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Dreher M, Min J, Mavroudis C, Ryba D, Ostapenko S, Melchior R, Rosenthal T, Nuri M, Blinder J. Indexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2023; 55:112-120. [PMID: 37682209 PMCID: PMC10487348 DOI: 10.1051/ject/2023029] [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: 04/20/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Acute kidney injury after pediatric cardiac surgery is a common complication with few established modifiable risk factors. We sought to characterize whether indexed oxygen delivery during cardiopulmonary bypass was associated with postoperative acute kidney injury in a large pediatric cohort. METHODS This was a retrospective analysis of patients under 1 year old undergoing cardiac surgery with cardiopulmonary bypass between January 1, 2013, and January 1, 2020. Receiver operating characteristic curves across values ranging from 260 to 400 mL/min/m2 were used to identify the indexed oxygen delivery most significantly associated with acute kidney injury risk. RESULTS We included 980 patients with acute kidney injury occurring in 212 (21.2%). After adjusting for covariates associated with acute kidney injury, an indexed oxygen delivery threshold of 340 mL/min/m2 predicted acute kidney injury in STAT 4 and 5 neonates (area under the curve = 0.66, 95% CI = 0.60 - 0.72, sensitivity = 56.1%, specificity = 69.4%). An indexed oxygen delivery threshold of 400 mL/min/m2 predicted acute kidney injury in STAT 1-3 infants (area under the curve = 0.65, 95% CI = 0.58 - 0.72, sensitivity = 52.6%, specificity = 74.6%). CONCLUSION Indexed oxygen delivery during cardiopulmonary bypass is a modifiable variable independently associated with postoperative acute kidney injury in specific pediatric populations. Strategies aimed at maintaining oxygen delivery greater than 340 mL/min/m2 in complex neonates and greater than 400 mL/min/m2 in infants may reduce the occurrence of postoperative acute kidney injury in the pediatric population.
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Affiliation(s)
- Molly Dreher
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Department of Cardiovascular Perfusion, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Jungwon Min
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Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Constantine Mavroudis
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Children’s Hospital of Philadelphia, Cardiac Center, Division of Cardiothoracic Surgery Philadelphia PA 19104 USA
| | - Douglas Ryba
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Information Services Department, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Svetlana Ostapenko
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Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Richard Melchior
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Department of Cardiovascular Perfusion, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Tami Rosenthal
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Department of Cardiovascular Perfusion, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Muhammad Nuri
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Children’s Hospital of Philadelphia, Cardiac Center, Division of Cardiothoracic Surgery Philadelphia PA 19104 USA
| | - Joshua Blinder
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Stanford University School of Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Division of Pediatric Cardiology Palo Alto CA 94304 USA
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2
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Weld J, Kim E, Chandra P, Savorgnan F, Acosta S, Flores S, Loomba RS. Fluid Overload and AKI After the Norwood Operation: The Correlation and Characterization of Routine Clinical Markers. Pediatr Cardiol 2023:10.1007/s00246-023-03167-0. [PMID: 37129600 DOI: 10.1007/s00246-023-03167-0] [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: 05/24/2022] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
The purpose of this study was to determine the correlation of different methods of assessing fluid overload and determine which metrics are associated with development of acute kidney injury (AKI) in the period immediately following Norwood palliation. This was a retrospective single-center study of Norwood patients from January 2011 through January 2021. AKI was defined using the Kidney Disease Improving Global Outcomes (KDIGO). Patients were separated into two groups: those with AKI and those without. A logistic regression analysis was conducted with AKI at any point in the study period as the dependent variable and clinical and laboratory data as independent variables. Analysis was conducted as a stepwise regression. The coefficients from the logistic regression were then used to develop a cumulative AKI risk score. Spearman correlations were conducted to analyze the correlation of fluid markers. 116 patients were included, and 49 (42.4%) developed AKI. The duration of open chest, duration of mechanical ventilation, need for dialysis, need for extracorporeal membrane oxygenation, and inpatient mortality were associated with AKI (p ≤ 0.05). Stepwise logistic regression demonstrated the following significant independent associations AKI: age at Norwood in days (p < 0.01), blood urea nitrogen (p < 0.01), central venous pressure (p = 0.04), and renal oxygen extraction ratio (p < 0.01). The area under the receiver operating characteristic curve for the logistic regression was 0.74. The fluid markers had weak R-value. Urea, central venous pressure, and renal oxygen extraction ratio are associated with AKI after the Norwood operation. Common clinical metrics used to assess fluid overload are poorly correlated with each other for postoperative Norwood patients.
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Affiliation(s)
- Julia Weld
- Division of Cardiology, Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA.
| | - Erin Kim
- Division of Nephrology, Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Priya Chandra
- Division of Nephrology, Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA
| | - Fabio Savorgnan
- Division of Critical Care and Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Sebastian Acosta
- Division of Critical Care and Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Saul Flores
- Division of Critical Care and Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Rohit S Loomba
- Division of Cardiology, Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, IL, USA
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3
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Saleem Y, Darbari A, Sharma R, Vashisth A, Gupta A. Recent advancements in pediatric cardiopulmonary bypass technology for better outcomes of pediatric cardiac surgery. THE CARDIOTHORACIC SURGEON 2022. [DOI: 10.1186/s43057-022-00084-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pediatric cardiac surgery is in itself very enigmatic and individualized. Presently, there has been a slew of new developments aimed primarily toward pediatric cardiopulmonary bypass for safer, patient-centered pediatric cardiac surgery. Still, lot of technological challenges need to be resolved, and their safer application in pediatric and neonate patients requires further refinement.
Main body of the abstract
Considering various significant yet unresolved issues of pediatric cardiac bypass, an exhaustive literature search was done on various internet databases with standard keywords. There are various new recent improvements; as the first oxygenator explicitly designed for neonatal patients; pediatric oxygenators with low prime volumes and surface areas that allow flows up to 2 L/min; pediatric oxygenators with integrated arterial filters; and miniature ultrafiltration devices that allow for high rates of ultrafiltrate removal. These advancements can significantly reduce cardiopulmonary bypass circuit surface areas and prime volumes. These advancements could reduce or eliminate the requirement for homologous red blood cells during or after surgery with reduction or eliminate bypass-related hemodilution, and inflammation. Because of the immaturity of the neonatal hemostatic system, conventional coagulation tests alone are insufficient to guide neonatal hemostatic therapy. Myocardial preservation techniques, safe temperature with duration are still debatable and yet to be fully explored.
Short conclusion
This review is based on Standards for Quality Improvement Reporting Excellence guidelines to provide a framework for reporting new knowledge to find better management strategy for pediatric cardiac cases.
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4
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Carrasco-Serrano E, Jorge-Monjas P, Muñoz-Moreno MF, Gómez-Sánchez E, Priede-Vimbela JM, Bardají-Carrillo M, Cubero-Gallego H, Tamayo E, Ortega-Loubon C. Impact of Oxygen Delivery on the Development of Acute Kidney Injury in Patients Undergoing Valve Heart Surgery. J Clin Med 2022; 11:jcm11113046. [PMID: 35683434 PMCID: PMC9180985 DOI: 10.3390/jcm11113046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/02/2022] [Accepted: 05/23/2022] [Indexed: 02/06/2023] Open
Abstract
One of the strongest risk factors for death in individuals undergoing cardiac surgery is Cardiac Surgery Associated-Acute Kidney Injury (CSA-AKI). Although the minimum kidney oxygen delivery index (DO2i) during cardiopulmonary bypass (CPB) has been reported, the optimal threshold value has not yet been established. A prospective study was conducted from June 2012 to January 2016 to asses how DO2i influences the pathogenesis of CSA-AKI, as well as its most favorable cut-off value. DO2 levels were recorded at the beginning, middle, and end of the CPB. The association between DO2i and CSA-AKI was investigated using multivariable logistic regression analysis. The optimal cut-off of DO2i as a predictor of CSA-AKI was determined using Classification and Regression Tree (CART) analysis. A total of 782 consecutive patients were enrolled. Of these, 231 (29.5%) patients developed AKI. Optimal DO2i thresholds of 303 mL/min/m2 during the CPB and 295 mL/min/m2 at the end of the intervention were identified, which increased the odds of CSA-AKI almost two-fold (Odds Ratio (OR), 1.90; 95% CI, 1.12–3.24) during the surgery and maintained that risk (OR 1.94; 95% CI, 1.15–3.29) until the end. Low DO2i during cardiopulmonary bypass is a risk factor for CSA-AKI that cannot be ruled out. Continuous renal oxygen supply monitoring for adult patients could be a promising method for predicting AKI during CPB.
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Affiliation(s)
- Elena Carrasco-Serrano
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47003 Valladolid, Spain; (E.C.-S.); (P.J.-M.); (J.M.P.-V.); (M.B.-C.); (E.T.); (C.O.-L.)
- Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, 47003 Valladolid, Spain
| | - Pablo Jorge-Monjas
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47003 Valladolid, Spain; (E.C.-S.); (P.J.-M.); (J.M.P.-V.); (M.B.-C.); (E.T.); (C.O.-L.)
- Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, 47003 Valladolid, Spain
- Department of Surgery, University of Valladolid, 47003 Valladolid, Spain
| | - María Fé Muñoz-Moreno
- Unit of Research, Clinical University Hospital of Valladolid, 47003 Valladolid, Spain;
| | - Esther Gómez-Sánchez
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47003 Valladolid, Spain; (E.C.-S.); (P.J.-M.); (J.M.P.-V.); (M.B.-C.); (E.T.); (C.O.-L.)
- Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, 47003 Valladolid, Spain
- Department of Surgery, University of Valladolid, 47003 Valladolid, Spain
- Correspondence:
| | - Juan Manuel Priede-Vimbela
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47003 Valladolid, Spain; (E.C.-S.); (P.J.-M.); (J.M.P.-V.); (M.B.-C.); (E.T.); (C.O.-L.)
- Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, 47003 Valladolid, Spain
| | - Miguel Bardají-Carrillo
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47003 Valladolid, Spain; (E.C.-S.); (P.J.-M.); (J.M.P.-V.); (M.B.-C.); (E.T.); (C.O.-L.)
- Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, 47003 Valladolid, Spain
| | - Héctor Cubero-Gallego
- Interventional Cardiology Unit, Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain;
| | - Eduardo Tamayo
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47003 Valladolid, Spain; (E.C.-S.); (P.J.-M.); (J.M.P.-V.); (M.B.-C.); (E.T.); (C.O.-L.)
- Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, 47003 Valladolid, Spain
- Department of Surgery, University of Valladolid, 47003 Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Christian Ortega-Loubon
- BioCritic, Group for Biomedical Research in Critical Care Medicine, 47003 Valladolid, Spain; (E.C.-S.); (P.J.-M.); (J.M.P.-V.); (M.B.-C.); (E.T.); (C.O.-L.)
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5
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Holcomb RM, Ündar A. Are outcomes in congenital cardiac surgery better than ever? J Card Surg 2022; 37:656-663. [PMID: 35023592 DOI: 10.1111/jocs.16225] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Congenital heart disease is the most common congenital defect among infants born in the United States. Within the first year of life, 1 in 4 of these infants will need surgery. Only one generation removed from an overall mortality of 14%, many changes have been introduced into the field. Have these changes measurably improved outcomes? METHODS The literature search was conducted through PubMed MEDLINE and Google Scholar from inception to October 31, 2021. Ultimately, 78 publications were chosen for inclusion. RESULTS The outcome of overall mortality has experienced continuous improvements in the modern era of the specialty despite the performance of more technically demanding surgeries on patients with complex comorbidities. This modality does not account for case-mix, however. In turn, clinical outcomes have not been consistent from center to center. Furthermore, variation in practice between institutions has also been documented. A recurring theme in the literature is a movement toward standardization and universalization. Examples include mortality risk-stratification that has allowed direct comparison of outcomes between programs and improved definitions of morbidities which provide an enhanced framework for diagnosis and management. CONCLUSIONS Overall mortality is now below 3%, which suggests that more patients are surviving their interventions than in any previous era in congenital cardiac surgery. Focus has transitioned from survival to improving the quality of life in the survivors by decreasing the incidence of morbidity and associated long-term effects. With the transformation toward standardization and interinstitutional collaboration, future advancements are expected.
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Affiliation(s)
- Ryan M Holcomb
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA.,Surgery, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
| | - Akif Ündar
- Penn State Hershey Pediatric Cardiovascular Research Center, Departments of Pediatrics, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA.,Biomedical Engineering, Penn State College of Medicine, Penn State Health Children's Hospital, Hershey, Pennsylvania, USA
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6
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Leghrouz B, Kaddourah A. Impact of Acute Kidney Injury on Critically Ill Children and Neonates. Front Pediatr 2021; 9:635631. [PMID: 33981652 PMCID: PMC8107239 DOI: 10.3389/fped.2021.635631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Acute kidney injury (AKI) is a clinical syndrome that manifests as an abrupt impairment of kidney function. AKI is common in critically ill pediatric patients admitted to the pediatric intensive care units. AKI is a deleterious complication in critically ill children as it is associated with increased morbidity and mortality. This review provides an overview of the incidence, morbidity, and mortality of AKI in critically ill children in general and specific cohorts such as post-cardiac surgeries, sepsis, critically ill neonates, and post stem cell transplantation.
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Affiliation(s)
- Bassil Leghrouz
- Pediatric Nephrology and Hypertension Division, Sidra Medicine, Doha, Qatar
| | - Ahmad Kaddourah
- Pediatric Nephrology and Hypertension Division, Sidra Medicine, Doha, Qatar.,Weill Cornel Medical College, Ar-Rayyan, Qatar
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7
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Xiong T, Pu L, Ma YF, Zhu YL, Cui X, Li H, Zhan X, Li YX. Safety of Normothermic Cardiopulmonary Bypass in Pediatric Cardiac Surgery: A System Review and Meta-Analysis. Front Pediatr 2021; 9:757551. [PMID: 34970516 PMCID: PMC8712704 DOI: 10.3389/fped.2021.757551] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/24/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives: Hypothermic cardiopulmonary bypass (HCPB) has been used successfully in cardiac surgery for more than half a century, although adverse effects have been reported with its use. Many studies on temperature management during CPB published to date have shown that normothermic CPB (NCPB) provides more benefits to children undergoing cardiac surgery. The present meta-analysis investigated the effect of NCPB on clinical outcomes based on results of randomized controlled trials and observational studies on pediatric cardiac surgery. Methods: Databases such as PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov were searched from inception to May 2021 to identify relevant studies published in English. Results: The present meta-analysis included 13 studies characterizing a total of 837 pediatric patients. The random effects model exhibited that the NCPB group had reduced revision for postoperative bleeding [odds ratio (OR): 0.11; 95% confidence interval (CI): 0.01-0.89; I 2 = 0%, P = 0.04], serum lactate 2-4 h after CPB (mean difference: -0.60; 95% CI: -1.09 to -0.11; I 2 = 82%, P = 0.02), serum creatinemia 24 h after CPB (mean difference: -2.73; 95% CI: -5.06 to -0.39; I 2 = 83%, P = 0.02), serum creatinemia 48 h after CPB (mean difference: -2.08; 95% CI: -2.78 to -1.39; I 2 = 0%, P < 0.05), CPB time (mean difference: -19.10, 95% CI: -32.03 to -6.18; I 2 = 96%, P = 0.04), and major adverse events (OR: 0.37; 95% CI: 0.15-0.93; Z = 2.12, P = 0.03) after simple congenital surgery compared with the HCPB group. Conclusion: NCPB is as safe as HCPB in pediatric congenital heart surgery. Moreover, NCPB provides more advantages than HCPB in simple congenital heart surgery.
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Affiliation(s)
- Tao Xiong
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lei Pu
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.,Cardiovascular Surgery, Institution of Yunnan, Kunming, China
| | - Yuan-Feng Ma
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yun-Long Zhu
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xu Cui
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.,Cardiovascular Surgery, Institution of Yunnan, Kunming, China
| | - Hua Li
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.,Cardiovascular Surgery, Institution of Yunnan, Kunming, China
| | - Xu Zhan
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.,Cardiovascular Surgery, Institution of Yunnan, Kunming, China
| | - Ya-Xiong Li
- Department of Cardiac Surgery, Kunming Yan'an Hospital, Affiliated Hospital of Kunming Medical University, Kunming, China.,Cardiovascular Surgery, Institution of Yunnan, Kunming, China
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8
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Tadphale SD, Ramakrishnan K, Spentzas T, Kumar TKS, Allen J, Staffa SJ, Zurakowski D, Bigelow WA, Gopal SH, Boston US, Jonas RA, Knott-Craig CJ. Impact of Different Cardiopulmonary Bypass Strategies on Renal Injury After Pediatric Heart Surgery. Ann Thorac Surg 2020; 111:1374-1379. [PMID: 32603703 DOI: 10.1016/j.athoracsur.2020.05.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/09/2020] [Accepted: 05/07/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose of this study is to compare the incidence and severity of acute kidney injury (AKI) after open heart surgery in neonates and infants for two different cardiopulmonary bypass (CPB) strategies. METHODS In all, 151 infants undergoing cardiac surgery were prospectively enrolled between June 2017 and June 2018 at two centers, one using conventional CPB (2.4 L · min-1 · m-2, 150 mL · kg-1 · min-1) with reduction of flow rates with moderate hypothermia and with a targeted hematocrit greater than 25% (center 1, n = 91), and the other using higher bypass flow rates (175 to 200 mL · kg-1 · min-1) and higher minimum hematocrit (greater than 32%) CPB (center 2, n = 60). The primary endpoint was the incidence of postoperative AKI as defined by Acute Kidney Injury Network criteria and risk factors associated with AKI. RESULTS Preoperative characteristics and complexity of surgery were comparable between centers. The overall incidence of early postoperative AKI was 10.6% (16 of 151), with 15.4% (14 of 91) in center 1 and 3.3% (2 of 60) in center 2 (P = .02). Mean lowest flow rates on CPB were 78 mL · kg-1 · min-1 vs 118 mL · kg-1 · min-1 and mean highest hematocrit on separation from CPB were 33% vs 43% at center 1 and 2, respectively (P < .001). Center 1 used less packed red blood cells but more fresh frozen plasma than center 2 (P = .001). By multivariate analysis, only lower flows on CPB (78 vs 96 mL · kg-1 · min-1, P = .043) and lower hematocrit at the end of CPB (33% vs 37%, P = .007) were associated with AKI. CONCLUSIONS In this contemporary comparative study, higher flow rates and higher hematocrit during cardiopulmonary bypass were associated with better preservation of renal function.
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Affiliation(s)
- Sachin D Tadphale
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Karthik Ramakrishnan
- Department of Pediatric Cardiovascular Surgery, Children's National Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington DC
| | - Thomas Spentzas
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - T K Susheel Kumar
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Jerry Allen
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William A Bigelow
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Srirupa Hari Gopal
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga, Tennessee
| | - Umar S Boston
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Richard A Jonas
- Department of Pediatric Cardiovascular Surgery, Children's National Medical Center, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington DC
| | - Christopher J Knott-Craig
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee; Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Cardiovascular Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee.
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