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Krzywda K, Affolter JT, Al-Hassan DM, Gibson WJ, Romans RA, Yeh HW, Tieves KS. Safety, timing, and outcomes of early post-operative cardiac catheterisation following congenital heart surgery. Cardiol Young 2024:1-6. [PMID: 38602077 DOI: 10.1017/s1047951124000568] [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] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The safety of early post-operative cardiac catheterisation has been described following congenital heart surgery. Optimal timing of early post-operative cardiac catheterisation remains uncertain. The aim of this study was to describe the safety of early post-operative cardiac catheterisation and its impact on cardiac ICU and hospital length of stay, duration of mechanical ventilation, and extracorporeal support. METHODS This single-centre retrospective cohort study compared clinical and outcome variables between "early" early post-operative cardiac catheterisation (less than 72 hours after surgery) and "late" early post-operative cardiac catheterisation (greater than 72 hours after surgery) groups using Chi-squared, Student's t, and log-rank test (or appropriate nonparametric test). RESULTS In total, 132 patients were included, 22 (16.7%) "early" early post-operative cardiac catheterisation, and 110 (83.3%) "late" early post-operative cardiac catheterisation. Interventions were performed in 63 patients (51.5%), 7 (11.1%) early and 56 (88.9%) late. Complications of catheterisation occurred in seven (5.3%) patients, two early and five late. There were no major complications. Patients in the late group trended towards a longer stay in the cardiac ICU (19 days [7, 62] versus 11.5 days [7.2, 31.5], p = 0.6) and in the hospital (26 days [9.2, 68] versus 19 days [13.2, 41.8], p = 0.8) compared to the earlier group. CONCLUSION "Early" early post-operative cardiac catheterisation was associated with an overall low rate of complications. Earlier catheterisations trended towards shorter cardiac ICU and hospital length of stays. Earlier catheterisations may lead to earlier recovery for patients not following an expected post-operative course.
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Affiliation(s)
- Karoline Krzywda
- Division of Critical Care, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jeremy T Affolter
- Department of Pediatrics, University of Texas at Austin, Dell Medical School, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin and Dell Children's Medical Center, Austin, TX, USA
| | - Darcie M Al-Hassan
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA
| | - William J Gibson
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Ryan A Romans
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Ward Family Heart Center, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Hung-Wen Yeh
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Division of Health Services & Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kelly S Tieves
- Division of Critical Care, Banner Children's at Desert, Mesa, AZ, USA
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Agrawal A, Janjua D, Alsayed Ali Zeyada AA, Taher Elsheikh A. Heart failure in children and adolescents: an update on diagnostic approaches and management. Clin Exp Pediatr 2024; 67:178-190. [PMID: 37350171 PMCID: PMC10990655 DOI: 10.3345/cep.2023.00528] [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: 04/01/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 06/24/2023] Open
Abstract
Cardiac failure is a clinical syndrome that may develop in children owing to cardiac dysfunction or underlying structural heart diseases. Considering the differences in diagnostic and therapeutic approaches for pediatric heart failure (PHF) and adult heart failure, we have reviewed the current literature on PHF. Relevant studies were extracted from MEDLINE/PubMed, Google Scholar, and Clinical Trial Registries using the terms "pediatric heart failure" or "heart failure in children" and "management" or "decongestive therapy." Recent advances in diagnostic approaches, such as cardiac magnetic resonance, speckle-tracking echocardiography, tissue Doppler imaging, and molecular diagnostic techniques, have increased our under -standing of PHF. It is imperative that clinicians evaluate the interrelated factors responsible for the develop ment of PHF, including myocardial function, pulmonary and systemic blood flow, heart rhythm, valve function, and nutritional status. Although recent advances have demon strated the efficacy of many new drugs in adult heart failure trials, it cannot be concluded that these drugs will show similar efficacy in children, considering the heterogeneous nature of the underlying mechanisms and variable pharmacody-namics and pharmacokinetics. Therefore, the underlying pathophysiology of PHF and the mechanisms of action of different drugs should be considered when selecting appropriate therapies. Further trials are needed to establi sh the efficacy and safety of these drugs, and a combined mul-ti disciplinary strategy will help enhance PHF outcomes.
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Affiliation(s)
- Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Bhopal, MP, India
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Callegari A, Logoteta J, Knirsch W, Cesnjevar R, Dave H, Kretschmar O, Quandt D. Risk Factors and Outcome of Pulmonary Artery Stenting After Bidirectional Cavopulmonary Connection (BDCPC) in Single Ventricle Circulation. Pediatr Cardiol 2023; 44:1495-1505. [PMID: 37453932 PMCID: PMC10435611 DOI: 10.1007/s00246-023-03229-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
After bidirectional cavopulmonary connection (BDCPC) central pulmonary arteries (PAs) of single ventricle (SV) patients can be affected by stenosis or even closure. Aim of this study is to compare SV patients with and without PA-stent implantation post-BDCPC regarding risk factors for stent implantation and outcome. Single center, retrospective (2006-2021) study of 136 SV consecutive patients with and without PA-stent implantation post-BDCPC. Patient characteristics, risk factors for PA-stent implantation and PA growth were assessed comparing angiographic data pre-BDCPC and pre-TCPC. A total of 40/136 (29%) patients underwent PA-stent implantation at median (IQR) 14 (1.1-39.0) days post-BDCPC. 37/40 (92.5%) underwent LPA-stenting. Multiple regression analysis showed single LV patients to receive less likely PA-stents than single RV patients (OR 0.41; p = 0.05). Reduced LPA/BSA (mm/m2) and larger diameter of neo-ascending aorta pre-BDCPC were associated with an increased likelihood of PA-stent implantation post-BDCPC (OR 0.89, p = 0.03; OR 1.05, p = 0.001). Stent re-dilatation was performed in 36/40 (89%) after 1 (0.8-1.5) year. Pulmonary artery diameters pre-BDCPC were lower in the PA-stent group: McGoon (p < 0.001), Nakata (p < 0.001). Indexed pulmonary artery diameters increased equally in both groups but remained lower pre-TCPC in the PA-stent group: McGoon (p < 0.001), Nakata (p = 0.009), and Lower Lobe Index (p = 0.003). LPA and RPA grew symmetrically in both groups. Single RV, larger neo-ascending aorta, and small LPA pre- BDCPC are independent risk factors for PA-stent implantation post-BDCPC. Pulmonary artery diameters after PA-stent implantation and stent re-dilatation showed significant growth together with the contralateral side, but the PA-system remained symmetrically smaller in the stent group.
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Affiliation(s)
- Alessia Callegari
- Pediatric Heart Centre, Division of Pediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
- Children's Research Centre, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
| | - Jana Logoteta
- Pediatric Heart Centre, Division of Pediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Pediatric Heart Centre, Division of Pediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Robert Cesnjevar
- Department of Congenital Cardiothoracic Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Department of Congenital Cardiothoracic Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Pediatric Heart Centre, Division of Pediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Daniel Quandt
- Pediatric Heart Centre, Division of Pediatric Cardiology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
- Children's Research Centre, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Quandt D, Callegari A, Niesse O, Meinhold A, Dave H, Knirsch W, Kretschmar O. Balloon angioplasty and stent implantation within 30 days postcongenital heart surgery (CHS) in children. J Card Surg 2022; 37:4606-4611. [PMID: 36273426 DOI: 10.1111/jocs.17057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/17/2022] [Accepted: 10/02/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study aims to assess balloon angioplasty (BAP) and stent implantation (SI) procedures early after congenital heart surgery (CHS) in children. BACKGROUND These interventions are considered potential high-risk procedures and often avoided or postponed. METHODS This is a retrospective, single centre study of all BAP and SI procedures within 30 days after CHS (01/2001 until 01/2021). RESULTS A total of 127 (96 SI, 31 BAP) procedures were performed in 104 patients at median 6.5 days (interquartile range: 1-15) after CHS. Balloon-to-stenosis ratio and balloon-to-reference vessel ratio were significantly smaller compared to stent-to-stenosis ratio and stent-to-reference vessel ratio (p < .001 and p = .005). There was a greater rise in absolute vessel diameter, greater rise in vessel diameter in relation to the stenosis and vessel diameter in relation to the reference vessel with SI (p < .001, p = .01, and p < .001). Up to 94% SIs fulfilled both success criteria (increase of vessel diameter ≥50% of minimal vessel diameter or achievement ≥75% of the reference vessel diameter). Major adverse events were more frequent in the BAP group (p = .05). Intraprocedural complications were 5/31 (16%) in the BAP group and 13/96 (13%) in the SI group (p = .77). CONCLUSION BAP and SI procedures within 30 days post-CHS can be performed safely, with a greater stent-to-stenosis ratio and a greater rise in vessel diameter with stent implantation.
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Affiliation(s)
- Daniel Quandt
- Division of Pediatric Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Alessia Callegari
- Division of Pediatric Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Oliver Niesse
- Division of Pediatric Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Anke Meinhold
- Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hitendu Dave
- Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,Department of Congenital Cardiothoracic Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Division of Pediatric Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Division of Pediatric Cardiology, Pediatric Heart Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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Abdelmohsen G, Al-Ata J, Alkhushi N, Bahaidarah S, Baho H, Abdelsalam M, Bekheet S, Ba-Atiyah W, Alghamdi A, Fawzy A, Elakaby A, Al-Radi O, Jamjoom A, Elassal A, Shihata M, Azhar A, Zaher Z, Maghrabi K, Mashali M, Dohain A. Cardiac Catheterization During Extracorporeal Membrane Oxygenation After Congenital Cardiac Surgery: A Multi-Center Retrospective Study. Pediatr Cardiol 2022; 43:92-103. [PMID: 34328521 DOI: 10.1007/s00246-021-02696-w] [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: 03/24/2021] [Accepted: 07/23/2021] [Indexed: 11/26/2022]
Abstract
Cardiac catheterization can affect clinical outcomes in patients on extracorporeal membrane oxygenation (ECMO) after congenital heart surgery; however, its effect in this group of patients remains unclear. This study aimed to evaluate the safety and outcome of cardiac catheterization in patients undergoing ECMO after congenital cardiac surgery and determine predictors that influence successful weaning. This retrospective cohort study included pediatric patients who underwent cardiac catheterization while on ECMO after congenital heart surgery in two cardiac centers between November 2012 and February 2020. Predictors of successful weaning from ECMO were studied using univariate and multivariate logistic regression analyses. Of 123 patients on ECMO support after congenital cardiac surgery, 60 patients underwent 60 cardiac catheterizations (31 diagnostic and 29 interventional). Thirty-four (56.7%) and 22 patients (36.7%) underwent successful decannulation from ECMO support and survived after hospital discharge, respectively. Patients who underwent earlier catheterization (within 24 h of ECMO initiation) had more successful weaning from ECMO and survival compared to others. Patients who underwent an interventional procedure (interventional catheterization or redo cardiac surgery after cardiac catheterization) had better survival than those who underwent only diagnostic catheterization (P = 0.038). Shorter durations of ECMO was the most important predictor of successful weaning from ECMO. Early cardiac catheterization greatly impacts successful weaning from ECMO and survival. Patients with correctable lesions amenable either by catheterization or redo surgery are more likely to survive. Shorter durations of ECMO could have a significant influence on successful weaning from ECMO and survival.
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Affiliation(s)
- Gaser Abdelmohsen
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia.
- Paediatric Cardiology Division, Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt.
| | - Jameel Al-Ata
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Paediatric Cardiology Division, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Naif Alkhushi
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Paediatric Cardiology Division, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Saud Bahaidarah
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Haysam Baho
- Paediatric Cardiology Division, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Mohamed Abdelsalam
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Cardiology Department, Benha University, Benha, Egypt
| | - Samia Bekheet
- Paediatric Cardiology Division, Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt
- Paediatric Cardiology Division, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Wejdan Ba-Atiyah
- Paediatric Cardiology Division, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Abdulhadi Alghamdi
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmed Fawzy
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmed Elakaby
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Paediatric Department, Al -Azhar University, Cairo, Egypt
| | - Osman Al-Radi
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Cardiac Surgery Division, Department of Surgery, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Ahmed Jamjoom
- Cardiac Surgery Division, Department of Surgery, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Ahmed Elassal
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Cardiothoracic Surgery Department, Zagazig University, Zagazig, Egypt
| | - Mohammad Shihata
- Cardiac Surgery Division, Department of Surgery, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Ahmed Azhar
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Zaher Zaher
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Khadijah Maghrabi
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Mohamed Mashali
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Paediatric Cardiology Division, Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt
| | - Ahmed Dohain
- Paediatric Cardiology Division, Department of Paediatrics, King Abdulaziz University Hospital, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Paediatric Cardiology Division, Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt
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