Transcatheter Aortic Valve Replacement in Congenital Heart Disease

Transcatheter aortic valve replacement is not widely used in patients with congenital heart disease. We describe our single-center experience of transcatheter aortic valve replacement in congenital heart disease, demonstrating short-term feasibility and safety, role in lifetime management of congenital aortic valve disease, and use as a bridge to recovery, future surgery, or transplantation.

Effects of Sociodemographic Factors on Access to and Outcomes in Congenital Heart Disease in the United States

Congenital heart defects (CHDs) are complex conditions affecting the heart and/or great vessels that are present at birth. These defects occur in approximately 9 in every 1000 live births. From diagnosis to intervention, care has dramatically improved over the last several decades. Patients with CHDs are now living well into adulthood. However, there are factors that have been associated with poor outcomes across the lifespan of these patients. These factors include sociodemographic and socioeconomic positions. This commentary examined the disparities and solutions within the evolution of CHD care in the United States.

Can Perioperative Electroencephalogram and Adverse Hemodynamic Events Predict Neurodevelopmental Outcomes in Infants with Congenital Heart Disease?

OBJECTIVE

To characterize pre- and postoperative continuous electroencephalogram (CEEG) metrics and hemodynamic adverse events (AE) as predictors of neurodevelopment in congenital heart disease (CHD) infants undergoing cardiac surgery.

PATIENTS AND METHODS

From 2010-2021, 320 infants underwent CHD surgery at our institution, of whom 217 had perioperative CEEG monitoring and were included in our study. Neurodevelopment was assessed in 76 patients by the Bayley Scales of Infant and Toddler Development®, 3rd edition (BSID-III), consisting of cognitive, communication, and motor scaled scores. Patient and procedural factors, including hemodynamic AE, were included by means of the likelihood of covariate selection in our predictive model. Median (25th, 75th percentile) follow-up was 1.03 (0.09, 3.44) years with 3 (1, 6) BSID-III evaluations per patient.

RESULTS

Median age at index surgery was 7 (4, 23) days, and 81 (37%) were female. Epileptiform discharges, encephalopathy, and abnormality (lethargy and coma) were more prevalent on postoperative CEEGs, compared to preoperative (P<0.005). In 76 patients with BSID-III evaluations, patients with diffuse abnormality (P=0.009), waveform discontinuity (P=0.007) and lack of continuity (P=0.037) on preoperative CEEG had lower cognitive scores. Patients with synchrony (P<0.005) on preoperative and waveform continuity (P=0.009) on postoperative CEEG had higher fine motor scores. Patients with postoperative AE had lower cognitive (P<0.005) and gross motor scores (P<0.005).

CONCLUSIONS

Phenotypic patterns of perioperative CEEG metrics are associated with late-term neurologic injury in CHD infants requiring surgery. CEEG metrics can be integrated with hemodynamic AE in a predictive algorithm for neurologic impairment.

Determining the Minimum Clinically Important Difference for the European Hernia Society Quality of Life Instrument in Inguinal Hernia Repair Patients

BACKGROUND

Patient-reported outcomes in clinical research allow for a more comprehensive and meaningful assessment of interventions but are subjective and difficult to interpret. European Registry for Abdominal Wall Hernias-Quality of Life (EuraHS-QoL) is a tool designed to assess perioperative quality of life for patients undergoing inguinal hernia repair, one of the most performed operations worldwide. Defining the minimum clinically important difference (MCID) for EuraHS-QoL tool can help standardize its interpretation for research purposes and facilitate improved shared decision making in clinical settings.

STUDY DESIGN

A combination of 3 approaches for estimating MCIDs was used in this study. First, 2 distribution-based approaches were used that based estimates on statistical parameters of the data. The SEM provided a minimum value for the MCID, and one-half of the SD provided a point estimate of the MCID. Second, anchor-based approaches integrated patient perceptions of their overall well-being before and after surgery to provide benchmarks for the MCID. Last, iterative surveys of expert hernia surgeons were used to yield the final MCIDs for each domain and the composite EuraHS-QoL score.

RESULTS

The overall range of EuraHS-QoL is 0 to 90, with subdomain ranges of 0 to 30 for the pain domain, 0 to 40 for the restriction of activities domain, and 0 to 20 for the cosmesis domain, with higher scores representing worse outcomes. The overall MCID for EuraHS-QoL is 10. Domain-specific MCIDs are 3 for the pain domain, 5 for the restriction of activities domain, and 2 for the cosmesis domain.

CONCLUSIONS

In this study, we define overall and domain-specific MCIDs for the EuraHS-QoL instrument using statistical methods, patient-based methods, and clinical expertise, providing estimates that are both statistically and clinically significant.