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Vaikunth SS, Ortega-Legaspi JM, Conrad DR, Chen S, Daugherty T, Haeffele CL, Teuteberg J, Mclean R, MacArthur JW, Woo YJ, Maeda K, Ma M, Nasirov T, Hoteit M, Hilscher MB, Wald J, Mandelbaum T, Olthoff KM, Abt PL, Atluri P, Cevasco M, Mavroudis CD, Fuller S, Lui GK, Kim YY. Mortality and morbidity after combined heart and liver transplantation in the failing Fontan: An updated dual center retrospective study. Clin Transplant 2024; 38:e15302. [PMID: 38567883 DOI: 10.1111/ctr.15302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION As the adult Fontan population with Fontan associated liver disease continues to increase, more patients are being referred for transplantation, including combined heart and liver transplantation. METHODS We report updated mortality and morbidity outcomes after combined heart and liver transplant in a retrospective cohort series of 40 patients (age 14 to 49 years) with Fontan circulation across two centers from 2006-2022. RESULTS The 30-day, 1-year, 5-year and 10-year survival rate was 90%, 80%, 73% and 73% respectively. Sixty percent of patients met a composite comorbidity of needing either post-transplant mechanical circulatory support, renal replacement therapy or tracheostomy. Cardiopulmonary bypass time > 283 min (4.7 h) and meeting the composite comorbidity were associated with mortality by Kaplan Meier analysis. CONCLUSION Further study to mitigate early mortality and the above comorbidities as well as the high risk of bleeding and vasoplegia in this patient population is warranted.
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Affiliation(s)
- Sumeet S Vaikunth
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Juan M Ortega-Legaspi
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Desiree R Conrad
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Tami Daugherty
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Christiane L Haeffele
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jeffrey Teuteberg
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rhondalynn Mclean
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Katsuhide Maeda
- Division of Cardiac Surgery, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Teimour Nasirov
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Marrouf Hoteit
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Moira B Hilscher
- Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joyce Wald
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tal Mandelbaum
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kim M Olthoff
- Division of Transplant Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter L Abt
- Division of Transplant Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marisa Cevasco
- Division of Cardiovascular Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Constantine D Mavroudis
- Division of Cardiac Surgery, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Stephanie Fuller
- Division of Cardiac Surgery, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - George K Lui
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Yuli Y Kim
- Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Li XE, McElhinney DB, Lui GK, Clark DE, Woo JP. Percutaneous Closure of a Ruptured Sinus of Valsalva Aneurysm under Transesophageal Echocardiography Guidance. CASE (Phila) 2024; 8:186-192. [PMID: 38524988 PMCID: PMC10954579 DOI: 10.1016/j.case.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•SOVA is a rare cardiac anomaly. •Ruptured SOVA carries a high mortality rate. •SOVA often coexists with other congenital lesions, most commonly VSD and bicuspid AV. •Ruptured SOVA needs repair; percutaneous repair is a safe alternative to surgery. •Echo plays a vital role in both diagnosing SOVA and guiding percutaneous closure.
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Affiliation(s)
- Xi E. Li
- Department of Anesthesia, Stanford University, Stanford, California
| | - Doff B. McElhinney
- Department of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University, Stanford, California
| | - George K. Lui
- Stanford Medicine Adult Congenital Heart Program, Department of Medicine, Stanford University, Stanford, California
| | - Daniel E. Clark
- Stanford Medicine Adult Congenital Heart Program, Department of Medicine, Stanford University, Stanford, California
| | - Jennifer P. Woo
- Stanford Medicine Adult Congenital Heart Program, Department of Medicine, Stanford University, Stanford, California
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Kobashigawa J, VanWagner LB, Hall S, Emamaullee J, Entwistle JW, Ganger D, Gebel H, Jeevanandam V, Kaldas F, Kilic A, Kittleson M, Kushwaha S, Kwong A, Lui GK, Motayagheni N, Patel J, Patel N, Pereira N, Potter L, Sani M, Schiano TD, Shingina A. Summary of a consensus conference on heart-liver transplantation. Am J Transplant 2024; 24:380-390. [PMID: 38072122 DOI: 10.1016/j.ajt.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/29/2023] [Accepted: 12/01/2023] [Indexed: 12/31/2023]
Abstract
Patients with severe heart disease may have coexisting liver disease from various causes. The incidence of combined heart-liver transplant (CHLT) is increasing as more patients with congenital heart disease survive to adulthood and develop advanced heart failure with associated liver disease from chronic right-sided heart or Fontan failure. However, the criteria for CHLT have not been established. To address this unmet need, a virtual consensus conference was organized on June 10, 2022, endorsed by the American Society of Transplantation. The conference represented a collaborative effort by experts in cardiothoracic and liver transplantation from across the United States to assess interdisciplinary criteria for liver transplantation in the CHLT candidate, surgical considerations of CHLT, current allocation system that generally results in the liver following the heart for CHLT, and optimal post-CHLT management. The conference served as a forum to unify criteria between the different specialties and to forge a pathway for patients who may need dual organ transplantation. Due to the continuing shortage of available donor organs, ethical issues related to multiorgan transplantation were also debated. The findings and consensus statements are presented.
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Affiliation(s)
- Jon Kobashigawa
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
| | - Lisa B VanWagner
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | | | | | | | | | | | - Fady Kaldas
- University of California, Los Angeles, Los Angeles, California, USA
| | - Ahmet Kilic
- Johns Hopkins Hospital, Baltimore, Maryland, USA
| | | | | | | | | | | | - Jignesh Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Nikhil Patel
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | | | - Lisa Potter
- University of Chicago, Chicago, Illinois, USA
| | - Maryam Sani
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
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4
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Conrad DR, Woo JP, Lui GK, Clark DE. Multimodality Imaging in Management of Adults with Dextro-Transposition of the Great Arteries Post Arterial Switch Operation. CASE (Phila) 2024; 8:162-166. [PMID: 38524978 PMCID: PMC10954704 DOI: 10.1016/j.case.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Echo is an essential tool for monitoring long-term complications of D-TGA with ASO. •Multimodality imaging is complementary to echo in the assessment of complications. •4D flow CMR can assess supravalvular PS post ASO. •Branch pulmonary arteries after LeCompte maneuver can be challenging to image.
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Affiliation(s)
- Desireé R. Conrad
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Department of Medicine and Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer P. Woo
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Department of Medicine and Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - George K. Lui
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Department of Medicine and Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Daniel E. Clark
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Department of Medicine and Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Hsu DT, Lui GK. Transplant in Single Ventricle Physiology: The Fourth Stage? J Am Coll Cardiol 2023; 82:1242-1244. [PMID: 37704314 DOI: 10.1016/j.jacc.2023.06.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Daphne T Hsu
- Departments of Pediatrics and Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
| | - George K Lui
- Departments of Medicine and Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
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6
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Ragheb DK, Martin E, Jaggi A, Lui GK, Maskatia SA, Ma M, Hanley FL, McElhinney DB. Short- and Mid-Term Results of Pulmonary Valve Replacement with the Inspiris Valve. Ann Thorac Surg 2023:S0003-4975(23)00854-8. [PMID: 37625611 DOI: 10.1016/j.athoracsur.2023.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/24/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Various bioprosthetic valves are used off-label for pulmonary valve replacement (PVR), but there is no consensus on whether a particular valve is best for this application. Recently, the Inspiris Resilia valve (Edwards Lifesciences Inc) was approved for aortic valve replacement, and surgeons have begun using it for PVR. There is limited evidence on the performance of the Inspiris valve compared with other valves in the pulmonary position. METHODS This study reviewed all patients who underwent PVR with a size 19- to 29-mm Inspiris valve or Mosaic valve (Medtronic Inc) from 2007 to 2022 at Lucile Packard Children's Hospital Stanford (Palo Alto, CA). Midterm outcomes included freedom from moderate or severe pulmonary regurgitation (PR), a maximum Doppler gradient ≥36 mm Hg, and freedom from reintervention. RESULTS A total of 225 consecutive patients who underwent PVR with a size 19- to 29-mm Mosaic (n = 163) or Inspiris (n = 62) valve were included. There was no difference in baseline characteristics. Early postoperative gradients were low in both groups but higher in the Mosaic cohort, and neither group had more than mild PR on discharge. On univariable and multivariable analysis, Inspiris valves were significantly more likely to develop moderate or greater PR over time. There was no significant difference between the valves in freedom from reintervention or from a maximum gradient ≥36 mm Hg. CONCLUSIONS Early and short-term gradients were similar in patients undergoing PVR with Inspiris and Mosaic valves, but significant PR was more common in patients who received an Inspiris valve. These preliminary findings suggest that the durability of the Inspiris valve in the pulmonary position may not be superior to that of other bioprosthetic valves used for PVR.
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Affiliation(s)
- Daniel K Ragheb
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Elisabeth Martin
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Ayush Jaggi
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - George K Lui
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Shiraz A Maskatia
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California; Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
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7
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Woo JP, Dong ML, Kong F, McElhinney DB, Schiavone N, Chan F, Lui GK, Haddad F, Bernstein D, Marsden A. Improved Right Ventricular Energy Efficiency by 4-Dimensional Flow Magnetic Resonance Imaging After Harmony Valve Implantation. JACC Adv 2023; 2:100284. [PMID: 37691969 PMCID: PMC10487049 DOI: 10.1016/j.jacadv.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | | | - Fanwei Kong
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Doff B. McElhinney
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Nicole Schiavone
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Frandics Chan
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - George K. Lui
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Francois Haddad
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Daniel Bernstein
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
| | - Alison Marsden
- Stanford University School of Medicine, 300 Pasteur Drive, 3rd Floor, Clinic A32 Rm A345 – MC: 5844 Stanford, California 94305, USA
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8
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Haeffele CL, Lui GK, Peng L, Chan F, Sharma RP. First described mitral clip in an adult extracardiac Fontan patient: a case report. Eur Heart J Case Rep 2022; 7:ytac479. [PMID: 36733686 PMCID: PMC9887705 DOI: 10.1093/ehjcr/ytac479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/11/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Background The use of transcatheter edge-to-edge repair (TEER) in patients with advanced heart failure has been shown to reduce hospitalizations and increase survival. As patients with Fontan circulations grow older, a significant proportion of them will develop severe atrioventricular (AV) valve regurgitation in the systemic ventricle. Conventional surgical repair and transplant carry high mortality risk for the adult Fontan patient with progressive heart failure. Case summary A 51-year-old female extracardiac Fontan patient developed severe AV valve regurgitation and progressive functional decline. Based on her operative risk for conventional surgical intervention or transplant, TEER using the Abbott MitraClip device was performed. The degree of mitral regurgitation was decreased from severe to moderate regurgitation. Discussion This is the first known case describing the use of a successful TEER in an adult patient with an extracardiac Fontan. Given the increasing numbers of patients surviving into adulthood with a Fontan circulation, transcatheter interventions may provide an alternative treatment option to conventional surgeries and medical therapies.
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Affiliation(s)
| | - George K Lui
- Department of Medicine, Division of Cardiovascular Medicine, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA
| | - Lynn Peng
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA
| | - Frandics Chan
- Division of Radiology, Stanford University, CV Medicine Division 870 Quarry Rd, Palo Alto, CA 94304, USA
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Romfh A, Lui GK. PAPVR – An incidental finding that may not be so benign. International Journal of Cardiology Congenital Heart Disease 2022. [DOI: 10.1016/j.ijcchd.2022.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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10
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Lui GK, Sommerhalter K, Xi Y, Botto LD, Crume T, Farr S, Feldkamp ML, Glidewell J, Hsu D, Khanna A, Krikov S, Li J, Raskind‐Hood C, Sarno L, Van Zutphen AR, Zaidi A, Soim A, Book WM. Health Care Usage Among Adolescents With Congenital Heart Defects at 5 Sites in the United States, 2011 to 2013. J Am Heart Assoc 2022; 11:e026172. [DOI: 10.1161/jaha.122.026172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
We sought to characterize health care usage for adolescents with congenital heart defects (CHDs) using population‐based multisite surveillance data.
Methods and Results
Adolescents aged 11 to 18 years with ≥1 CHD‐related diagnosis code and residing in 5 US sites were identified in clinical and administrative data sources for the years 2011 to 2013. Sites linked data on all inpatient, emergency department (ED), and outpatient visits. Multivariable log‐binomial regression models including age, sex, unweighted Charlson comorbidity index, CHD severity, cardiology visits, and insurance status, were used to identify associations with inpatient, ED, and outpatient visits. Of 9626 eligible adolescents, 26.4% (n=2543) had severe CHDs and 21.4% had Charlson comorbidity index >0. At least 1 inpatient, ED, or outpatient visit was reported for 21%, 25%, and 96% of cases, respectively. Cardiology visits, cardiac imaging, cardiac procedures, and vascular procedures were reported for 38%, 73%, 10%, and 5% of cases, respectively. Inpatient, ED, and outpatient visits were consistently higher for adolescents with severe CHDs compared with nonsevere CHDs. Adolescents with severe and nonsevere CHDs had higher health care usage compared with the 2011 to 2013 general adolescent US population. Adolescents with severe CHDs versus nonsevere CHDs were twice as likely to have at least 1 inpatient visit when Charlson comorbidity index was low (Charlson comorbidity index =0). Adolescents with CHDs and public insurance, compared with private insurance, were more likely to have inpatient (adjusted prevalence ratio, 1.5 [95% CI, 1.3–1.7]) and ED (adjusted prevalence ratio, 1.6 [95% CI, 1.4–1.7]) visits.
Conclusions
High resource usage by adolescents with CHDs indicates a substantial burden of disease, especially with public insurance, severe CHDs, and more comorbidities.
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Affiliation(s)
| | | | - Yizhao Xi
- New York State Department of Health Albany NY
| | | | | | - Sherry Farr
- Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities Atlanta GA
| | | | - Jill Glidewell
- Centers for Disease Control and Prevention National Center on Birth Defects and Developmental Disabilities Atlanta GA
| | - Daphne Hsu
- Albert Einstein College of Medicine Bronx NY
| | | | - Sergey Krikov
- Department of Pediatrics University of Utah Salt Lake City UT
| | | | | | | | - Alissa R. Van Zutphen
- New York State Department of Health Albany NY
- School of Public Health University at Albany Rensselaer NY
| | - Ali Zaidi
- Mt. Sinai Medical Center New York NY
| | - Aida Soim
- New York State Department of Health Albany NY
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Rodriguez FH, Raskind-Hood CL, Hoffman T, Farr SL, Glidewell J, Li JS, D'Ottavio A, Botto L, Reeder MR, Hsu D, Lui GK, Sullivan AM, Book WM. How Well Do ICD-9-CM Codes Predict True Congenital Heart Defects? A Centers for Disease Control and Prevention-Based Multisite Validation Project. J Am Heart Assoc 2022; 11:e024911. [PMID: 35862148 PMCID: PMC9375472 DOI: 10.1161/jaha.121.024911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The Centers for Disease Control and Prevention's Surveillance of Congenital Heart Defects Across the Lifespan project uses large clinical and administrative databases at sites throughout the United States to understand population-based congenital heart defect (CHD) epidemiology and outcomes. These individual databases are also relied upon for accurate coding of CHD to estimate population prevalence. Methods and Results This validation project assessed a sample of 774 cases from 4 surveillance sites to determine the positive predictive value (PPV) for identifying a true CHD case and classifying CHD anatomic group accurately based on 57 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Chi-square tests assessed differences in PPV by CHD severity and age. Overall, PPV was 76.36% (591/774 [95% CI, 73.20-79.31]) for all sites and all CHD-related ICD-9-CM codes. Of patients with a code for complex CHD, 89.85% (177/197 [95% CI, 84.76-93.69]) had CHD; corresponding PPV estimates were 86.73% (170/196 [95% CI, 81.17-91.15]) for shunt, 82.99% (161/194 [95% CI, 76.95-87.99]) for valve, and 44.39% (83/187 [95% CI, 84.76-93.69]) for "Other" CHD anatomic group (X2=142.16, P<0.0001). ICD-9-CM codes had higher PPVs for having CHD in the 3 younger age groups compared with those >64 years of age, (X2=4.23, P<0.0001). Conclusions While CHD ICD-9-CM codes had acceptable PPV (86.54%) (508/587 [95% CI, 83.51-89.20]) for identifying whether a patient has CHD when excluding patients with ICD-9-CM codes for "Other" CHD and code 745.5, further evaluation and algorithm development may help inform and improve accurate identification of CHD in data sets across the CHD ICD-9-CM code groups.
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Affiliation(s)
- Fred H Rodriguez
- Division of Cardiology Emory University School of Medicine and Emory University Rollins School of Public Health Atlanta GA.,Sibley Heart Center Cardiology Atlanta GA
| | - Cheryl L Raskind-Hood
- Division of Cardiology Emory University School of Medicine and Emory University Rollins School of Public Health Atlanta GA
| | - Trenton Hoffman
- Division of Cardiology Emory University School of Medicine and Emory University Rollins School of Public Health Atlanta GA
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention Atlanta GA
| | - Jill Glidewell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention Atlanta GA
| | | | | | - Lorenzo Botto
- Division of Medical Genetics, Department of Pediatrics University of Utah Salt Lake City UT
| | - Matthew R Reeder
- Division of Medical Genetics, Department of Pediatrics University of Utah Salt Lake City UT
| | - Daphne Hsu
- Albert Einstein College of Medicine and The Children"s Hospital at Montefiore Bronx NY
| | - George K Lui
- Divisions of Cardiovascular Medicine and Pediatric Cardiology Stanford University School of Medicine Palo Alto CA
| | - Anaclare M Sullivan
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology Albany NY
| | - Wendy M Book
- Division of Cardiology Emory University School of Medicine and Emory University Rollins School of Public Health Atlanta GA
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Vaikunth SS, Chan JL, Woo JP, Bykhovsky MR, Lui GK, Ma M, Romfh AW, Lamberti J, Mastrodicasa D, Fleischmann D, Fischbein MP. Tetralogy of Fallot and Aortic Dissection: Implications in Management. JACC Case Rep 2022; 4:581-586. [PMID: 35615213 PMCID: PMC9125517 DOI: 10.1016/j.jaccas.2022.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/10/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022]
Abstract
We present the case of a 61-year-old man with tetralogy of Fallot postrepair and mechanical aortic valve replacement with an aortic root/ascending/arch aneurysm with chronic type A aortic dissection. He underwent uncomplicated aortic root and total arch replacement. Continued surveillance for aortic aneurysm is necessary in the tetralogy of Fallot population. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Sumeet S. Vaikunth
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Joshua L. Chan
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jennifer P. Woo
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael R. Bykhovsky
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - George K. Lui
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael Ma
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anitra W. Romfh
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - John Lamberti
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael P. Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California, USA,Address for correspondence: Dr Michael P. Fischbein, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Falk CVRB, 300 Pasteur Drive, Falk CVRB ULN MC5407, Stanford, California 94305, USA.
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13
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Rosner A, Mc Elhinney DB, Friedberg MK, Lui GK. Classic pattern dyssynchrony predicting outcome in patients with Fontan circulation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Helse Nord, Norway
Background
Morbidity and mortality increase as Fontan patients age into adulthood. Limited studies have examined cardiac magnetic resonance and echocardiographic parameters to predict death and transplantation in children after Fontan operation.
Purpose
The aim of the study was to investigate echocardiographic parameters in adolescents and adults after Fontan operation including myocardial mechanics including classic pattern dyssynchrony (CPD) as predictors of transplantation or death.
Methods
In a cross-sectional retrospective study, strain analysis was performed on echocardiography studies performed between 2001 and 2014 of 110 patients with single ventricle physiology after the Fontan procedure. Strain curves were measured and visually assessed for the presence of CPD. The primary end point was death or transplantation after a follow-up period of 85 ± 35 months after echocardiography.
Results
Median age at date of echocardiography was 20, range 3 to 45 years. Of 110 patients 28 patients were transplanted. During the study-period 3 patients died after transplantation and 7 patients died without being transplanted. CPD was seen in 16 and protein losing enteropathy (PLE) in 21 of 110 patients. By multivariate-analysis, CPD (HR 9.4 CI 2.6-34.6), PLE (HR 10.6 CI 3.4-33.2); systolic blood pressure (HR 0.954 CI 0.913-0.996), systolic/diastolic duration ratio (HR 6.83 CI 1.33-35.0) and E wave deceleration time (HR 0.98 CI 0.97 - 0.99) were independently associated with the primary end point.
Conclusion
CPD, PLE, systolic and diastolic ventricular dysfunction are significantly associated with transplantation or death in Fontan operated patients. In selected patients, the presence of CPD may be a basis to investigate cardiac resynchronization therapy as a treatment strategy. Abstract Figure: Mortality in patients with CPD
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Affiliation(s)
- A Rosner
- University Hospital of North Norway, Tromso, Tromso, Norway
| | - DB Mc Elhinney
- Stanford University Medical Center, Stanford, United States of America
| | | | - GK Lui
- Stanford University Medical Center, Stanford, United States of America
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14
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Lui GK, Moons P. Exercise prescription as medicine. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Vaikunth SS, Haeffele C, McElhinney DB, Lui GK, Romfh AW. Erratum to “The atrial switch patient with a dilated subpulmonic left ventricle” [Int. J. Cardiol. Congenit. Heart Dis. 4 (August 2021) 100153]. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2021.100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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16
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Abstract
Introduction: Advancements in surgery and management have resulted in a growing population of aging adults with tetralogy of Fallot (TOF). As a result, there has been a parallel growth in late complications associated with the sequelae from the underlying cardiac anomalies as well as the surgical and other interventional treatments.Areas covered: Here, we review challenges related to an aging population of patients with TOF, particularly late complications, and highlight advances in management and key areas for future research. Pulmonary regurgitation, heart failure, arrhythmias, and aortic complications are some of these late complications. There is also a growing incidence of acquired cardiovascular disease, obesity, and diabetes associated with aging. Management of these late complications and acquired comorbidities continues to evolve as research provides insights into long-term outcomes from medical therapies and surgical interventions.Expert opinion: The management of an aging TOF population will continue to transform with advances in imaging technologies to identify subclinical disease and valve replacement technologies that will prevent and mitigate disease progression. In the coming years, we speculate that there will be more data to support the use of novel heart failure therapies in TOF and consensus guidelines on the management of refractory arrhythmias and aortic complications.
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Affiliation(s)
- Jennifer P Woo
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, California, USA
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California, USA
| | - George K Lui
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, California, USA
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17
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Insaf TZ, Sommerhalter KM, Jaff TA, Farr SL, Downing KF, Zaidi AN, Lui GK, Van Zutphen AR. Access to cardiac surgery centers for cardiac and non-cardiac hospitalizations in adolescents and adults with congenital heart defects- a descriptive case series study. Am Heart J 2021; 236:22-36. [PMID: 33636136 PMCID: PMC8097661 DOI: 10.1016/j.ahj.2021.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/19/2021] [Indexed: 01/14/2023]
Abstract
Background Individuals with congenital heart defects (CHDs) are recommended to receive all inpatient cardiac and noncardiac care at facilities that can offer specialized care. We describe geographic accessibility to such centers in New York State and determine several factors associated with receiving care there. Methods We used inpatient hospitalization data from the Statewide Planning and Research Cooperative System (SPARCS) in New York State 2008–2013. In the absence of specific adult CHD care center designations during our study period, we identified pediatric/adult and adult-only cardiac surgery centers through the Cardiac Surgery Reporting System to estimate age-based specialized care. We calculated one-way drive and public transit time (in minutes) from residential address to centers using R gmapsdistance package and the Google Maps Distance Application Programming Interface (API). We calculated prevalence ratios using modified Poisson regression with model-based standard errors, fit with generalized estimating equations clustered at the hospital level and subclustered at the individual level. Results Individuals with CHDs were more likely to seek care at pediatric/adult or adult-only cardiac surgery centers if they had severe CHDs, private health insurance, higher severity of illness at encounter, a surgical procedure, cardiac encounter, and shorter drive time. These findings can be used to increase care receipt (especially for noncardiac care) at pediatric/adult or adult-only cardiac surgery centers, identify areas with limited access, and reduce disparities in access to specialized care among this high-risk population.
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Affiliation(s)
- Tabassum Z Insaf
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
| | | | - Treeva A Jaff
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
| | - Sherry L Farr
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Ali N Zaidi
- Adult Congenital Heart Disease Center, Mount Sinai Heart/Icahn School of Medicine at Mount Sinai, New York, NY
| | - George K Lui
- Stanford University School of Medicine, Stanford, CA
| | - Alissa R Van Zutphen
- Center for Environmental Health, New York State Department of Health, Albany, NY; School of Public Health, University at Albany, Albany, NY
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18
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Maeda K, Lui GK, Zhang Y, Maskatia SA, Romfh A, Yarlagadda VV, Hanley FL, McElhinney DB. Durability of Pulmonary Valve Replacement with Large Diameter Stented Porcine Bioprostheses. Semin Thorac Cardiovasc Surg 2021; 34:994-1000. [PMID: 33971298 DOI: 10.1053/j.semtcvs.2021.03.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
There is limited information about durability of large diameter porcine bioprostheses implanted for pulmonary valve replacement (PVR). We studied patients who underwent surgical PVR from 2002-2019 with a stented porcine bioprosthetic valve (BPV) with a labeled size ≥27 mm. The primary outcome was freedom from reintervention. During the study period, 203 patients underwent PVR using a porcine BPV ≥27 mm, 94% of whom received a Mosaic valve (Medtronic Inc., Minneapolis, MN). Twenty patients underwent reintervention from 3.4-12.0 years after PVR: 5 surgical and 15 transcatheter PVR procedures. The indication for reintervention was regurgitation in 13 patients, stenosis in 2, mixed disease in 4, and endocarditis in 1. Estimated freedom from reintervention was 97±1% at 5 years and 82±4% at 10 years, and freedom from prosthesis dysfunction (moderate or severe regurgitation and/or a maximum Doppler gradient ≥50 mm Hg) over time was 91±2% at 5 years and 74±4% at 10 years. Younger age and smaller true valve diameter were associated with shorter freedom from reintervention, but valve oversizing was not. The durability of large stented porcine bioprostheses in the pulmonary position is generally excellent, particularly in adolescents and adults, similar to various other types of BPV. In the current study, relative valve size was not associated with valve longevity, although the low event-rate in this population was a limiting factor.
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Affiliation(s)
- Katsuhide Maeda
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine
| | - George K Lui
- Cardiovascular Medicine, Stanford University School of Medicine; Pediatrics, Stanford University School of Medicine
| | - Yulin Zhang
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine
| | | | - Anitra Romfh
- Cardiovascular Medicine, Stanford University School of Medicine; Pediatrics, Stanford University School of Medicine
| | | | - Frank L Hanley
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine
| | - Doff B McElhinney
- Departments of Cardiothoracic Surgery, Stanford University School of Medicine; Pediatrics, Stanford University School of Medicine.
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19
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Broberg CS, Kovacs AH, Sadeghi S, Rosenbaum MS, Lewis MJ, Carazo MR, Rodriguez FH, Halpern DG, Feinberg J, Galilea FA, Baraona F, Cedars AM, Ko JM, Porayette P, Maldonado J, Sarubbi B, Fusco F, Frogoudaki AA, Nir A, Chaudhry A, John AS, Karbassi A, Hoskoppal AK, Frischhertz BP, Hendrickson B, Bouma BJ, Rodriguez-Monserrate CP, Broda CR, Tobler D, Gregg D, Martinez-Quintana E, Yeung E, Krieger EV, Ruperti-Repilado FJ, Giannakoulas G, Lui GK, Ephrem G, Singh HS, Almeneisi HM, Bartlett HL, Lindsay I, Grewal J, Nicolarsen J, Araujo JJ, Cramer JW, Bouchardy J, Al Najashi K, Ryan K, Alshawabkeh L, Andrade L, Ladouceur M, Schwerzmann M, Greutmann M, Meras P, Ferrero P, Dehghani P, Tung PP, Garcia-Orta R, Tompkins RO, Gendi SM, Cohen S, Klewer S, Hascoet S, Mohammadzadeh S, Upadhyay S, Fisher SD, Cook S, Cotts TB, Aboulhosn JA. COVID-19 in Adults With Congenital Heart Disease. J Am Coll Cardiol 2021; 77:1644-1655. [PMID: 33795039 PMCID: PMC8006800 DOI: 10.1016/j.jacc.2021.02.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
Background Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. Objectives This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. Methods Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. Results From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. Conclusions COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.
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Affiliation(s)
- Craig S Broberg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Soraya Sadeghi
- Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA
| | - Marlon S Rosenbaum
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Matthew J Lewis
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Matthew R Carazo
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fred H Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dan G Halpern
- Division of Cardiology, York University Langone Health, New York, New York, USA
| | - Jodi Feinberg
- Division of Cardiology, York University Langone Health, New York, New York, USA
| | | | - Fernando Baraona
- Instituto Nacional del Tórax - Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ari M Cedars
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jong M Ko
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prashob Porayette
- Division of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Jennifer Maldonado
- Division of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Berardo Sarubbi
- Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - Flavia Fusco
- Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | | | - Amiram Nir
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anisa Chaudhry
- Penn State Hershey Heart and Vascular Institute, State College, Pennsylvania, USA
| | - Anitha S John
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | | | - Arvind K Hoskoppal
- UPMC Adult Congenital Heart Disease Program, Pittsburgh, Pennsylvania, USA
| | - Benjamin P Frischhertz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Hendrickson
- University of Tennessee Health Science Center, Le Bonheur Heart Institute, Memphis, Tennessee, USA
| | - Berto J Bouma
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | - Daniel Tobler
- Division of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - David Gregg
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Efren Martinez-Quintana
- Cardiology Service, Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Elizabeth Yeung
- Anschutz Medical Campus, Colorado's Adult and Teen Congenital Heart Program, Aurora, Colorado, USA
| | - Eric V Krieger
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - George K Lui
- Division of Cardiovascular Medicine and Pediatric Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Georges Ephrem
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA
| | - Harsimran S Singh
- Weill Cornell Medicine, New York Presbyterian Hospital, Department of Medicine and Pediatrics, New York, New York, USA
| | - Hassan Mk Almeneisi
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | - Heather L Bartlett
- Department of Pediatrics and Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Ian Lindsay
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, USA
| | - Jasmine Grewal
- University of British Columbia, St. Paul's Hospital, Vancouver, British Colombia, Canada
| | - Jeremy Nicolarsen
- Providence Adult and Teen Congenital Heart Program, Pediatric and Adult Cardiology, Spokane, Washington, USA
| | - John J Araujo
- Department of Pediatric and Adult Congenital Heart Disease, Somer Incare Cardiovascular Center, Rionegro, Colombia
| | - Jonathan W Cramer
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Judith Bouchardy
- Department of Cardiology and Cardiac Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Khalid Al Najashi
- Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Kristi Ryan
- OSF Healthcare Children's Hospital of Illinois, Adult Congenital Heart Program, Peoria, Illinois, USA
| | - Laith Alshawabkeh
- Department of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Lauren Andrade
- Division of Cardiology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Magalie Ladouceur
- Hôpital Européen Georges Pompidou, Adult Congenital Heart Disease Unit, Paris, France
| | - Markus Schwerzmann
- University Hospital Inselspital, Center for Congenital Heart Disease, Bern, Switzerland
| | | | | | - Paolo Ferrero
- ASST Papa Giovanni XXIII, Cardiovascular Department, University of Milano, Bergamo, Italy
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Poyee P Tung
- University of Texas at Houston, Adult Congenital Heart Disease, Houston, Texas, USA
| | - Rocio Garcia-Orta
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rose O Tompkins
- Cedars-Sinai Medical Center, The Geurin Family Congenital Heart Program, Los Angeles, California, USA
| | - Salwa M Gendi
- West Virginia University, Adult Congenital Heart Disease Program, Morgantown, West Virginia, USA
| | - Scott Cohen
- Medical College of Wisconsin, Adult Congenital Heart Disease Program, Milwaukee, Wisconsin, USA
| | - Scott Klewer
- Division of Cardiology, University of Arizona, Tucson, Arizona, USA
| | | | | | - Shailendra Upadhyay
- Connecticut Children's Medical Center, Pediatric Cardiology Hartford, Connecticut, USA
| | - Stacy D Fisher
- Department of Medicine and Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stephen Cook
- Helen DeVos Children's Hospital, Adult Congenital Heart Center, Grand Rapids, Michigan, USA
| | - Timothy B Cotts
- Department of Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA.
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20
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Abstract
Heart failure with reduced ejection fraction (HFrEF) is common in patients with adult congenital heart disease. Many of the most common congenital defects have a high prevalence of HFrEF, including left-sided obstructive lesions (aortic stenosis, coarctation of the aorta, Shone complex), tetralogy of Fallot, Ebstein anomaly, lesions in which there is a systemic right ventricle, and lesions palliated with a Fontan circulation. However, heart failure with preserved ejection fraction (HFpEF) is also prevalent in all these lesions. Comprehensive evaluation includes physical exam, biomarkers, echocardiography and advanced imaging, exercise stress testing, and, in some cases, invasive hemodynamics. Guideline-directed medical therapy for HFrEF can be applied to left-sided lesions and may be considered on an individual basis for systemic right ventricle and single-ventricle patients. Medical therapy is limited for HFpEF. However, in both HFrEF and HFpEF, ventricular dyssynchrony and arrhythmias play an important role, and medications for rhythm control, ablation, and cardiac resynchronization therapy should be considered. Finally, aggressive management of cardiovascular risk factors and comorbidities, including, but not limited to, hypertension, obesity, diabetes, dyslipidemia, and obstructive sleep apnea, cannot be overemphasized.
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Affiliation(s)
- Sumeet S Vaikunth
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - George K Lui
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
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21
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Mullen M, Zhang A, Lui GK, Romfh AW, Rhee JW, Wu JC. Race and Genetics in Congenital Heart Disease: Application of iPSCs, Omics, and Machine Learning Technologies. Front Cardiovasc Med 2021; 8:635280. [PMID: 33681306 PMCID: PMC7925393 DOI: 10.3389/fcvm.2021.635280] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Congenital heart disease (CHD) is a multifaceted cardiovascular anomaly that occurs when there are structural abnormalities in the heart before birth. Although various risk factors are known to influence the development of this disease, a full comprehension of the etiology and treatment for different patient populations remains elusive. For instance, racial minorities are disproportionally affected by this disease and typically have worse prognosis, possibly due to environmental and genetic disparities. Although research into CHD has highlighted a wide range of causal factors, the reasons for these differences seen in different patient populations are not fully known. Cardiovascular disease modeling using induced pluripotent stem cells (iPSCs) is a novel approach for investigating possible genetic variants in CHD that may be race specific, making it a valuable tool to help solve the mystery of higher incidence and mortality rates among minorities. Herein, we first review the prevalence, risk factors, and genetics of CHD and then discuss the use of iPSCs, omics, and machine learning technologies to investigate the etiology of CHD and its connection to racial disparities. We also explore the translational potential of iPSC-based disease modeling combined with genome editing and high throughput drug screening platforms.
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Affiliation(s)
- McKay Mullen
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States.,Department of Physiology, Morehouse School of Medicine, Atlanta, GA, United States
| | - Angela Zhang
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States.,Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | - George K Lui
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States.,Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, United States.,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Stanford, CA, United States
| | - Anitra W Romfh
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States.,Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, CA, United States.,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Stanford, CA, United States
| | - June-Wha Rhee
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States.,Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, CA, United States
| | - Joseph C Wu
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States.,Department of Genetics, Stanford School of Medicine, Stanford University, Stanford, CA, United States.,Department of Radiology, Stanford University, Stanford, CA, United States
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22
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Vaikunth SS, Bykhovsky MR, Romfh AW, Haeffele CL, Rogers IS, Dong E, Scribner C, Lui GK. A 40-Year-Old Man With Tricuspid Atresia, Status Post-Fontan, With Severe COVID-19 Pneumonia and Pneumothorax. JACC Case Rep 2021; 3:187-191. [PMID: 33558861 PMCID: PMC7857704 DOI: 10.1016/j.jaccas.2020.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/26/2020] [Indexed: 12/03/2022]
Abstract
We report a case of COVID-19 in an adult single-ventricle patient post-Fontan—to our knowledge, the first report in this population documenting the use of the latest management recommendations for this novel disease. Additionally, this patient had significant pre-existing ventricular dysfunction, valvular disease, and comorbidities including HIV. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Sumeet S Vaikunth
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Michael R Bykhovsky
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anitra W Romfh
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Christiane L Haeffele
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ian S Rogers
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Emily Dong
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Caroline Scribner
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
| | - George K Lui
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California, USA.,Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California, USA
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23
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Fernandes SM, Lui GK, Long J, Lin A, Rogers IS, Sillman C, Romfh A, Dade TC, Dong E, Haeffele C, Scribner C, Major M, McElhinney DB. Predicting 10-year mortality in adults with congenital heart disease. International Journal of Cardiology Congenital Heart Disease 2021. [DOI: 10.1016/j.ijcchd.2020.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz-Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin MF, Rose GA, Swaminathan M, Arrighi JA, Mendes LA, Adams JE, Brush JE, Dec GW, Denktas A, Fernandes S, Freeman R, Hahn RT, Halperin JL, Housholder-Hughes SD, Khan SS, Klarich KW, Lin CH, Marine JE, McPherson JA, Niazi K, Ryan T, Solomon MA, Spicer RL, Tam M, Wang A, Weissman G, Weitz HH, Williams ES. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee. J Am Soc Echocardiogr 2020; 32:919-943. [PMID: 31378259 DOI: 10.1016/j.echo.2019.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Vaikunth SS, Higgins JP, Concepcion W, Haeffele C, Wright GE, Chen S, Lui GK, Daugherty T. Does liver biopsy accurately measure fibrosis in Fontan-associated liver disease? A comparison of liver biopsy pre-combined heart and liver transplant and liver explant post-transplant. Clin Transplant 2020; 34:e14120. [PMID: 33053213 DOI: 10.1111/ctr.14120] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/13/2020] [Accepted: 09/30/2020] [Indexed: 01/12/2023]
Abstract
The accuracy of liver biopsy to stage fibrosis due to Fontan-associated liver disease (FALD) remains unclear. We compared the results of biopsy pre-combined heart and liver transplantation (CHLT) to the results of whole liver explant. Liver biopsy and explants from 15 Fontan patients (ages 16-49, median 28 years) were retrospectively reviewed. Staging was as follows: stage 0: no fibrosis, stage 1: pericellular fibrosis, stage 2: bridging fibrosis, and stage 3: regenerative nodules. There is no stage 4. Clinical characteristics including Model of End-stage Liver Disease eXcluding INR and Varices, Ascites, Splenomegaly, and Thrombocytopenia (VAST) scores were collected, and descriptive statistics and Mann-Whitney U tests were used to analyze the data. All patients had biopsies with at least bridging fibrosis, and all had nodularity on explant; transjugular biopsy never overestimated fibrosis. Explant showed higher-grade fibrosis (stage 3) than pre-CHLT biopsy (stage 2) in 6 of 15 patients and equal grade of fibrosis (stage 3) in 9 of 15 patients. Though clinical characteristics varied significantly, VAST score was ≥2 in all but two patients. Transjugular liver biopsy does not overestimate and can underestimate fibrosis in Fontan patients undergoing CHLT, likely due to the patchy nature of fibrosis in FALD.
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Affiliation(s)
- Sumeet S Vaikunth
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John P Higgins
- Department of Pathology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Waldo Concepcion
- Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Christiane Haeffele
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Gail E Wright
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sharon Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - George K Lui
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.,Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tami Daugherty
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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Sachdeva R, Valente AM, Armstrong AK, Cook SC, Han BK, Lopez L, Lui GK, Pickard SS, Powell AJ, Bhave NM, Sachdeva R, Valente AM, Pickard SS, Baffa JM, Banka P, Cohen SB, Glickstein JS, Kanter JP, Kanter RJ, Kim YY, Kipps AK, Latson LA, Lin JP, Parra DA, Rodriguez FH, Saarel EV, Srivastava S, Stephenson EA, Stout KK, Zaidi AN, Gluckman TJ, Aggarwal NR, Bhave NM, Dehmer GJ, Gilbert ON, Kumbhani DJ, Price AL, Winchester DE, Gulati M, Dehmer GJ, Doherty JU, Bhave NM, Daugherty SL, Dean LS, Desai MY, Gillam LD, Mehrotra P, Sachdeva R, Winchester DE. ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease: A Report of the American College of Cardiology Solution Set Oversight Committee and Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Soc Echocardiogr 2020; 33:e1-e48. [PMID: 33010859 DOI: 10.1016/j.echo.2020.04.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The American College of Cardiology (ACC) collaborated with the American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Pediatric Echocardiography to develop Appropriate Use Criteria (AUC) for multimodality imaging during the follow-up care of patients with congenital heart disease (CHD). This is the first AUC to address cardiac imaging in adult and pediatric patients with established CHD. A number of common patient scenarios (also termed "indications") and associated assumptions and definitions were developed using guidelines, clinical trial data, and expert opinion in the field of CHD.1 The indications relate primarily to evaluation before and after cardiac surgery or catheter-based intervention, and they address routine surveillance as well as evaluation of new-onset signs or symptoms. The writing group developed 324 clinical indications, which they separated into 19 tables according to the type of cardiac lesion. Noninvasive cardiac imaging modalities that could potentially be used for these indications were incorporated into the tables, resulting in a total of 1,035 unique scenarios. These scenarios were presented to a separate, independent panel for rating, with each being scored on a scale of 1 to 9, with 1 to 3 categorized as "Rarely Appropriate," 4 to 6 as "May Be Appropriate," and 7 to 9 as "Appropriate." Forty-four percent of the scenarios were rated as Appropriate, 39% as May Be Appropriate, and 17% as Rarely Appropriate. This AUC document will provide guidance to clinicians in the care of patients with established CHD by identifying the reasonable imaging modality options available for evaluation and surveillance of such patients. It will also serve as an educational and quality improvement tool to identify patterns of care and reduce the number of Rarely Appropriate tests in clinical practice.
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Hsu WH, Sommerhalter KM, McGarry CE, Farr SL, Downing KF, Lui GK, Zaidi AN, Hsu DT, Van Zutphen AR. Inpatient admissions and costs for adolescents and young adults with congenital heart defects in New York, 2009-2013. Birth Defects Res 2020; 113:173-188. [PMID: 32990389 DOI: 10.1002/bdr2.1809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Most individuals born with congenital heart defects (CHDs) survive to adulthood, but healthcare utilization patterns for adolescents and adults with CHDs have not been well described. We sought to characterize the healthcare utilization patterns and associated costs for adolescents and young adults with CHDs. METHODS We examined 2009-2013 New York State inpatient admissions of individuals ages 11-30 years with ≥1 CHD diagnosis codes recorded during any admission. We conducted multivariate linear regression using generalized estimating equations to examine associations between inpatient costs and sociodemographic and clinical variables. RESULTS We identified 5,100 unique individuals with 9,593 corresponding hospitalizations over the study period. Median inpatient cost and length of stay (LOS) were $10,720 and 3.0 days per admission, respectively; 55.1% were emergency admissions. Admission volume increased 48.7% from 2009 (1,538 admissions) to 2013 (2,287 admissions), while total inpatient costs increased 91.8% from 2009 ($27.2 million) to 2013 ($52.2 million). Inpatient admissions and costs rose more sharply over the study period for those with nonsevere CHDs compared to severe CHDs. Characteristics associated with higher costs were longer LOS, severe CHD, cardiac/vascular hospitalization classification, surgical procedures, greater severity of illness, and admission in New York City. CONCLUSION This study provides an informative baseline of health care utilization patterns and associated costs among adolescents and young adults with CHDs in New York State. Structured transition programs may aid in keeping this population in appropriate cardiac care as they move to adulthood.
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Affiliation(s)
- Wan-Hsiang Hsu
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA
| | - Kristin M Sommerhalter
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA
| | - Claire E McGarry
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA
| | - Sherry L Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karrie F Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - George K Lui
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Stanford School of Medicine, Stanford, California, USA
| | - Ali N Zaidi
- Sinai Adult Congenital Heart Disease Program, Mount Sinai Cardiovascular Institute & The Pediatric Heart Center, New York, New York, USA
| | - Daphne T Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alissa R Van Zutphen
- New York State Department of Health, Bureau of Environmental & Occupational Epidemiology, Albany, New York, USA.,University at Albany School of Public Health, Rensselaer, New York, USA
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Perrotta ML, Saha P, Zawadzki R, Beidelman M, Ingelsson E, Lui GK, Priest JR. Adults With Mild-to-Moderate Congenital Heart Disease Demonstrate Measurable Neurocognitive Deficits. J Am Heart Assoc 2020; 9:e015379. [PMID: 32981450 PMCID: PMC7792385 DOI: 10.1161/jaha.119.015379] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Neurocognitive impairment is a common complication of congenital heart disease (CHD) as well as acquired cardiovascular disease. Data are limited on neurocognitive function in adults with CHD (ACHD). Methods and Results A total of 1020 individuals with mild‐to‐moderate ACHD and 497 987 individuals without ACHD from the volunteer‐based UK Biobank study underwent neurocognitive tests for fluid intelligence, reaction time, numeric memory, symbol‐digit substitution, and trail making at enrollment and follow‐up. Performance scores were compared before and after exclusion of preexisting stroke or coronary artery disease as measures of cerebro‐ and cardiovascular disease. Individuals with ACHD had significantly poorer performance on alpha‐numeric trail making, a measure of visual attention and cognitive flexibility, spending 6.4 seconds longer on alpha‐numeric trail making (95% CI, 3.0–9.9 seconds, P=0.002) and 2.5 seconds longer on numeric trail making (95% CI, 0.5–4.6 seconds, P=0.034), a measure of visual attention and processing speed. The ACHD cohort had modestly lower performance on symbol‐digit substitution, a measure of processing speed, with 0.9 fewer correct substitutions (95% CI, − 1.5 to − 0.2 substitutions, P=0.021). After excluding preexisting stroke or coronary artery disease, individuals with ACHD continued to show poorer performance in all 6 domains (P=NS). Conclusions Individuals with mild‐to‐moderate ACHD had poorer neurocognitive performance, most significantly in tests of cognitive flexibility, analogous to deficits in children with CHD. These differences appear to be driven by increased burden of cerebro‐ and cardiovascular disease among individuals with ACHD.
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Affiliation(s)
- Melissa L Perrotta
- Stanford Cardiovascular Institute Stanford University School of Medicine Palo Alto CA.,Department of Pediatrics Lucile Packard Children's Hospital and Stanford University School of Medicine Palo Alto CA.,Department of Medicine Stanford University School of Medicine Palo Alto CA.,Department of Pediatrics University of Louisville School of Medicine and Norton Children's Hospital Louisville KY
| | - Priyanka Saha
- Department of Pediatrics Lucile Packard Children's Hospital and Stanford University School of Medicine Palo Alto CA.,Department of Pediatrics University of Washington School of Medicine Seattle WA
| | - Roy Zawadzki
- Department of Pediatrics Lucile Packard Children's Hospital and Stanford University School of Medicine Palo Alto CA
| | - Mark Beidelman
- Department of Pediatrics Lucile Packard Children's Hospital and Stanford University School of Medicine Palo Alto CA
| | - Erik Ingelsson
- Stanford Cardiovascular Institute Stanford University School of Medicine Palo Alto CA.,Department of Medicine Stanford University School of Medicine Palo Alto CA
| | - George K Lui
- Stanford Cardiovascular Institute Stanford University School of Medicine Palo Alto CA.,Department of Pediatrics Lucile Packard Children's Hospital and Stanford University School of Medicine Palo Alto CA.,Department of Medicine Stanford University School of Medicine Palo Alto CA
| | - James R Priest
- Stanford Cardiovascular Institute Stanford University School of Medicine Palo Alto CA.,Department of Pediatrics Lucile Packard Children's Hospital and Stanford University School of Medicine Palo Alto CA.,Chan-Zuckerberg Biohub San Francisco CA
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30
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Affiliation(s)
- Sonia A. El-Saiedi
- Division of Pediatric Cardiology, Pediatrics Department, Cairo University, Cairo, Egypt
| | - Christiane Haeffele
- Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, California
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Baher M. Hanna
- Division of Pediatric Cardiology, Pediatrics Department, Cairo University, Cairo, Egypt
| | - George K. Lui
- Division of Pediatric Cardiology, Stanford University School of Medicine, Stanford, California
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
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Schlichting LE, Insaf TZ, Zaidi AN, Lui GK, Van Zutphen AR. Maternal Comorbidities and Complications of Delivery in Pregnant Women With Congenital Heart Disease. J Am Coll Cardiol 2020; 73:2181-2191. [PMID: 31047006 DOI: 10.1016/j.jacc.2019.01.069] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/19/2018] [Accepted: 01/06/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pregnant women with congenital heart defects (CHDs) may be at increased risk for adverse events during delivery. OBJECTIVES This study sought to compare comorbidities and adverse cardiovascular, obstetric, and fetal events during delivery between pregnant women with and without CHDs in the United States. METHODS Comorbidities and adverse delivery events in women with and without CHDs were compared in 22,881,691 deliveries identified in the 2008 to 2013 National Inpatient Sample using multivariable logistic regression. Among those with CHDs, associations by CHD severity and presence of pulmonary hypertension (PH) were examined. RESULTS There were 17,729 deliveries to women with CHDs (77.5 of 100,000 deliveries). These women had longer lengths of stay and higher total charges than women without CHDs. They had greater odds of comorbidities, including PH (adjusted odds ratio [aOR]: 193.8; 95% confidence interval [CI]: 157.7 to 238.0), congestive heart failure (aOR: 49.1; 95% CI: 37.4 to 64.3), and coronary artery disease (aOR: 31.7; 95% CI: 21.4 to 47.0). Greater odds of adverse events were observed, including heart failure (aOR: 22.6; 95% CI: 20.5 to 37.3), arrhythmias (aOR: 12.4; 95% CI: 11.0 to 14.0), thromboembolic events (aOR: 2.4; 95% CI: 2.0 to 2.9), pre-eclampsia (aOR: 1.5; 95% CI: 1.3 to 1.7), and placenta previa (aOR: 1.5; 95% CI: 1.2 to 1.8). Cesarean section, induction, and operative vaginal delivery were more common, whereas fetal distress was less common. Among adverse events in women with CHDs, PH was associated with heart failure, hypertension in pregnancy, pre-eclampsia, and pre-term delivery; there were no differences in most adverse events by CHD severity. CONCLUSIONS Pregnant women with CHDs were more likely to have comorbidities and experience adverse events during delivery. These women require additional monitoring and care.
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Affiliation(s)
- Lauren E Schlichting
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island; Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York; University at Albany School of Public Health, Rensselaer, New York.
| | - Tabassum Z Insaf
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York; University at Albany School of Public Health, Rensselaer, New York
| | - Ali N Zaidi
- Montefiore Medical Center, Children's Hospital at Montefiore/Albert Einstein College of Medicine, New York, New York
| | - George K Lui
- Stanford University School of Medicine, Stanford, California
| | - Alissa R Van Zutphen
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, New York; University at Albany School of Public Health, Rensselaer, New York
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Raskind-Hood C, Saraf A, Riehle-Colarusso T, Glidewell J, Gurvitz M, Dunn JE, Lui GK, Van Zutphen A, McGarry C, Hogue CJ, Hoffman T, Rodriguez III FH, Book WM. Assessing Pregnancy, Gestational Complications, and Co-morbidities in Women With Congenital Heart Defects (Data from ICD-9-CM Codes in 3 US Surveillance Sites). Am J Cardiol 2020; 125:812-819. [PMID: 31902476 DOI: 10.1016/j.amjcard.2019.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 12/13/2022]
Abstract
Improved treatment of congenital heart defects (CHDs) has resulted in women with CHDs living to childbearing age. However, no US population-based systems exist to estimate pregnancy frequency or complications among women with CHDs. Cases were identified in multiple data sources from 3 surveillance sites: Emory University (EU) whose catchment area included 5 metropolitan Atlanta counties; Massachusetts Department of Public Health (MA) whose catchment area was statewide; and New York State Department of Health (NY) whose catchment area included 11 counties. Cases were categorized into one of 5 mutually exclusive CHD severity groups collapsed to severe versus not severe; specific ICD-9-CM codes were used to capture pregnancy, gestational complications, and nongestational co-morbidities in women, age 11 to 50 years, with a CHD-related ICD-9-CM code. Pregnancy, CHD severity, demographics, gestational complications, co-morbidities, and insurance status were evaluated. ICD-9-CM codes identified 26,655 women with CHDs, of whom 5,672 (21.3%, range: 12.8% in NY to 22.5% in MA) had codes indicating a pregnancy. Over 3 years, age-adjusted proportion pregnancy rates among women with severe CHDs ranged from 10.0% to 24.6%, and 14.2% to 21.7% for women with nonsevere CHDs. Pregnant women with CHDs of any severity, compared with nonpregnant women with CHDs, reported more noncardiovascular co-morbidities. Insurance type varied by site and pregnancy status. These US population-based, multisite estimates of pregnancy among women with CHD indicate a substantial number of women with CHDs may be experiencing pregnancy and complications. In conclusion, given the growing adult population with CHDs, reproductive health of women with CHD is an important public health issue.
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Kitani T, Tian L, Zhang T, Itzhaki I, Zhang JZ, Ma N, Liu C, Rhee JW, Romfh AW, Lui GK, Wu JC. RNA Sequencing Analysis of Induced Pluripotent Stem Cell-Derived Cardiomyocytes From Congenital Heart Disease Patients. Circ Res 2020; 126:923-925. [PMID: 32070195 DOI: 10.1161/circresaha.119.315653] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Tomoya Kitani
- From the Stanford Cardiovascular Institute (T.K., L.T., T.Z., I.I., J.Z.Z., N.M., C.L., J.-W.R., J.C.W.), Stanford University School of Medicine, CA.,Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan (T.K.)
| | - Lei Tian
- From the Stanford Cardiovascular Institute (T.K., L.T., T.Z., I.I., J.Z.Z., N.M., C.L., J.-W.R., J.C.W.), Stanford University School of Medicine, CA
| | - Tiejun Zhang
- From the Stanford Cardiovascular Institute (T.K., L.T., T.Z., I.I., J.Z.Z., N.M., C.L., J.-W.R., J.C.W.), Stanford University School of Medicine, CA
| | - Ilanit Itzhaki
- From the Stanford Cardiovascular Institute (T.K., L.T., T.Z., I.I., J.Z.Z., N.M., C.L., J.-W.R., J.C.W.), Stanford University School of Medicine, CA
| | - Joe Z Zhang
- From the Stanford Cardiovascular Institute (T.K., L.T., T.Z., I.I., J.Z.Z., N.M., C.L., J.-W.R., J.C.W.), Stanford University School of Medicine, CA
| | - Ning Ma
- From the Stanford Cardiovascular Institute (T.K., L.T., T.Z., I.I., J.Z.Z., N.M., C.L., J.-W.R., J.C.W.), Stanford University School of Medicine, CA
| | - Chun Liu
- From the Stanford Cardiovascular Institute (T.K., L.T., T.Z., I.I., J.Z.Z., N.M., C.L., J.-W.R., J.C.W.), Stanford University School of Medicine, CA
| | - June-Wha Rhee
- From the Stanford Cardiovascular Institute (T.K., L.T., T.Z., I.I., J.Z.Z., N.M., C.L., J.-W.R., J.C.W.), Stanford University School of Medicine, CA.,Division of Cardiovascular Medicine (J.-W.R., A.W.R., G.K.L., J.C.W.), Stanford University School of Medicine, CA
| | - Anitra W Romfh
- Division of Cardiovascular Medicine (J.-W.R., A.W.R., G.K.L., J.C.W.), Stanford University School of Medicine, CA
| | - George K Lui
- Division of Cardiovascular Medicine (J.-W.R., A.W.R., G.K.L., J.C.W.), Stanford University School of Medicine, CA
| | - Joseph C Wu
- From the Stanford Cardiovascular Institute (T.K., L.T., T.Z., I.I., J.Z.Z., N.M., C.L., J.-W.R., J.C.W.), Stanford University School of Medicine, CA.,Division of Cardiovascular Medicine (J.-W.R., A.W.R., G.K.L., J.C.W.), Stanford University School of Medicine, CA
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Sachdeva R, Valente AM, Armstrong AK, Cook SC, Han BK, Lopez L, Lui GK, Pickard SS, Powell AJ, Bhave NM, Sachdeva R, Valente AM, Pickard SS, Baffa JM, Banka P, Cohen SB, Glickstein JS, Kanter JP, Kanter RJ, Kim YY, Kipps AK, Latson LA, Lin JP, Parra DA, Rodriguez FH, Saarel EV, Srivastava S, Stephenson EA, Stout KK, Zaidi AN. ACC/AHA/ASE/HRS/ISACHD/SCAI/SCCT/SCMR/SOPE 2020 Appropriate Use Criteria for Multimodality Imaging During the Follow-Up Care of Patients With Congenital Heart Disease: A Report of the American College of Cardiology Solution Set Oversight Committee and Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography. J Am Coll Cardiol 2020; 75:657-703. [PMID: 31918898 DOI: 10.1016/j.jacc.2019.10.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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35
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Saha P, Potiny P, Rigdon J, Morello M, Tcheandjieu C, Romfh A, Fernandes SM, McElhinney DB, Bernstein D, Lui GK, Shaw GM, Ingelsson E, Priest JR. Substantial Cardiovascular Morbidity in Adults With Lower-Complexity Congenital Heart Disease. Circulation 2020; 139:1889-1899. [PMID: 30813762 DOI: 10.1161/circulationaha.118.037064] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although lower-complexity cardiac malformations constitute the majority of adult congenital heart disease (ACHD), the long-term risks of adverse cardiovascular events and relationship with conventional risk factors in this population are poorly understood. We aimed to quantify the risk of adverse cardiovascular events associated with lower-complexity ACHD that is unmeasured by conventional risk factors. METHODS A multitiered classification algorithm was used to select individuals with lower-complexity ACHD and individuals without ACHD for comparison among >500 000 British adults in the UK Biobank. ACHD diagnoses were subclassified as isolated aortic valve and noncomplex defects. Time-to-event analyses were conducted for the primary end points of fatal or nonfatal acute coronary syndrome, ischemic stroke, heart failure, and atrial fibrillation and a secondary combined end point for major adverse cardiovascular events. Maximum follow-up time for the study period was 22 years with retrospectively and prospectively collected data from the UK Biobank. RESULTS We identified 2006 individuals with lower-complexity ACHD and 497 983 unexposed individuals in the UK Biobank (median age at enrollment, 58 [interquartile range, 51-63] years). Of the ACHD-exposed group, 59% were male, 51% were current or former smokers, 30% were obese, and 69%, 41%, and 7% were diagnosed or treated for hypertension, hyperlipidemia, and diabetes mellitus, respectively. After adjustment for 12 measured cardiovascular risk factors, ACHD remained strongly associated with the primary end points, with hazard ratios ranging from 2.0 (95% CI, 1.5-2.8; P<0.001) for acute coronary syndrome to 13.0 (95% CI, 9.4-18.1; P<0.001) for heart failure. ACHD-exposed individuals with ≤2 cardiovascular risk factors had a 29% age-adjusted incidence rate of major adverse cardiovascular events, in contrast to 13% in individuals without ACHD with ≥5 risk factors. CONCLUSIONS Individuals with lower-complexity ACHD had a higher burden of adverse cardiovascular events relative to the general population that was unaccounted for by conventional cardiovascular risk factors. These findings highlight the need for closer surveillance of patients with mild to moderate ACHD and further investigation into management and mechanisms of cardiovascular risk unique to this growing population of high-risk adults.
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Affiliation(s)
- Priyanka Saha
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Harvard Medical School, Boston, MA (P.S.)
| | - Praneetha Potiny
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA
| | - Joseph Rigdon
- Quantitative Sciences Unit (J.R.), Stanford University School of Medicine, CA
| | - Melissa Morello
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Catherine Tcheandjieu
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Anitra Romfh
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Susan M Fernandes
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Doff B McElhinney
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Cardiothoracic Surgery (D.B.M.), Stanford University School of Medicine, CA
| | - Daniel Bernstein
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA
| | - George K Lui
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA
| | - Gary M Shaw
- Department of Pediatrics (G.M.S.), Stanford University School of Medicine, CA
| | - Erik Ingelsson
- Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Department of Medicine, Division of Cardiovascular Medicine (M.M., C.T., A.R., S.M.F., G.K.L., E.I.), Stanford University School of Medicine, CA.,Stanford Diabetes Research Center, Stanford University, CA (E.I., J.R.P.)
| | - James R Priest
- Division of Cardiology, Department of Pediatrics (P.S., P.P., M.M., C.T., A.R., S.M.F., D.B.M., D.B., G.K.L., J.R.P.), Stanford University School of Medicine, CA.,Stanford Cardiovascular Institute (P.S., C.T., D.B.M., D.B., E.I., J.R.P.), Stanford University School of Medicine, CA.,Stanford Diabetes Research Center, Stanford University, CA (E.I., J.R.P.).,Chan-Zuckerberg BioHub, San Francisco, CA (J.R.P.)
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36
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Mainwaring RD, Rosenblatt TR, Lui GK, Ma M, Hanley FL. Surgical Repair of Ebstein’s Anomaly Using a Bicuspidization Approach. Ann Thorac Surg 2019; 108:1875-1882. [DOI: 10.1016/j.athoracsur.2019.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
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37
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Maeda K, Lui GK. Commentary: Risk prediction model on adult congenital heart surgery. And more…. J Thorac Cardiovasc Surg 2019; 159:2416-2417. [PMID: 31669012 DOI: 10.1016/j.jtcvs.2019.08.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Katsuhide Maeda
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
| | - George K Lui
- Department of Cardiology, Stanford University School of Medicine, Stanford, Calif
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38
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Haeffele C, Aggarwal A, Lutchman G, Veldtman GR, Wu FM, Lui GK. Fontan Liver Lesions: Not Always HCC. JACC Case Rep 2019; 1:175-178. [PMID: 34316779 PMCID: PMC8301494 DOI: 10.1016/j.jaccas.2019.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/29/2019] [Indexed: 11/30/2022]
Abstract
A 24-year-old Fontan procedure patient underwent surveillance liver cardiac magnetic resonance imaging. Findings were suggestive of hepatocellular carcinoma (HCC). Currently, HCC is diagnosed based on imaging alone. Given her otherwise reassuring clinical profile, she underwent liver biopsy. Pathology demonstrated focal nodular hyperplasia. This raises concern for overdiagnosis of HCC in Fontan patients without tissue confirmation. (Level of Difficulty: Advanced.)
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Key Words
- AASLD, American Association for Study of Liver Disease
- AFP, alpha-fetoprotein
- ALT, lanine aminotransferase
- AST, aspartate aminotransferase
- AV, atrioventricular
- CT, computed tomography
- FALD, Fontan associated liver disease
- FNH, focal nodular hyperplasia
- GS, glutamine synthetase
- HCC, hepatocellular carcinoma
- INR, international normalized ratio
- MRI, magnetic resonance imaging
- US, ultrasound
- awareness
- congenital heart defect
- cyanotic heart disease
- imaging
- treatment
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Affiliation(s)
- Christiane Haeffele
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, California
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, California
- Address for correspondence: Dr. Christiane Haeffele, Stanford University, 870 Quarry Road Extension, Palo Alto, California 94304.
| | - Avin Aggarwal
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - Glen Lutchman
- Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California
| | - Gruschen R. Veldtman
- Cincinnati Children’s Hospital Adolescent and Adult Congenital Heart Program, Cincinnati, Ohio
| | - Fred M. Wu
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - George K. Lui
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, California
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, California
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39
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz‐Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin M, Rose GA, Swaminathan M. 2019 ACC/AHA/ASE advanced training statement on echocardiography (revision of the 2003 ACC/AHA clinical competence statement on echocardiography). Catheter Cardiovasc Interv 2019; 94:481-505. [DOI: 10.1002/ccd.28313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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40
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Wiegers SE, Ryan T, Arrighi JA, Brown SM, Canaday B, Damp JB, Diaz-Gomez JL, Figueredo VM, Garcia MJ, Gillam LD, Griffin BP, Kirkpatrick JN, Klarich KW, Lui GK, Maffett S, Naqvi TZ, Patel AR, Poulin MF, Rose GA, Swaminathan M. 2019 ACC/AHA/ASE Advanced Training Statement on Echocardiography (Revision of the 2003 ACC/AHA Clinical Competence Statement on Echocardiography): A Report of the ACC Competency Management Committee. Circ Cardiovasc Imaging 2019. [DOI: 10.1161/hci.0000000000000026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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Lui GK, McGarry C, Bhatt A, Book W, Riehle-Colarusso TJ, Dunn JE, Glidewell J, Gurvitz M, Hoffman T, Hogue CJ, Hsu D, Obenhaus S, Raskind-Hood C, Rodriguez FH, Zaidi A, Van Zutphen AR. Surveillance of Congenital Heart Defects among Adolescents at Three U.S. Sites. Am J Cardiol 2019; 124:137-143. [PMID: 31030970 DOI: 10.1016/j.amjcard.2019.03.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
The prevalence, co-morbidities, and healthcare utilization in adolescents with congenital heart defects (CHDs) is not well understood. Adolescents (11 to 19 years old) with a healthcare encounter between January 1, 2008 (January 1, 2009 for MA) and December 31, 2010 with a CHD diagnosis code were identified from multiple administrative data sources compiled at 3 US sites: Emory University, Atlanta, Georgia (EU); Massachusetts Department of Public Health (MA); and New York State Department of Health (NY). The estimated prevalence for any CHD was 4.77 (EU), 17.29 (MA), and 4.22 (NY) and for severe CHDs was 1.34 (EU), 3.04 (MA), and 0.88 (NY) per 1,000 adolescents. Private or commercial insurance was the most common insurance type for EU and NY, and Medicaid for MA. Inpatient encounters were more frequent in severe CHDs. Cardiac co-morbidities included rhythm and conduction disorders at 20% (EU), 46% (MA), and 9% (NY) as well as heart failure at 3% (EU), 15% (MA), and 2% (NY). Leading noncardiac co-morbidities were respiratory/pulmonary (22% EU, 34% MA, 16% NY), infectious disease (17% EU, 22% MA, 20% NY), non-CHD birth defects (12% EU, 23% MA, 14% NY), gastrointestinal (10% EU, 28% MA, 13% NY), musculoskeletal (10% EU, 32% MA, 11% NY), and mental health (9% EU, 30% MA, 11% NY). In conclusion, this study used a novel approach of uniform CHD definition and variable selection across administrative data sources in 3 sites for the first population-based CHD surveillance of adolescents in the United States. High resource utilization and co-morbidities illustrate ongoing significant burden of disease in this vulnerable population.
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42
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Tompkins R, Kelle AM, Cabalka AK, Lui GK, Aboulhosn J, Dvir D, McElhinney DB. Echocardiographic Evaluation of Patients Undergoing Transcatheter Tricuspid Valve-In-Valve Replacement. J Am Soc Echocardiogr 2019; 32:616-623. [DOI: 10.1016/j.echo.2018.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Indexed: 11/24/2022]
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43
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Vaikunth SS, Concepcion W, Daugherty T, Fowler M, Lutchman G, Maeda K, Rosenthal DN, Teuteberg J, Woo YJ, Lui GK. Short-term outcomes of en bloc combined heart and liver transplantation in the failing Fontan. Clin Transplant 2019; 33:e13540. [PMID: 30891780 DOI: 10.1111/ctr.13540] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/09/2019] [Accepted: 03/15/2019] [Indexed: 12/18/2022]
Abstract
Patients with failing Fontan physiology and liver cirrhosis are being considered for combined heart and liver transplantation. We performed a retrospective review of our experience with en bloc combined heart and liver transplantation in Fontan patients > 10 years old from 2006 to 18 per Institutional Review Board approval. Six females and 3 males (median age 20.7, range 14.2-41.3 years) underwent en bloc combined heart and liver transplantation. Indications for heart transplant included ventricular dysfunction, atrioventricular valve regurgitation, arrhythmia, and/or lymphatic abnormalities. Indication for liver transplant included portal hypertension and cirrhosis. Median Fontan/single ventricular end-diastolic pressure was 18/12 mm Hg, respectively. Median Model for End-Stage Liver Disease excluding International Normalized Ratio score was 10 (7-26), eight patients had a varices, ascites, splenomegaly, thrombocytopenia score of ≥ 2, and all patients had cirrhosis. Median cardiopulmonary bypass and donor ischemic times were 262 (178-307) and 287 (227-396) minutes, respectively. Median intensive care and hospital stay were 19 (5-96) and 29 (13-197) days, respectively. Survival was 100%, and rejection was 0% at 30 days and 1 year post-transplant. En bloc combined heart and liver transplantation is an acceptable treatment in the failing Fontan patient with liver cirrhosis.
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Affiliation(s)
- Sumeet S Vaikunth
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California
| | - Waldo Concepcion
- Department of Transplant Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Tami Daugherty
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California
| | - Michael Fowler
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Glen Lutchman
- Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California
| | - Katsuhide Maeda
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - David N Rosenthal
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California
| | - Jeffrey Teuteberg
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - George K Lui
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, California.,Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, California
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44
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Adamson GT, Peng LF, Lui GK, Perry SB. Transcatheter redirection of hepatic venous blood to treat unilateral pulmonary arteriovenous malformations in a Fontan circulation by short-term total exclusion of the unaffected lung. Catheter Cardiovasc Interv 2019; 93:660-663. [PMID: 30629315 DOI: 10.1002/ccd.28073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/13/2018] [Accepted: 12/22/2018] [Indexed: 11/09/2022]
Abstract
Clinically significant unilateral pulmonary arteriovenous malformations (PAVM) can develop in patients with a Fontan circulation when there is unbalanced distribution of hepatic venous (HV) blood flow to the lungs. There are reported surgical and transcatheter techniques to treat PAVMs by rerouting HV return, with promising short-term results. We report a case of a novel, technically simple transcatheter approach to redirect HV blood flow in an adult Fontan patient with polysplenia syndrome and severe unilateral PAVMs. Our patient had a two-stage procedure, the first to redirect all HV blood flow to the affected lung with a single covered stent, and a second to confirm resolution of PAVMs and to reintroduce HV effluent to the unaffected lung. At 10-month follow-up, her oxygen saturations had increased from 75% to 93% with a marked improvement in her functional status.
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Affiliation(s)
- Gregory T Adamson
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Lynn F Peng
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - George K Lui
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Stanton B Perry
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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45
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Puchalski MD, Lui GK, Miller-Hance WC, Brook MM, Young LT, Bhat A, Roberson DA, Mercer-Rosa L, Miller OI, Parra DA, Burch T, Carron HD, Wong PC. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic. J Am Soc Echocardiogr 2019; 32:173-215. [DOI: 10.1016/j.echo.2018.08.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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46
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Schultz KE, Lui GK, McElhinney DB, Long J, Balasubramanian V, Sakarovitch C, Fernandes SM, Dubin AM, Rogers IS, Romfh AW, Motonaga KS, Viswanathan MN, Ceresnak SR. Extended cardiac ambulatory rhythm monitoring in adults with congenital heart disease: Arrhythmia detection and impact of extended monitoring. CONGENIT HEART DIS 2019; 14:410-418. [DOI: 10.1111/chd.12736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/07/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Karen E. Schultz
- Department of Pediatrics, Division of Cardiology Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford California
| | - George K. Lui
- Department of Pediatrics, Division of Cardiology Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford California
- Department of Medicine, Division of Cardiovascular Medicine Stanford University School of Medicine Stanford California
| | - Doff B. McElhinney
- Department of Pediatrics, Division of Cardiology Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford California
| | - Jin Long
- Department of Medicine, Quantitative Sciences Unit Stanford Univeristy Stanford California
| | - Vidhya Balasubramanian
- Department of Medicine, Quantitative Sciences Unit Stanford Univeristy Stanford California
| | - Charlotte Sakarovitch
- Department of Medicine, Quantitative Sciences Unit Stanford Univeristy Stanford California
| | - Susan M. Fernandes
- Department of Pediatrics, Division of Cardiology Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford California
- Department of Medicine, Division of Cardiovascular Medicine Stanford University School of Medicine Stanford California
| | - Anne M. Dubin
- Department of Pediatrics, Division of Cardiology Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford California
| | - Ian S. Rogers
- Department of Pediatrics, Division of Cardiology Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford California
- Department of Medicine, Division of Cardiovascular Medicine Stanford University School of Medicine Stanford California
| | - Anitra W. Romfh
- Department of Pediatrics, Division of Cardiology Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford California
- Department of Medicine, Division of Cardiovascular Medicine Stanford University School of Medicine Stanford California
| | - Kara S. Motonaga
- Department of Pediatrics, Division of Cardiology Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford California
| | - Mohan N. Viswanathan
- Department of Medicine, Division of Cardiovascular Medicine Stanford University School of Medicine Stanford California
| | - Scott R. Ceresnak
- Department of Pediatrics, Division of Cardiology Stanford University School of Medicine, Lucile Packard Children’s Hospital Stanford California
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47
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Vaikunth SS, Bauser-Heaton H, Lui GK, Wise-Faberowski L, Chan FP, Asija R, Hanley FL, McElhinney DB. Repair of Untreated Older Patients With Tetralogy of Fallot With Major Aortopulmonary Collaterals. Ann Thorac Surg 2018; 107:1218-1224. [PMID: 30550802 DOI: 10.1016/j.athoracsur.2018.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/18/2018] [Accepted: 11/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Our programmatic approach to tetralogy of Fallot with major aortopulmonary collaterals emphasizes single-stage unifocalization with complete intracardiac repair during infancy. Little is known about suitability for complete repair in patients beyond infancy. We sought to analyze outcomes of our approach in older patients with previously untreated tetralogy of Fallot with major aortopulmonary collaterals. METHODS Any patient with this lesion not treated before 2 years of age referred to our center from 2002 to 2017 met inclusion criteria. RESULTS Of 33 patients, 32 were out-of-state (64% international) referrals, and 33% (n = 11) were older than 9 years, had polycythemia, or at least 1 high pressure collateral (>25 mm Hg). Complete repair was achieved in 94% (n = 31) of patients, 82% (n = 27) in one stage and 12% (n = 4) after unifocalization to a central shunt. The median right ventricular-to-aortic pressure ratio was 0.31 after the operation and 0.37 at follow-up. At a median of 4.8 years after repair, 9 patients (19%) underwent reintervention, including 5 conduit and 7 branch pulmonary artery interventions. Three patients also underwent aortic valve replacement. CONCLUSIONS In this selected cohort of older patients with previously unoperated tetralogy of Fallot with major aortopulmonary collaterals, outcomes were comparable with infants undergoing treatment according to our approach. These findings support the notion that patients who are either born in low-resource settings or present to health care providers beyond infancy should be considered candidates and evaluated for complete repair.
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Affiliation(s)
- Sumeet S Vaikunth
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California.
| | - Holly Bauser-Heaton
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - George K Lui
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California; Department of Medicine, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Lisa Wise-Faberowski
- Department of Anesthesiology, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Frandics P Chan
- Department of Radiology, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Ritu Asija
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Doff B McElhinney
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California; Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
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48
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Rösner A, Khalapyan T, Pedrosa J, Dalen H, McElhinney DB, Friedberg MK, Lui GK. Ventricular mechanics in adolescent and adult patients with a Fontan circulation: Relation to geometry and wall stress. Echocardiography 2018; 35:2035-2046. [DOI: 10.1111/echo.14169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Assami Rösner
- Department of Cardiology; Division of Cardiothoracic and Respiratory Medicine; University Hospital of North Norway; Tromsø Norway
| | - Tigran Khalapyan
- Department of Cardiothoracic Surgery; Stanford University School of Medicine; Stanford California
| | - João Pedrosa
- Department of Cardiovascular Sciences; K.U. Leuven; Leuven Belgium
| | - Håvard Dalen
- Department of Medicine; Levanger Hospital; Nord-Trøndelag Hospital Trust; Levanger Norway
- Department of Cardiology; St. Olav's University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| | - Doff B. McElhinney
- Division of Pediatric Cardiology; Department of Pediatrics; Stanford University School of Medicine; Stanford California
| | - Mark K. Friedberg
- Division of Pediatric Cardiology; Hospital for Sick Children; Toronto Ontario Canada
| | - George K. Lui
- Division of Pediatric Cardiology; Department of Pediatrics; Stanford University School of Medicine; Stanford California
- Division of Cardiovascular Medicine; Department of Medicine; Stanford University School of Medicine; Stanford California
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49
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Beurskens NEG, Hagdorn QAJ, Gorter TM, Berger RMF, Vermeulen KM, van Melle JP, Ebels TE, Lui GK, Ceresnak SR, Chan FP, Willems TP. Risk of cardiac tachyarrhythmia in patients with repaired tetralogy of Fallot: a multicenter cardiac MRI based study. Int J Cardiovasc Imaging 2018; 35:143-151. [PMID: 30094564 DOI: 10.1007/s10554-018-1435-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/02/2018] [Indexed: 11/24/2022]
Abstract
Cardiac tachyarrhythmias are the leading cause of morbidity and mortality in patients with repaired tetralogy of Fallot (TOF). We evaluated risk factors for sustained ventricular tachyarrhythmia (VT) and atrial tachyarrhythmia (ATA) in these patients. Patients (n = 319) who underwent cardiac magnetic resonance (CMR) imaging at two tertiary centers between 2007 and 2016 were assessed. Potential risk markers, based on history, cardiac magnetic resonance imaging (CMR), electrocardiography (ECG) and echocardiography, were analyzed for prediction of the primary endpoint of VT, and the secondary endpoint of ATA. During a follow-up of 3.5 (0.9-6.1) years, 20 (6.3%) patients reached the primary endpoint, and 30 (9.4%) the secondary endpoint. Multivariable cox hazards regression identified right ventricular (RV) end-diastolic volume (Hazard ratio [HR] 2.03, per 10 ml/m2 increase; p = 0.02), RV end-systolic volume (HR 3.04, per 10 ml/m2 increase; p = 0.04), RV mass (HR 1.88, per 10 g/m2 increase; p = 0.02), and RV ejection fraction (HR 6.06, per 10% decrease; p = 0.02) derived from CMR to be independent risk factors of VT. In addition, QRS-duration (HR 1.70, per 10 ms increase; p = 0.001) and body mass index (BMI: HR 1.8, per 5 kg/m2 increase; p = 0.02) were independent markers of VT. Older age at TOF repair (HR 1.33, per 2 months increase; p = 0.03) and BMI (HR 1.76, per 5 kg/m2 increase; p < 0.001) independently predicted ATA. RV systolic dysfunction, hypertrophy and dilatation on CMR, together with QRS prolongation, and obesity are predictive of VT in TOF patients. Older age at TOF repair and obesity were associated with the occurrence of ATA.
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Affiliation(s)
- Niek E G Beurskens
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Quint A J Hagdorn
- Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas M Gorter
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Rolf M F Berger
- Center for Congenital Heart Diseases, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joost P van Melle
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Tjark E Ebels
- Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - George K Lui
- Departments of Medicine and Pediatrics, Divisions of Cardiovascular Medicine and Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Scott R Ceresnak
- Division of Pediatric Cardiology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Frandics P Chan
- Department of Radiology, Stanford University Medical Center, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tineke P Willems
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Sommerhalter KM, Insaf TZ, Akkaya-Hocagil T, McGarry CE, Farr SL, Downing KF, Lui GK, Zaidi AN, Van Zutphen AR. Proximity to Pediatric Cardiac Surgical Care among Adolescents with Congenital Heart Defects in 11 New York Counties. Birth Defects Res 2018; 109:1494-1503. [PMID: 29152921 DOI: 10.1002/bdr2.1129] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/31/2017] [Accepted: 08/25/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many individuals with congenital heart defects (CHDs) discontinue cardiac care in adolescence, putting them at risk of adverse health outcomes. Because geographic barriers may contribute to cessation of care, we sought to characterize geographic access to comprehensive cardiac care among adolescents with CHDs. METHODS Using a population-based, 11-county surveillance system of CHDs in New York, we characterized proximity to the nearest pediatric cardiac surgical care center among adolescents aged 11 to 19 years with CHDs. Residential addresses were extracted from surveillance records documenting 2008 to 2010 healthcare encounters. Addresses were geocoded using ArcGIS and the New York State Street and Address Maintenance Program, a statewide address point database. One-way drive and public transit time from residence to nearest center were calculated using R packages gmapsdistance and rgeos with the Google Maps Distance Matrix application programming interface. A marginal model was constructed to identify predictors associated with one-way travel time. RESULTS We identified 2522 adolescents with 3058 corresponding residential addresses and 12 pediatric cardiac surgical care centers. The median drive time from residence to nearest center was 18.3 min, and drive time was 30 min or less for 2475 (80.9%) addresses. Predicted drive time was longest for rural western addresses in high poverty census tracts (68.7 min). Public transit was available for most residences in urban areas but for few in rural areas. CONCLUSION We identified areas with geographic barriers to surgical care. Future research is needed to determine how these barriers influence continuity of care among adolescents with CHDs. Birth Defects Research 109:1494-1503, 2017.© 2017 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Tabassum Z Insaf
- New York State Department of Health, Albany, New York.,Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
| | - Tugba Akkaya-Hocagil
- New York State Department of Health, Albany, New York.,Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
| | | | - Sherry L Farr
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karrie F Downing
- U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - George K Lui
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Stanford School of Medicine, Stanford, California
| | - Ali N Zaidi
- Children's Hospital at Montefiore, Bronx, New York.,Albert Einstein College of Medicine, Bronx, New York
| | - Alissa R Van Zutphen
- New York State Department of Health, Albany, New York.,Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
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