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Salavitabar A, Armstrong AK, Carrillo SA. Hybrid Interventions in Congenital Heart Disease. Interv Cardiol Clin 2024; 13:399-408. [PMID: 38839172 DOI: 10.1016/j.iccl.2024.02.005] [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: 06/07/2024]
Abstract
Hybrid interventions in congenital heart disease (CHD) embody the inherent collaboration between congenital interventional cardiology and cardiothoracic surgery. Hybrid approaches to complex and common lesions provide the opportunity to circumvent the limitations of patient size, vascular access, severity of illness, and anatomy that would otherwise be prohibitive to surgical and percutaneous techniques alone. This review describes several important hybrid approaches to interventions in CHD.
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Affiliation(s)
- Arash Salavitabar
- The Heart Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA.
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
| | - Sergio A Carrillo
- The Heart Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH 43205, USA
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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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Matsunaga Y, Shikata F, Oka N, Okamura T, Tomoyasu T, Kaneko M, Inoue T, Matsui K, Miyaji K. Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery banding. JTCVS OPEN 2023; 16:675-688. [PMID: 38204621 PMCID: PMC10774982 DOI: 10.1016/j.xjon.2023.07.023] [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: 05/03/2023] [Revised: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 01/12/2024]
Abstract
Objective To investigate the early and long-term outcomes of the deferred Norwood procedure by bilateral pulmonary artery banding (BPAB) versus the neonatal Norwood procedure. Methods This retrospective study examined 46 patients with hypoplastic left heart syndrome and its variants undergoing the Norwood procedure for single ventricle physiology between 2004 and 2022 at 3 institutions. The patients were divided into 2 groups: neonatal Norwood procedure (group N; n = 23) and staged Norwood procedure in infants following BPAB (group I; n = 23). Preoperative risk factors, surgical results, survival rates, Fontan candidacy, and long-term complications were compared. Results Early survival rates after the Norwood procedure were 91.3% (21 of 23) in both groups. Late survival rates after the Norwood procedure were similar at the 10-year follow-up (group N, 76.3%; group I, 68.7%; P = .63). Fontan completion rates also were comparable in the 2 groups (group N, 77.8%; group I, 85.7%; P = .67). Group N showed a higher median pulmonary artery (PA) index before bidirectional cavopulmonary connection (group N, 177 [interquartile range (IQR), 147-243] mm2/m2; group I, 152 [IQR, 146-163] mm2/m2; P = .03); this trend continued until 5 years after Fontan completion (P = .01). Group N also had a lower rate of freedom from protein-losing enteropathy (PLE) at 9.0 years after the Fontan operation (90.0% vs 52.5% for group I; P = .04), although the incidences of other Fontan-associated events were not significantly different. Conclusions Fontan candidacy and survival rates were similar regardless of the timing of the Norwood procedure. Early performance of the Norwood procedure may lead to lower rates of late Fontan-associated events, such as PLE.
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Affiliation(s)
- Yoshikiyo Matsunaga
- Department of Cardiovascular Surgery, Kitasato University Hospital, Kanagawa, Japan
- Cardiovascular Surgery, Gunma Children's Medical Center, Gunma, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University Hospital, Kanagawa, Japan
| | - Norihiko Oka
- Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center, Tochigi, Japan
| | - Toru Okamura
- Cardiovascular Surgery, Gunma Children's Medical Center, Gunma, Japan
| | - Takahiro Tomoyasu
- Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center, Tochigi, Japan
| | - Masahiro Kaneko
- Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center, Tochigi, Japan
| | - Takamichi Inoue
- Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center, Tochigi, Japan
| | - Kenta Matsui
- Department of Cardiovascular Surgery, Kitasato University Hospital, Kanagawa, Japan
- Pediatric and Congenital Cardiovascular Surgery, Jichi Children's Medical Center, Tochigi, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University Hospital, Kanagawa, Japan
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Argo MB, Barron DJ, Eghtesady P, Alsoufi B, Honjo O, Yerebakan C, DeCampli WM, Jacobs JP, Carrillo SA, Jegatheeswaran A, Karamlou T, Paramananthan T, Rahman M, Lambert LM, Nelson J, Caldarone CA, Husain SA, Galantowicz ME, Ramakrishnan K, Kirklin JK, Turek JW, Mannie C, Blackstone EH, Mitchell ME, McCrindle BW. Norwood operation versus comprehensive stage II after bilateral pulmonary artery banding palliation for infants with critical left heart obstruction. J Thorac Cardiovasc Surg 2023; 166:943-954.e1. [PMID: 36804212 DOI: 10.1016/j.jtcvs.2023.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/15/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To determine patient characteristics and outcomes after Norwood versus comprehensive stage II (COMPSII) for infants with critical left heart obstruction who had prior hybrid palliation (bilateral pulmonary artery banding ± ductal stent). METHODS From 23 Congenital Heart Surgeons' Society institutions (2005-2020), 138 infants underwent hybrid palliation followed by either Norwood (n = 73, 53%) or COMPSII (n = 65). Baseline characteristics were compared between Norwood and COMPSII groups. Parametric hazard model with competing risk methodology was used to determine risk and factors associated with outcomes of Fontan, transplantation, or death. RESULTS Infants who underwent Norwood versus COMPSII had a higher prevalence of prematurity (26% vs 14%, P = .08), lower birth weight (median 2.8 vs 3.2 kg, P < .01) and less frequent ductal stenting (37% vs 99%; P < .01). Norwood was performed at a median age of 44 days and median weight of 3.5 kg, versus COMPSII at 162 days and 6.0 kg (both P < .01). Median follow-up was 6.5 years. At 5 years after Norwood and COMPSII, respectively; 50% versus 68% had Fontan (P = .16), 3% versus 5% had transplantation (P = .70), 40% versus 15% died (P = .10), and 7% versus 11% are alive without transition, respectively. For factors associated with either mortality or Fontan, only preoperative mechanical ventilation occurred more frequently in the Norwood group. CONCLUSIONS Higher prevalence of prematurity, lower birth weight, and other patient-related characteristics in the Norwood versus COMPSII groups may influence differences in outcomes that were not statistically significant for this limited risk-adjusted cohort. The clinical decision regarding Norwood versus COMPSII after initial hybrid palliation remains challenging.
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Affiliation(s)
- Madison B Argo
- Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wis; Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - David J Barron
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, St. Louis, Mo
| | - Bahaaldin Alsoufi
- Department of Cardiovascular and Thoracic Surgery, Norton Children's Hospital, Louisville, Ky
| | - Osami Honjo
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Can Yerebakan
- Division of Cardiac Surgery, Children's National Hospital, Washington, DC
| | - William M DeCampli
- Division of Pediatric Cardiac Surgery, Arnold Palmer Hospital for Children, Orlando, Fla
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Sergio A Carrillo
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Anusha Jegatheeswaran
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tharini Paramananthan
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maha Rahman
- Divisions of Cardiovascular Surgery and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linda M Lambert
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Jennifer Nelson
- Division of Pediatric Cardiovascular Surgery, Children's Mercy Kansas City, Kansas City, Mo
| | | | - S Adil Husain
- Division of Cardiothoracic Surgery, Primary Children's Hospital, Salt Lake City, Utah
| | - Mark E Galantowicz
- Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Karthik Ramakrishnan
- Division of Pediatric Cardiovascular Surgery, LeBonheur Children's Hospital, Memphis, Tenn
| | - James K Kirklin
- Division of Cardiothoracic Surgery, The University of Alabama at Birmingham, Birmingham, Ala
| | - Joseph W Turek
- Department of Surgery, Duke Children's Hospital and Health Center, Durham, NC
| | - Chelsea Mannie
- Division of Pediatric Cardiothoracic Surgery, St. Louis Children's Hospital, St. Louis, Mo
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael E Mitchell
- Division of Pediatric Cardiothoracic Surgery, Children's Wisconsin, Milwaukee, Wis
| | - Brian W McCrindle
- Pediatric Cardiology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Nandi D, Culp S, Yates AR, Hoffman TM, Juraszek AL, Snyder CS, Feltes TF, Cua CL. Initial Counseling Prior to Palliation for Hypoplastic Left Heart Syndrome: 2021 vs 2011. Pediatr Cardiol 2023; 44:1118-1124. [PMID: 37099209 DOI: 10.1007/s00246-023-03170-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/19/2023] [Indexed: 04/27/2023]
Abstract
We sought to examine current practices and changes in practice regarding initial counseling for families of patients with hypoplastic left heart syndrome (HLHS) given the evolution of options and outcomes over time. Counseling (Norwood with Blalock-Taussig-Thomas shunt (NW-BTT), NW with right ventricle to pulmonary artery conduit (NW-RVPA), hybrid palliation, heart transplantation, or non-intervention/hospice (NI)) for patients with HLHS were queried via questionnaire of pediatric care professionals in 2021 and compared to identical questionnaire from 2011. Of 322 respondents in 2021 (39% female), 299 respondents were cardiologists (92.9%), 17cardiothoracic surgeons (5.3%), and 6 were nurse practitioners (1.9%). Respondents were largely from North America (96.9%). In 2021, NW-RVPA procedure was the preferred palliation for standard risk HLHS patient (61%) and was preferred across all US regions (p < 0.001). NI was offered as an option by 71.4% of respondents for standard risk patients and was the predominant strategy for patients with end-organ dysfunction, chromosomal abnormality, and prematurity (52%, 44%, and 45%, respectively). The hybrid procedure was preferred for low birth-weight infants (51%). In comparison to the identical 2011 questionnaire (n = 200), the NW-RVPA was endorsed more in 2021 (61% vs 52%, p = 0.04). For low birth-weight infants, hybrid procedure was more recommended than in 2011 (51% vs 21%, p < 0.001). The NW-RVPA operation is the most recommended strategy throughout the US for infants with HLHS. The hybrid procedure for low birth-weight infants is increasingly recommended. NI continues to be offered even in standard risk patients with HLHS.
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Affiliation(s)
- Deipanjan Nandi
- Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA.
| | - Stacey Culp
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | - Andrew R Yates
- Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | | | | | | | - Timothy F Feltes
- Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Clifford L Cua
- Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
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Gilmore A, Davis JA, Low S, Chisolm J, Kelly J, Hone E, Bai S, McConnell P, Galantowicz M, Cua CL. Incidence of and Risk Factors for Aortic Arch Interventions After the Comprehensive Stage II Procedure for Hypoplastic Left Heart Syndrome. Pediatr Cardiol 2022; 43:426-434. [PMID: 34609534 DOI: 10.1007/s00246-021-02739-2] [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: 06/29/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Abstract
Minimal data exist about the incidence and risk factors for arch intervention after comprehensive stage II (CSII). Goal of this study was to document incidence of arch interventions after CSII and determine if any differences existed between those who underwent an arch intervention (aiCSII) versus those did not have an intervention. Single-center retrospective chart review of all hypoplastic left heart syndrome patients who underwent a CSII between 6/1/2005 and 2/1/2020 was performed. Univariate analysis was conducted in addition to principal components analysis (PCA). One hundred patients were evaluated. Sixteen patients underwent 24 arch interventions. Age at initial arch reintervention was 1.3 ± 1.2 years (median 1.0 years, range 0.5-2.2 years). Univariate analysis showed that the aiCSII group were more likely to be female, to have had a retrograde arch intervention post-hybrid procedure, and to be younger at time of CSII. On echocardiograms, aiCSII group had significantly higher pre-CSII patent ductus arteriosus velocities, arch velocities on their 1st post-operative and discharge study post-CSII, and arch velocities pre-Fontan. Gradients were higher in the aiCSII via pre-Fontan catheterization. With PCA, echocardiographic and catheterization data remained significantly associated with aiCSII versus those who did not undergo an arch intervention (OR = 4.5 (1.9, 19.8), p = 0.008). Incidence of arch intervention post-CSII was 16%. Echocardiographic arch velocities during the CSII hospitalization were the strongest predictors for subsequent aortic arch interventions. Further studies are needed to determine any modifiable variables that may reduce the incidence of arch interventions.
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Affiliation(s)
- Annaka Gilmore
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Jo Ann Davis
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Samantha Low
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Joanne Chisolm
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - John Kelly
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Emily Hone
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Shasha Bai
- Heart Center, Nationwide Children's Hospital, Columbus, OH, 43205, USA
| | - Patrick McConnell
- 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.
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Clark JB. Commentary: Successful pairing of the Norwood and bidirectional Glenn in select older infants. J Thorac Cardiovasc Surg 2021; 163:1601-1602. [PMID: 34955282 DOI: 10.1016/j.jtcvs.2021.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Joseph B Clark
- Division of Pediatric Cardiac Surgery, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pa.
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Incidence and impact of acute kidney injury in patients with hypoplastic left heart syndrome following the hybrid stage 1 palliation. Cardiol Young 2021; 31:414-420. [PMID: 33261689 DOI: 10.1017/s1047951120004199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Acute kidney injury leads to worse outcomes following paediatric cardiac surgery. There is a lack of literature focusing on acute kidney injury after the Hybrid stage 1 palliation for single ventricle physiology. Patients undergoing the Hybrid Stage 1, as a primary option, may have a lower incidence of kidney injury than previously reported. When present, kidney injury may increase the risk of post-operative morbidity and mortality. METHODS A retrospective, single centre review was conducted in patients with hypoplastic left heart syndrome who underwent Hybrid Stage 1 from 2008 to 2018. Acute kidney injury was defined as a dichotomous yes (meeting any injury criteria) or no (no injury) utilising two different criteria utilised in paediatrics. The impact of kidney injury on perioperative characteristics and 30-day mortality was analysed. RESULTS The incidence of acute kidney injury is 13.4-20.7%, with a severe injury rate of 2.4%. Patients without a prenatal diagnosis of hypoplastic left heart syndrome have a higher incidence of kidney injury than those prenatally diagnosed, (40% versus 14.5%, p = 0.024). Patients with acute kidney injury have a significantly higher incidence of 30-day mortality, 27.3%, compared to without, 5.6% (p = 0.047). DISCUSSION The incidence of severe acute kidney injury after the Hybrid Stage 1 palliation is low. A prenatal diagnosis may be associated with a lower incidence of kidney injury following the Hybrid Stage 1. Though uncommon, severe acute kidney injury following Hybrid Stage 1 may be associated with higher 30-day mortality.
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Wilder TJ, Caldarone CA. Apples to oranges: Making sense of hybrid palliation for hypoplastic left heart syndrome. JTCVS OPEN 2020; 4:47-54. [PMID: 36004289 PMCID: PMC9390685 DOI: 10.1016/j.xjon.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Travis J. Wilder
- Address for reprints: Travis J. Wilder, MD, Legacy Tower, Floor 19, 6651 Main St, Mail Code 19345H, Houston, TX 77030.
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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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Abstract
PURPOSE OF REVIEW The development of biventricular repair and conversion pathways for patients with borderline hypoplastic heart disease represents an area of recent inquiry and innovation. This review summarizes emerging techniques and novel treatment algorithms for borderline hypoplastic heart disease with a focus on surgical advances within the last 10 years. RECENT FINDINGS Many patients with borderline hypoplastic heart disease are amenable to primary biventricular repair, or biventricular conversion following single-ventricle palliation coupled with ventricular rehabilitation strategies. New insights into the potential for growth and recovery of borderline ventricles have been uncovered. However, questions remain regarding optimal patient selection and the long-term outcomes of select patient groups treated with single-ventricle palliation versus biventricular repair/conversion or transplantation. Efforts to direct a greater proportion of borderline hypoplastic heart patients towards a biventricular circulation are accelerating and represent important avenues for progress and future research in the field of congenital heart disease.
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12
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Karamlou T, Najm HK. Evolution of care pathways for babies with hypoplastic left heart syndrome: integrating mechanistic and clinical process investigation, standardization, and collaborative study. J Thorac Dis 2020; 12:1174-1183. [PMID: 32274198 PMCID: PMC7139006 DOI: 10.21037/jtd.2019.10.75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Since initial descriptions of staged palliation for hypoplastic left heart syndrome (HLHS) in the 1980’s, much has been learned about the pathophysiology of the single ventricle circulation. New therapies that leverage systems biology and clinical derivatives have been developed. While in-hospital mortality and morbidity for babies with HLHS have continued to improve, there remains a long (and daresay winding) road ahead to achieve ideal outcomes. Important variation in even these abbreviated in-hospital metrics persists among institutions and currently utilized prediction models explain only a small amount of this variation. Moreover, long-term survival and neurodevelopmental health for patients with HLHS are infrequently reported and remain suboptimal despite improved in-hospital outcomes. This focused review will describe the evolution of national outcomes for HLHS over time and the potential factors motivating improved time-related mortality. Emerging modifiable risk-factors that hold promise in terms of moving the needle for long-term success, including social determinants of health and the delineation of genetic profiles, will be discussed. Specifically, this review will integrate contemporary data based on the first murine HLHS models that suggest a genetically elicited modular phenotype with environmental factors known to impact the initial durability of surgical therapies. A comprehensive approach to the management of HLHS, which leverages both proactive transplantation and hybrid palliation, in addition to traditional Norwood palliation, will be emphasized to extend and match management to the complete spectrum of patient risk-profiles. Finally, we will explore the critical role that national collaboratives and quality reporting initiatives have played in improving outcomes and shifting the focus to more meaningful long-term survival and neurodevelopment.
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Affiliation(s)
- Tara Karamlou
- Division of Pediatric Cardiac Surgery, Cleveland Clinic Heart Vascular Institute, Cleveland, OH, USA
| | - Hani K Najm
- Division of Pediatric Cardiac Surgery, Cleveland Clinic Heart Vascular Institute, Cleveland, OH, USA
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Cua CL, Moore-Clingenpeel M, Husain N, Holzer R, Cheatham JP, Gokhale J. Systolic/diastolic ratio correlates with end diastolic pressures in pediatric patients with single right ventricles. CONGENIT HEART DIS 2019; 14:609-613. [PMID: 30698332 DOI: 10.1111/chd.12755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/29/2018] [Accepted: 01/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Increased ventricular end-diastolic pressure (VEDP) is a known risk factor for morbidity and mortality in patients with single right ventricle (RV) physiology. Previous studies have shown mixed results correlating echocardiographic measurements with catheter-derived VEDP in this population. Goal of this study was to evaluate if echocardiographic systolic/diastolic ratio (S/D) correlated with VEDP. METHODS Patients with single RV physiology who underwent simultaneous echocardiography and catheterization were evaluated. Systolic and diastolic durations were measured using tricuspid inflow durations from Doppler analysis to calculate the S/D ratio. VEDP was obtained from the catheterization report. RESULTS Twenty-seven studies were performed on patients with single RV physiology. Median age at time of catheterization was 11.4 months (range, 0-132 months). Mean VEDP was 9.9 ± 4.5 mm Hg. S/D ratio was 1.8 ± 0.5. S/D ratio significantly correlated with VEDP (r = 0.63, P < .01). Optimum value of S/D ratio for discriminating between patients with high (>10 mm Hg) vs low EDP was found to be 1.9. High S/D ratio had an area under the curve of 0.82 (0.65, 1.0), with 75% sensitivity and 89% specificity for predicting elevated VEDP. CONCLUSION In patients with single RV physiology, S/D significantly correlated with VEDP. S/D ratio is a simple technique that may be useful in both estimating and discriminating between high and low VEDP in this complex patient population.
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Affiliation(s)
- Clifford L Cua
- Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Nazia Husain
- Pediatric Cardiology, Lurie Children's Hospital, Chicago, Illinois
| | - Ralf Holzer
- New York-Presbyterian/Weill Cornell Medical Center, New York City, New York
| | - John P Cheatham
- Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Janaki Gokhale
- Pediatric Cardiology, Lucille Packard Children's Hospital, Palo Alto, California
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Jacobs ML, Jacobs JP, Hill KD, O’Brien SM, Pasquali SK, Vener D, Kumar SR, Chiswell K, Habib RH, Shahian DM, Fernandez FG. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2018 Update on Research. Ann Thorac Surg 2018; 106:654-663. [DOI: 10.1016/j.athoracsur.2018.06.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/24/2018] [Indexed: 12/27/2022]
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