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Aly S, Qattea I, Othman H, Nguyen HH, Aly HZ. Outcomes of atrioventricular septal defects with and without down syndrome: analysis of the national inpatient database. Cardiol Young 2024; 34:614-623. [PMID: 37667895 DOI: 10.1017/s1047951123003116] [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] [Indexed: 09/06/2023]
Abstract
BACKGROUND Controversial data exist about the impact of Down syndrome on outcomes after surgical repair of atrioventricular septal defect. AIMS (A) assess trends and outcomes of atrioventricular septal defect with and without Down syndrome and (B) determine risk factors associated with adverse outcomes after atrioventricular septal defect repair. METHODS We queried The National Inpatient Sample using International Classification of Disease codes for patients with atrioventricular septal defect < 1 year of age from 2000 to 2018. Patients' characteristics, co-morbidities, mortality, and healthcare utilisation were evaluated by comparing those with versus without Down syndrome. RESULTS In total, 2,318,706 patients with CHD were examined; of them, 61,101 (2.6%) had atrioventricular septal defect. The incidence of hospitalisation in infants with atrioventricular septal defect ranged from 4.5 to 7.5% of all infants hospitalised with CHD per year. A total of 33,453 (54.7%) patients were associated with Down syndrome. Double outlet right ventricle, coarctation of the aorta, and tetralogy of Fallot were the most commonly associated with CHD in 6.9, 5.7, and 4.3% of patients, respectively. Overall atrioventricular septal defect mortality was 6.3%. Multivariate analysis revealed that prematurity, low birth weight, pulmonary hypertension, and heart block were associated with mortality. Down syndrome was associated with a higher incidence of pulmonary hypertension (4.3 versus 2.8%, p < 0.001), less arrhythmia (6.6 versus 11.2%, p < 0.001), shorter duration for mechanical ventilation, shorter hospital stay, and less perioperative mortality (2.4 versus 11.1%, p < 0.001). CONCLUSION Trends in atrioventricular septal defect hospitalisation had been stable over time. Perioperative mortality in atrioventricular septal defect was associated with prematurity, low birth weight, pulmonary hypertension, heart block, acute kidney injury, and septicaemia. Down syndrome was present in more than half of atrioventricular septal defect patients and was associated with a higher incidence of pulmonary hypertension but less arrhythmia, lower mortality, shorter hospital stay, and less resource utilisation.
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Affiliation(s)
- Safwat Aly
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ibrahim Qattea
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Hasan Othman
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Hoang H Nguyen
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Hany Z Aly
- Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA
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Wang B, Verrocchi J, Liew D, Zentner D. Does Down syndrome influence the outcomes of congenital cardiac surgery? A systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:240-248. [PMID: 35612980 DOI: 10.1093/ehjqcco/qcac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 05/17/2023]
Abstract
BACKGROUND Congenital cardiac surgery for individuals with Down syndrome (DS) has historically occurred at a reduced frequency. Little data are available regarding long-term post-congenital cardiac surgical outcomes. Limited sample sizes and clinical heterogeneity require a pooled analysis approach. AIMS To compare long-term outcomes post-congenital heart surgery between adults with and without DS. METHODS Databases (Medline, Embase, and PubMed) were searched utilizing terms related to DS and congenital heart disease.Studies that enrolled adults (>18 years) with operated congenital heart disease and compared long-term outcomes with respect to DS presence were included. All study designs were included, but those with limited/peri-operative follow-up, non-English texts, case studies, and literature reviews were excluded.Blinded screening, data extraction, and quality assessment were independently conducted by two reviewers. QUIPS criteria were used for risk of bias analysis. Both random- and fixed-effects models were used for meta-analysis. RESULTS A total of 23 studies (n = 10 466) were included. Risk of bias was frequently high due to unblinded retrospective study designs and analyses limited in adjustment for other prognostic factors.Meta-analysis demonstrated no effect of DS on long-term mortality [hazard ratio (HR) 0.86, 95% confidence interval (95% CI) 0.6-1.23], to a maximum described follow-up of 38 years. Lower cardiac reoperation risk (HR 0.6, 95% CI 0.46-0.78) for individuals with DS was found on pooled analysis. Meta-analysis was limited by between-study variation. CONCLUSION DS does not affect post-congenital cardiac surgical survival in adulthood. Reduced reoperation may reflect challenges in assessing functional and symptomatic status and/or concerns regarding perceived reoperation difficulties or likely benefits.
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Affiliation(s)
- Benjamen Wang
- Cardiology Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Justin Verrocchi
- Monash Medical Centre, Monash Health, Clayton, VIC 3168, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Dominica Zentner
- Cardiology Department, The Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
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Kinami H, Morita K, Shinohara G, Uno Y. Echocardiographic Evaluation of Postoperative Coaptation Geometry of Left AV Valve in Complete Atrioventricular Septal Defect. CLINICAL MEDICINE. PEDIATRICS 2022; 16:11795565221139118. [PMCID: PMC9742689 DOI: 10.1177/11795565221139118] [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: 04/16/2021] [Accepted: 10/28/2022] [Indexed: 12/13/2022]
Abstract
Background: We sought to determine the difference in geometric parameters in the left atrioventricular valve (LAVV) postoperative complete atrioventricular septal defect (CAVSD) compared to the normal heart, and the correlation between geometric and functional parameters for detecting the mechanism of LAVV regurgitation (LAVVR) in CAVSD. Methods: LAVV geometric parameters based on complete and acceptable quality echocardiograms of 18 patients with repaired CAVSD compared with 17 normal controls. LAVVR severity was also quantified by indexed vena contracta (I-VC) (mm) and % jet area/left atrium area (% Jet/LA), and the correlation with LAVV parameters in the CAVSD group was investigated. Results: In the CAVSD group, the posterior closing angle (Pc) was nearly the same as the anterior closing angle (Ac), yet in the normal heart, the Pc angle was double the Ac angle. The anterior opening angle (Ao) and posterior-to-anterior leaflet diameter ratio (a/p) in the CAVSD group was also significantly smaller. The CAVSD group also had a shorter indexed coaptation length (I-CL) and indexed tenting height (I-TH). Displacement length (ΔD) differed completely between the CAVSD and Normal groups, and also showed a strong positive correlation to the functional parameters of LAVVR (% Jet/LA: r = .70, P = .02; I-VC: r = .60, P = .02). Conclusions: The parameters in this study were applicable to CAVSD AV valve coaptation characteristics. We introduced 2 novel measures that may provide important insights into the differences in geometry and performance of the LAVV in repaired CAVSD as compared to normal hearts.
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Affiliation(s)
- Hiroo Kinami
- Hiroo Kinami, Department of Cardiac Surgery, Jikei University School of Medicine, 3-25-8 Nishinbashi, Minato-ku, Tokyo 105-8461, Japan.
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Dhillon GS, Ghanayem NS, Broda CR, Lalani SR, Mery CM, Shekerdemian LS, Staffa SJ, Morris SA. An Analysis of Hospital Mortality After Cardiac Operations in Children With Down Syndrome. Semin Thorac Cardiovasc Surg 2020; 32:947-957. [PMID: 32621963 DOI: 10.1053/j.semtcvs.2020.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/27/2020] [Indexed: 11/11/2022]
Abstract
Children with Down syndrome (DS) have lower mortality compared to nonsyndromic (NS) children after atrioventricular septal defect (AVSD) repair. Limited data exist regarding hospital mortality and utilization after other congenital heart disease (CHD) operations in DS. We compared hospital mortality and utilization after CHD operations in both populations and hypothesized that the survival benefit in children with DS is not consistent across CHD lesions. The Texas Inpatient Public Use Datafile was queried for all patients <18 years old undergoing operations for CHD between 1999 and 2016. Hospital mortality, length-of-stay and charges were compared between DS and NS groups, stratified by CHD operation using mixed-effects multivariable analyses and propensity score matching analyses adjusting for prematurity, low birth weight, age, and sex. Over the 18-year period, 2841 cases with DS underwent CHD operations compared to 25,063 NS cases. The most common types of interventions performed in DS were AVSD repair, isolated ventricular septal defect (VSD) repair and tetralogy of Fallot (TOF) repair. By multivariable analyses, DS was associated with lower mortality after isolated AVSD repair (RR 0.40 [IQR 0.20-0.79]), and higher hospital mortality after bidirectional Glenn anastomosis (BDG) (RR 5.17 [IQR 2.10-12.77]) and TOF/pulmonary atresia repair (RR 9.71 [IQR 2.16-43.68]) compared to NS children. Similar results were noted using propensity score matching. Children with DS had lower mortality after AVSD repair than NS children, but higher mortality after operations for BDG and TOF/pulmonary atresia. Further study is needed to determine if the presence of pulmonary hypertension in DS modifies the association between DS and mortality depending on cardiac lesion.
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Affiliation(s)
- Gurpreet S Dhillon
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.
| | - Nancy S Ghanayem
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Christopher R Broda
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Seema R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School and Dell Children's Medical Center, Austin, Texas
| | - Lara S Shekerdemian
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Shaine A Morris
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Kosiv KA, Gossett JM, Bai S, Collins RT. Congenital Heart Surgery on In-Hospital Mortality in Trisomy 13 and 18. Pediatrics 2017; 140:peds.2017-0772. [PMID: 29046387 DOI: 10.1542/peds.2017-0772] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Congenital heart disease (CHD) is common in trisomy 13 (T13) and trisomy 18 (T18), but surgical repair has not been offered in most centers. Data on outcomes of congenital heart surgery (CHS) for T13 and T18 are lacking. We sought to determine the impact of CHS on in-hospital mortality in T13 and T18. METHODS Data from the 2004 to 2015 Pediatric Health Information System database were used to identify inpatients with T13 or T18 and CHD. Data were restricted to newborns with T13 or T18 admitted at ≤14 days of age. Hospital readmissions were examined to analyze longer-term in-hospital mortality. In-hospital mortality and length of stay were compared between infants with and without CHD and with and without CHS. RESULTS The study cohort included 1020 infants with T18 and 648 infants with T13. CHD was present in 91% of infants with T18 and 86% of infants with T13. CHS was performed in 7% of each group. In-hospital mortality was decreased in those who underwent CHS (64% lower in T18 [P <.001]; 45% lower in T13 [P = .003]) and remained decreased throughout the 24 months of follow-up. In-hospital mortality was decreased in infants with higher weight, female sex, and older age at admission. CONCLUSIONS CHS is associated with decreased in-hospital mortality in T18 and T13. These results suggest CHS may be beneficial in select cases.
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Affiliation(s)
| | | | | | - R Thomas Collins
- Departments of Pediatrics and .,Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.,Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Kozak MF, Kozak ACLFBM, Marchi CHD, Sobrinho Junior SH, Croti UA, Moscardini AC. Factors associated with moderate or severe left atrioventricular valve regurgitation within 30 days of repair of complete atrioventricular septal defect. Braz J Cardiovasc Surg 2015; 30:304-10. [PMID: 26313720 PMCID: PMC4541776 DOI: 10.5935/1678-9741.20150036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/25/2015] [Indexed: 11/20/2022] Open
Abstract
Introduction Left atrioventricular valve regurgitation is the most concerning residual lesion
after surgical correction of atrioventricular septal defects. Objective To determine factors associated with moderate or severe left atrioventricular
valve regurgitation within 30 days of surgical repair of complete atrioventricular
septal defect. Methods We assessed the results of 53 consecutive patients 3 years-old and younger
presenting with complete atrioventricular septal defect that were operated on at
our practice between 2002 and 2010. The following variables were considered: age,
weight, absence of Down syndrome, grade of preoperative atrioventricular valve
regurgitation, abnormalities on the left atrioventricular valve and the use of
annuloplasty. Median age was 6.7 months; median weight was 5.3 Kg; 86.8% had Down
syndrome. At the time of preoperative evaluation, there were 26 cases with
moderate or severe left atrioventricular valve regurgitation (49.1%).
Abnormalities on the left atrioventricular valve were found in 11.3%; annuloplasty
was performed in 34% of the patients. Results At the time of postoperative evaluation, there were 21 cases with moderate or
severe left atrioventricular valve regurgitation (39.6%). After performing a
multivariate analysis, the only significant factor associated with moderate or
severe left atrioventricular valve regurgitation was the absence of Down syndrome
(P=0.03). Conclusion Absence of Down syndrome was associated with moderate or severe postoperative left
atrioventricular valve regurgitation after surgical repair of complete
atrioventricular septal defect at our practice.
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Affiliation(s)
- Marcelo Felipe Kozak
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | | | - Carlos Henrique De Marchi
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Sirio Hassem Sobrinho Junior
- Department of Cardiology, Hospital de Base, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Ulisses Alexandre Croti
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
| | - Airton Camacho Moscardini
- Department of Pediatrics and Pediatric Surgery, Hospital de Base, São José do Rio Preto Medical School, São José do Rio Preto, SP, BR
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St Louis JD, Jodhka U, Jacobs JP, He X, Hill KD, Pasquali SK, Jacobs ML. Contemporary outcomes of complete atrioventricular septal defect repair: analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 2014; 148:2526-31. [PMID: 25125206 DOI: 10.1016/j.jtcvs.2014.05.095] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/12/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Contemporary outcomes data for complete atrioventricular septal defect (CAVSD) repair are limited. We sought to describe early outcomes of CAVSD repair across a large multicenter cohort, and explore potential associations with patient characteristics, including age, weight, and genetic syndromes. METHODS Patients in the Society of Thoracic Surgeons Congenital Heart Surgery Database having repair of CAVSD (2008-2011) were included. Preoperative, operative, and outcomes data were described. Univariate associations between patient factors and outcomes were described. RESULTS Of 2399 patients (101 centers), 78.4% had Down syndrome. Median age at surgery was 4.6 months (interquartile range, 3.5-6.1 months), with 11.8% (n = 284) aged ≤ 2.5 months. Median weight at surgery was 5.0 kg (interquartile range, 4.3-5.8 kg) with 6.3% (n = 151) < 3.5 kg. Pulmonary artery band removal at CAVSD repair was performed in 122 patients (4.6%). Major complications occurred in 9.8%, including permanent pacemaker implantation in 2.7%. Median postoperative length of stay (PLOS) was 8 days (interquartile range, 5-14 days). Overall hospital mortality was 3.0%. Weight < 3.5 kg and age ≤ 2.5 months were associated with higher mortality, longer PLOS, and increased frequency of major complications. Patients with Down syndrome had lower rates of mortality and morbidities than other patients; PLOS was similar. CONCLUSIONS In a contemporary multicenter cohort, most patients with CAVSD have repair early in the first year of life. Prior pulmonary artery band is rare. Hospital mortality is generally low, although patients at extremes of low weight and younger age have worse outcomes. Mortality and major complication rates are lower in patients with Down syndrome.
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Affiliation(s)
- James D St Louis
- Division of Pediatric Cardiac Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn.
| | - Upinder Jodhka
- Department of Pediatrics, University of Minnesota, Minneapolis, Minn
| | - Jeffrey P Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
| | - Xia He
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kevin D Hill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Sara K Pasquali
- Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Mich
| | - Marshall L Jacobs
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Md
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Abanto J, Ciamponi AL, Francischini E, Murakami C, de Rezende NPM, Gallottini M. Medical problems and oral care of patients with Down syndrome: a literature review. SPECIAL CARE IN DENTISTRY 2011; 31:197-203. [DOI: 10.1111/j.1754-4505.2011.00211.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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