer durations of L lung hypoperfusion did not detrimentally affect PA growth and R heart hemodynamics. Functional and anatomical discrepancies persist despite successful stent interventions that warrant additional investigation.
Collapse
Affiliation(s)
- Ryan Pewowaruk
- Biomedical Engineering, University of Wisconsin – Madison
| | - Joshua Hermsen
- School of Medicine and Public Health, University of Wisconsin – Madison
- Cardiovascular Surgery, University of Wisconsin – Madison
| | | | - Alexandra Erdmann
- School of Medicine and Public Health, University of Wisconsin – Madison
| | - Kevin Pettit
- School of Medicine and Public Health, University of Wisconsin – Madison
| | - Scott Aesif
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pathology, University of Wisconsin – Madison
| | - J. Carter Ralphe
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pediatrics, Division of Cardiology, University of Wisconsin – Madison
| | - Christopher J. Francois
- School of Medicine and Public Health, University of Wisconsin – Madison
- Radiology, University of Wisconsin – Madison
| | - Alejandro Roldán-Alzate
- Biomedical Engineering, University of Wisconsin – Madison
- Mechanical Engineering, University of Wisconsin – Madison
- Radiology, University of Wisconsin – Madison
| | - Luke Lamers
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pediatrics, Division of Cardiology, University of Wisconsin – Madison
| |
Collapse
|
16
|
Bell D, Betts K, Justo R, Forde N, Venugopal P, Corno AF, Smith P, Caputo M, Marsico R, Karl TR, Alphonso N. Multicenter Experience With 500 CardioCel Implants Used for the Repair of Congenital Heart Defects. Ann Thorac Surg 2019; 108:1883-1888. [DOI: 10.1016/j.athoracsur.2019.04.085] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/14/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
|
17
|
Pewowaruk R, Roldán-Alzate A. 4D Flow MRI Estimation of Boundary Conditions for Patient Specific Cardiovascular Simulation. Ann Biomed Eng 2019; 47:1786-1798. [PMID: 31069584 DOI: 10.1007/s10439-019-02285-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/02/2019] [Indexed: 12/11/2022]
Abstract
Accurate image based cardiovascular simulations require patient specific boundary conditions (BCs) for inlets, outlets and vessel wall mechanical properties. While inlet BCs are typically determined non-invasively, invasive pressure catheterization is often used to determine patient specific outlet BCs and vessel wall mechanical properties. A method using 4D Flow MRI to non-invasively determine both patient specific outlet BCs and vessel wall mechanical properties is presented and results for both in vitro validation with a latex tube and an in vivo pulmonary artery stenosis (PAS) stent intervention are presented. For in vitro validation, acceptable agreement is found between simulation using BCs from 4D Flow MRI and benchtop measurements. For the PAS virtual intervention, simulation correctly predicts flow distribution with 9% error compared to MRI. Using 4D Flow MRI to noninvasively determine patient specific BCs increases the ability to use image based simulations as pressure catheterization is not always performed.
Collapse
Affiliation(s)
- Ryan Pewowaruk
- Biomedical Engineering, University of Wisconsin - Madison, 1111 Highland Ave, Room 2476 WIMR 2, Madison, WI, 53705, USA
| | - Alejandro Roldán-Alzate
- Biomedical Engineering, University of Wisconsin - Madison, 1111 Highland Ave, Room 2476 WIMR 2, Madison, WI, 53705, USA. .,Mechanical Engineering, University of Wisconsin - Madison, 1111 Highland Ave, Room 2476 WIMR 2, Madison, WI, 53705, USA. .,Department of Radiology, University of Wisconsin - Madison, 1111 Highland Ave, Room 2476 WIMR 2, Madison, WI, 53705, USA.
| |
Collapse
|
18
|
Dorobantu DM, Mahani AS, Sharabiani MTA, Pandey R, Angelini GD, Parry AJ, Tulloh RMR, Martin RP, Stoica SC. Primary repair versus surgical and transcatheter palliation in infants with tetralogy of Fallot. Heart 2018; 104:1864-1870. [DOI: 10.1136/heartjnl-2018-312958] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 12/13/2022] Open
Abstract
ObjectivesTreatment of infants with tetralogy of Fallot (ToF) has evolved in the last two decades with increasing use of primary surgical repair (PrR) and transcatheter right ventricular outflow tract palliation (RVOTd), and fewer systemic-to-pulmonary shunts (SPS). We aim to report contemporary results using these treatment options in a comparative study.MethodsThis a retrospective study using data from the UK National Congenital Heart Disease Audit. All infants (n=1662, median age 181 days) with ToF and no other complex defects undergoing repair or palliation between 2000 and 2013 were considered. Matching algorithms were used to minimise confounding due to lower age and weight in those palliated.ResultsPatients underwent PrR (n=1244), SPS (n=311) or RVOTd (n=107). Mortality at 12 years was higher when repair or palliation was performed before the age of 60 days rather than after, most significantly for primary repair (18.7% vs 2.2%, P<0.001), less so for RVOTd (10.8% vs 0%, P=0.06) or SPS (12.4% vs 8.3%, P=0.2). In the matched groups of patients, RVOTd was associated with more right ventricular outflow tract (RVOT) reinterventions (HR=2.3, P=0.05 vs PrR, HR=7.2, P=0.001 vs SPS) and fewer pulmonary valve replacements (PVR) (HR=0.3 vs PrR, P=0.05) at 12 years, with lower mortality after complete repair (HR=0.2 versus PrR, P=0.09).ConclusionsWe found that RVOTd was associated with more RVOT reinterventions, fewer PVR and fewer deaths when compared with PrR in comparable, young infants, especially so in those under 60 days at the time of the first procedure.
Collapse
|
19
|
Mayer JE. Invited Commentary. Ann Thorac Surg 2016; 101:1004. [PMID: 26897192 DOI: 10.1016/j.athoracsur.2015.11.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 11/18/2022]
Affiliation(s)
- John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Bader 273, 300 Longwood Ave, Boston, MA 02115.
| |
Collapse
|