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Cho J, Tunuguntla HP, Tume SC, Spinner JA, Bocchini CE, Teruya J, Heinle JS, Hickey EJ, Adachi I. Long-term implantable ventricular assist device support in children. J Thorac Cardiovasc Surg 2024; 167:1417-1426.e1. [PMID: 37913838 DOI: 10.1016/j.jtcvs.2023.10.048] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND In pediatrics, implantable continuous-flow ventricular assist devices (IC-VAD) are often used as a "temporary" support, bridging children to cardiac transplantation during the same hospital admission. METHODS We conducted a retrospective review of our consecutive patients undergoing IC-VAD support at a tertiary pediatric heart center between 2008 and 2022. RESULTS We identified 100 IC-VAD implant encounters: HeartWare HVAD (67; 67%), HeartMate II (17; 17%), and HeartMate 3 (16; 16%). The median (range) age, weight, and body surface area at implantation were 14.1 (3.0-56.5) years, 54.8 (13.3-140) kg, and 1.6 (0.6-2.6) m2, respectively. Cardiomyopathy (58; 58%) was the most common etiology, followed by congenital heart disease (37; 37%, including 13 single ventricle). At 6 months of IC-VAD support, 94 (94%) encounters achieved positive outcomes: ongoing support (59; 59%), transplant (33; 33%), and cardiac recovery (2; 2%). Eighty-two encounters (82%) resulted in home discharge with ongoing VAD support, including 38 (46%, out of 82) requiring readmission and 7 (9%, out of 82) resulting in death. There was a clinically significant decrease in morbidity rates before versus after home discharge: bleeding (1.55 vs 0.06), infection (0.84 vs 0.37), and stroke (0.84 vs 0.15 event per patient-year). Overall, 86 encounters (86%) reached positive end points at the latest follow-up (64 transplant, 15 ongoing support, and 7 recovery). Infection (29%; 4 of 14) was the most common cause of negative outcomes, followed by cerebrovascular accident (21%; 3), and unresolved frailty (21%; 3). The estimated overall survival at 1, 2, and 5 years was 90%, 86%, and 77%, respectively. CONCLUSIONS This study suggests the feasibility of outpatient management of pediatric IC-VAD support. The ability to offer true long-term support maximizes the potential of IC-VAD support, not limited to a temporary bridging tool for heart transplantation.
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Affiliation(s)
- Junsang Cho
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Hari P Tunuguntla
- Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Sebastian C Tume
- Pediatric Critical Care, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Joseph A Spinner
- Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Claire E Bocchini
- Pediatric Infectious Disease, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Jun Teruya
- Pathology & Immunology, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Jeffrey S Heinle
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Edward J Hickey
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Iki Adachi
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
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Yoneyama F, Kalustian AB, McKenzie ED, Heinle JS, Doan TT, Binsalamah Z. Long-Term Outcomes of Ascending Sliding Arch Aortoplasty. World J Pediatr Congenit Heart Surg 2024:21501351241232071. [PMID: 38465582 DOI: 10.1177/21501351241232071] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background: Coarctation of the aorta can be associated with significant hypoplasia of the aortic arch. In contrast to patch aortoplasty, ascending sliding arch aortoplasty uses viable autologous tissue for potential growth in children. We reviewed the mid- to long-term outcomes of this technique. Methods: Between 2002 and 2023, 28 patients underwent ascending sliding arch aortoplasty for the patients with coarctation of the aorta (n = 22) and interrupted aortic arch (n = 2). Four patients underwent previous surgical coarctation repair at other institutions. The median patient age and body weight were 28.5 months (3 weeks to 15.6 years) and 13.4 kg (3.7-70 kg), respectively. Results: Although one patient had a recurrent nerve injury postoperatively, there were no other major morbidities or mortalities. The last follow-up echocardiography demonstrated that the mean peak velocity improved from 3.9 ± 0.6 to 0.9 ± 0.8 m/s, and the pressure gradient improved from 63.6 ± 21.5 to 7.1 ± 7.7 mm Hg. The postoperative diameters of the ascending aorta, proximal arch, distal arch, and isthmus all increased significantly. The mean postoperative length of stay was 5.9 ± 2.1 days, and the median follow-up time was 7.3 years (10 days to 20.5 years). No reoperation or catheterization-based intervention was performed for residual coarctation. Conclusions: Ascending sliding arch aortoplasty is safe and effective for treating coarctation of the aorta with aortic arch hypoplasia. This technique is applicable for children ranging in size from neonates to older children (or adolescents), recurrent coarctation cases, and provides complete relief of narrowing by utilizing viable native aortic tissue.
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Affiliation(s)
- Fumiya Yoneyama
- Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Alyssa B Kalustian
- Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - E Dean McKenzie
- Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S Heinle
- Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Tam T Doan
- Department of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ziyad Binsalamah
- Department of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Hashemi ASA, Gimenez A, Yim N, Bay C, Grush AE, Heinle JS, Buchanan EP. Anterior Chest Wall Reconstruction After Separation of Thoraco-Omphalopagus Conjoined Twins With Cadaveric Rib Grafts and Omental Flap. Ann Plast Surg 2023; 91:753-757. [PMID: 38079320 DOI: 10.1097/sap.0000000000003645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Anterior chest wall defects have a wide range of etiologies in the pediatric population, ranging from infection, tumor, and trauma to congenital diseases. The reconstructive goals include restoring skeletal stability, obliterating dead space, preserving cardiopulmonary mechanics, and protecting vital underlying mediastinal organs. Although various reconstructive methods have been described in the literature, selecting the optimal method is challenging for the growing pediatric skeleton. Here, we report a case of previously thoraco-omphalopagus twins who underwent successful separation and reconstruction and presented for definitive anterior chest wall reconstruction. METHODS A pair of previously thoraco-omphalopagus conjoined twins underwent definitive anterior chest wall defect reconstruction using cadaveric ribs and omental flap. Twin A received 2 cadaveric ribs, whereas twin B had a much larger sternal defect that required 3 cadaveric ribs combined with an omental flap for soft tissue chest coverage. Both twins were followed up for 8 months. RESULTS Twin A's postoperative course was uneventful, and she was discharged on postoperative day 6. Twin B's course was complicated, and she was discharged on supported ventilation on postoperative day 10. At 8 months postoperatively, both twins healed well, and chest radiographs confirmed the stability of the chest reconstructions. The rib grafts in the twin with a tracheostomy were not mobile, and the patient had a solid sternum with adequate pulmonary expansion. The construct initially did not facilitate pulmonary functioning, but after a healing process, it eventually allowed for the twin with the tracheostomy who required pulmonary assistance to no longer need this device. CONCLUSIONS Cryopreserved cadaveric ribs and omental flaps offer safe and reliable reconstructive methods to successfully reconstruct congenital anterior chest wall skeletal defects in the growing pediatric population. The involvement of multidisciplinary team care is key to optimizing the outcomes.
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Affiliation(s)
| | - Alejandro Gimenez
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | | | - Caroline Bay
- From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine
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Kalustian AB, Spigel ZA, Greenleaf CE, Doan TT, Chavez AI, Adachi I, Heinle JS, Binsalamah ZM. Comparing palliation strategies for single-ventricle anatomy with transposed great arteries and systemic outflow obstruction. JTCVS Tech 2023; 21:149-177. [PMID: 37854812 PMCID: PMC10579964 DOI: 10.1016/j.xjtc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/15/2023] [Accepted: 06/20/2023] [Indexed: 10/20/2023] Open
Abstract
Objective Patients with complex single-ventricle anatomy with transposed great arteries and systemic outflow obstruction (SV-TGA-SOO) undergo varied initial palliation with ultimate goal of Fontan circulation. We examine a longitudinal experience with multiple techniques, including the largest published cohort following palliative arterial switch operation (pASO), to describe outcomes and decision-making factors. Methods Neonates with SV-TGA-SOO who underwent initial surgical palliation from 1995 to 2022 at a single institution were retrospectively reviewed. Results In total, 71 neonates with SV-TGA-SOO underwent index surgical palliation at a median age of 7 days (interquartile range, 6-10) by pASO (n = 23), pulmonary artery band (PAB) with or without arch repair (n = 25), or modified Norwood with Damus-Kaye-Stansel aortopulmonary amalgamation (n = 23). Single-ventricle pathology included double-inlet left ventricle (n = 37, 52%), tricuspid atresia (n = 27, 38%), and others (n = 7, 10%). All mortalities (n = 5, 7%) occurred in the first interstage period after PAB (n = 3) and Norwood (n = 2). Subaortic obstruction in the PAB group was addressed by operative resection (n = 10 total, 7 at index operation) and/or delayed aortopulmonary amalgamation (n = 13, 52%). Two patients with pASO (9%) had early postoperative coronary complications, 1 requiring operative revision. Median follow-up for survivors was 10.4 years (interquartile range, 4.5-16.6 years). Comparing patients by their initial palliation type, notable significant differences included size of bulboventricular foramen, weight at initial operation, operation duration, postoperative length of stay, time to second-stage palliation, multiple pulmonary artery reinterventions, and left pulmonary artery interventions. There were no significant differences in overall survival, Fontan completion, reintervention-free survival in the first interstage period, pulmonary artery reintervention-free survival, long-term systemic valve competency, or ventricular dysfunction. Conclusions Excellent mid- to long-term outcomes are achievable following neonatal palliation for SV-TGA-SOO via pASO, PAB, and modified Norwood, with comparable survival and Fontan completion. Initial palliation strategy should be individualized to optimize anatomy and physiology for successful Fontan by ensuring an unobstructed subaortic pathway and accessible pulmonary arteries. pASO is a reasonable strategy to consider for these heterogeneous lesions.
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Affiliation(s)
- Alyssa B. Kalustian
- Congenital Heart Surgery, Texas Children's Hospital–Baylor College of Medicine, Houston, Tex
| | | | - Christopher E. Greenleaf
- Congenital Heart Surgery, Pediatric Surgery, The University of Texas Health Science Center at Houston, Houston, Tex
| | - Tam T. Doan
- Pediatric Cardiology, Texas Children's Hospital–Baylor College of Medicine, Houston, Tex
| | - Alejandra I. Chavez
- Pediatric Cardiology, Texas Children's Hospital–Baylor College of Medicine, Houston, Tex
| | - Iki Adachi
- Congenital Heart Surgery, Texas Children's Hospital–Baylor College of Medicine, Houston, Tex
| | - Jeffrey S. Heinle
- Congenital Heart Surgery, Texas Children's Hospital–Baylor College of Medicine, Houston, Tex
| | - Ziyad M. Binsalamah
- Congenital Heart Surgery, Texas Children's Hospital–Baylor College of Medicine, Houston, Tex
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Doan TT, Wilkes JK, Reaves O'Neal DL, Bonilla-Ramirez C, Sachdeva S, Masand P, Mery CM, Binsalamah Z, Heinle JS, Molossi S. Clinical Presentation and Medium-Term Outcomes of Children With Anomalous Aortic Origin of the Left Coronary Artery: High-Risk Features Beyond Interarterial Course. Circ Cardiovasc Interv 2023; 16:e012635. [PMID: 37192311 DOI: 10.1161/circinterventions.122.012635] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/04/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Anomalous aortic origin of the left coronary artery (AAOLCA) confers a rare, but significant, risk of sudden cardiac death in children. Surgery is recommended for interarterial AAOLCA, and other subtypes considered benign. We aimed to determine the clinical characteristics and outcomes of 3 AAOLCA subtypes. METHODS All patients with AAOLCA <21 years old were prospectively enrolled (December 2012-November 2020), including group 1: AAOLCA from the right aortic sinus with interarterial course, group 2: AAOLCA from the right aortic sinus with intraseptal course, and group 3: AAOLCA with a juxtacommissural origin between the left and noncoronary aortic sinus. Anatomic details were assessed using computed tomography angiography. Provocative stress testing (exercise stress testing and stress perfusion imaging) was performed in patients >8 years old or younger if concerning symptoms. Surgery was recommended for group 1 and in select cases in group 2 and group 3. RESULTS We enrolled 56 patients (64% males) with AAOLCA (group 1, 27; group 2, 20; group 3, 9) at median age of 12 years (interquartile range, 6-15). Intramural course was common in group 1 (93%) compared with group 3 (56%) and group 2 (10%). Seven (13%) presented with aborted sudden cardiac death (group 1, 6/27; group 3, 1/9); 1 (group 3) with cardiogenic shock. Fourteen/42 (33%) had inducible ischemia on provocative testing (group 1, 32%; group 2, 38%; group 3, 29%). Surgery was recommended in 31/56 (56%) patients (group 1, 93%; group 2, 10%; and group 3, 44%). Surgery was performed in 25 patients at a median age 12 (interquartile range, 7-15) years; all have been asymptomatic and free from exercise restrictions at median follow-up of 4 (interquartile range, 1.4-6.3) years. CONCLUSIONS Inducible ischemia was noted in all 3 AAOLCA subtypes while most aborted sudden cardiac deaths occurred in interarterial AAOLCA (group 1). Aborted sudden cardiac death and cardiogenic shock may occur in AAOLCA with left/nonjuxtacommissural origin and intramural course, thus also deemed high-risk. A systematic approach is essential to adequately risk stratify this population.
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Affiliation(s)
- Tam T Doan
- Division of Cardiology, Department of Pediatrics (T.T.D., D.L.R.O., S.S., S.M.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - J Kevin Wilkes
- Pediatric Cardiology, Cook Children's Medical Center, Fort Worth, TX (J.K.W.)
| | - Dana L Reaves O'Neal
- Division of Cardiology, Department of Pediatrics (T.T.D., D.L.R.O., S.S., S.M.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Carlos Bonilla-Ramirez
- Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.S.H.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Shagun Sachdeva
- Division of Cardiology, Department of Pediatrics (T.T.D., D.L.R.O., S.S., S.M.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Prakash Masand
- Pediatric Radiology (P.M.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin (C.M.M.)
| | - Ziyad Binsalamah
- Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.S.H.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Jeffrey S Heinle
- Congenital Heart Surgery, Department of Surgery (C.B.-R., Z.B., J.S.H.), Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Silvana Molossi
- Division of Cardiology, Department of Pediatrics (T.T.D., D.L.R.O., S.S., S.M.), Texas Children's Hospital, Baylor College of Medicine, Houston
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Stephens NA, Chartan CA, Gazzaneo MC, Thomas JA, Das S, Mallory GB, Melicoff E, Vogel AM, Parker A, Hermes E, Heinle JS, McKenzie ED, Coleman RD. Use of Berlin EXCOR Cannulas in both Veno-Venous and Veno-Arterial Central ECMO Configurations Overcomes the Problem of Cannula Instability while Bridging Infants and Young Children to Lung Transplant. JTCVS Tech 2023; 18:111-120. [PMID: 37096088 PMCID: PMC10122161 DOI: 10.1016/j.xjtc.2023.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
Objectives Infants and young children awaiting lung transplantation present challenges that often preclude successful extracorporeal membrane oxygenation support as a bridge to transplantation. Instability of neck cannulas often results in the need for intubation, mechanical ventilation, and muscle relaxation creating a worse transplant candidate. With the use of Berlin Heart EXCOR cannulas (Berlin Heart, Inc) in both venoarterial and venovenous central cannulation configurations, 5 pediatric patients were successfully bridged to lung transplant. Methods We performed a single-center retrospective case review of central extracorporeal membrane oxygenation cannulation used as a bridge to lung transplantation cases performed at Texas Children's Hospital between 2019 and 2021. Results Six patients, 2 with pulmonary veno-occlusive disease (15-month-old male and 8-month-old male), 1 with ABCA3 mutation (2-month-old female), 1 with surfactant protein B deficiency (2-month-old female), 1 with pulmonary arterial hypertension in the setting of D-transposition of the great arteries after repair as a neonate (13-year-old male), and 1 with cystic fibrosis and end-stage lung disease, were supported for a median of 56.3 days on extracorporeal membrane oxygenation while awaiting transplantation. All patients were extubated after initiation of extracorporeal membrane oxygenation, participating in rehabilitation until transplant. No complications due to central cannulation and use of the Berlin Heart EXCOR cannulas were observed. One patient with cystic fibrosis developed fungal mediastinitis and osteomyelitis resulting in discontinuation of mechanical support and death. Conclusions Novel use of Berlin Heart EXCOR cannulas for central cannulation eliminates the problem of cannula instability allowing extubation, rehabilitation, and bridge to lung transplant for infants and young children.
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Wattenbarger LE, Kim JJ, Melicoff E, Miyake CY, Valdes SO, Pham TDN, Adachi I, Heinle JS, Howard TS. Atrial tachyarrhythmias after lung transplantation in children: A common occurrence. Pediatr Transplant 2023; 27:e14410. [PMID: 36314299 DOI: 10.1111/petr.14410] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Atrial arrhythmia's (AA) following lung transplant in adults are a well-described clinical finding. In pediatrics, however, there are limited data with some reports suggesting that arrhythmias are rare. METHODS We performed a single-center retrospective review of lung transplant recipients from January 2013 to June 2020. A detailed evaluation of clinical characteristics, presence of arrhythmias, and outcomes was completed. Arrhythmias were documented based on inpatient telemetry or remote Holter monitoring. Analyses assessing risk factors for arrhythmias and associations with clinical outcomes were performed. RESULTS Ninety-one lung transplants were performed in 90 patients. Post-operative AA occurred following 19% transplants. Ectopic atrial tachycardia was seen in 14%, atrial flutter in 2%, and a combination in 2%. The majority of these arrhythmias occurred within the first 45 days post-operatively. Antiarrhythmic treatment was required in 59%, but none required ablation or electrical cardioversion. In patients followed for a year or more, 88% had resolution of their arrhythmia. Arrhythmias were not associated with mortality. In further analysis, however, the presence of arrhythmia was associated with an increased length of ICU stay (median of 12 days (IQR 6, 23) versus 5 days (IQR 4, 9); p = .019) and overall length of hospital stay (median of 26 days (IQR 19, 36) versus 17 days (IQR 19, 36); p = .043). CONCLUSIONS Atrial tachyarrhythmias after lung transplantation are common in the pediatric population and usually occur early. Although they frequently require medical therapy and are associated with longer stays, there is no associated increased mortality. In addition, the arrhythmias typically self-resolve.
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Affiliation(s)
| | - Jeffrey J Kim
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Ernestina Melicoff
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Christina Y Miyake
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Santiago O Valdes
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Tam Dan N Pham
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Iki Adachi
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffrey S Heinle
- Section of Pediatric Cardiovascular Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Taylor S Howard
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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Backes ER, Afonso NS, Guffey D, Tweddell JS, Tabbutt S, Rudd NA, O'Harrow G, Molossi S, Hoffman GM, Hill G, Heinle JS, Bhat P, Anderson JB, Ghanayem NS. Cumulative comorbid conditions influence mortality risk after staged palliation for hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 2023; 165:287-298.e4. [PMID: 35599210 DOI: 10.1016/j.jtcvs.2022.01.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/10/2021] [Revised: 12/29/2021] [Accepted: 01/27/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Prematurity, low birth weight, genetic syndromes, extracardiac conditions, and secondary cardiac lesions are considered high-risk conditions associated with mortality after stage 1 palliation. We report the impact of these conditions on outcomes from a prospective multicenter improvement collaborative. METHODS The National Pediatric Cardiology Quality Improvement Collaborative Phase II registry was queried. Comorbid conditions were categorized and quantified to determine the cumulative burden of high-risk diagnoses on survival to the first birthday. Logistic regression was applied to evaluate factors associated with mortality. RESULTS Of the 1421 participants, 40% (575) had at least 1 high-risk condition. The aggregate high-risk group had lower survival to the first birthday compared with standard risk (76.2% vs 88.1%, P < .001). Presence of a single high-risk diagnosis was not associated with reduced survival to the first birthday (odds ratio, 0.71; confidence interval, 0.49-1.02, P = .066). Incremental increases in high-risk diagnoses were associated with reduced survival to first birthday (odds ratio, 0.23; confidence interval, 0.15-0.36, P < .001) for 2 and 0.17 (confidence interval, 0.10-0.30, P < .001) for 3 to 5 high-risk diagnoses. Additional analysis that included prestage 1 palliation characteristics and stage 1 palliation perioperative variables identified multiple high-risk diagnoses, poststage 1 palliation extracorporeal membrane oxygenation support (odds ratio, 0.14; confidence interval, 0.10-0.22, P < .001), and cardiac reoperation (odds ratio, 0.66; confidence interval, 0.45-0.98, P = .037) to be associated with reduced survival odds to the first birthday. CONCLUSIONS The presence of 1 high-risk diagnostic category was not associated with decreased survival at 1 year. Cumulative diagnoses across multiple high-risk diagnostic categories were associated with decreased odds of survival. Further patient accrual is needed to evaluate the impact of specific comorbid conditions within the broader high-risk categories.
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Affiliation(s)
- Emily R Backes
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex.
| | - Natasha S Afonso
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex
| | - Danielle Guffey
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex
| | - James S Tweddell
- Division of Cardiology, Department of Surgery, Department of Pediatrics, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sarah Tabbutt
- Divisions of Critical Care and Cardiology, Department of Pediatrics, University of California San Francisco and Benioff Children's Hospital, San Francisco, Calif
| | - Nancy A Rudd
- Division of Cardiology, Department of Pediatrics, Department of Anesthesia, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wis
| | - Ginny O'Harrow
- Division of Critical Care, Department of Pediatrics, University of Chicago Medicine and Comer Children's Hospital, Chicago, Ill
| | - Silvana Molossi
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex
| | - George M Hoffman
- Division of Cardiology, Department of Pediatrics, Department of Anesthesia, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wis
| | - Garick Hill
- Division of Cardiology, Department of Surgery, Department of Pediatrics, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey S Heinle
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex
| | - Priya Bhat
- Divisions of Cardiology and Critical Care, Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Tex
| | - Jeffrey B Anderson
- Division of Cardiology, Department of Surgery, Department of Pediatrics, University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nancy S Ghanayem
- Division of Critical Care, Department of Pediatrics, University of Chicago Medicine and Comer Children's Hospital, Chicago, Ill; Advocate Children's Hospital, Oak Lawn, Ill
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Spielberg DR, Melicoff E, Heinle JS, Hosek K, Mallory GB. Differential donor management of pediatric vs adult organ donors and potential impact on pediatric lung transplantation. J Heart Lung Transplant 2022; 42:522-532. [PMID: 36564335 DOI: 10.1016/j.healun.2022.11.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite clinical progress over time, a shortage of suitable donor organs continues to limit solid organ transplantation around the world. Lungs are the organs most likely to be assessed as unsuitable during donor management among all transplantable organs. Although the number of lung transplants performed in children is limited, death on the wait list remains a barrier to transplant success for many potential transplant candidates. Optimizing organ donor management can yield additional organs for transplant candidates. METHODOLOGY We accessed the Donor Management Goal (DMG) Registry to evaluate the efficiency and efficacy of donor management in the procurement of lungs for transplantation. Further, we stratified donors by age and compared pediatric age cohorts to adult cohorts with respect to attainment of donor management target goals and successful pathway to transplantation. We utilized recipient data from the Organ Procurement Transplantation Network (OPTN) to put this data into context. The DMG bundle consists of nine physiologic parameters chosen as end-points guiding donor management for potential organ donors. The number of parameters fulfilled has been regarded as an indication of efficacy of donor management. RESULTS We noted a markedly lower number of organ donors in the pediatric age group compared to adults. On the other hand, the number of donors greatly exceeds the number of infants, children and adolescents who undergo lung transplantation. Organs transplanted per donor peaks in the adolescent age group. At initial donor referral, DMG bundle attainment is lower in all age groups and improves during donor management. With respect to oxygenation, there is less overall improvement in younger donors compared to older donors during donor management. When donors who yield lungs for transplantation are compared to those whose lungs were not transplanted, oxygenation improved more substantially during donor management. Furthermore, improved oxygenation correlated with the total number of organs transplanted per donor. CONCLUSIONS In the face of continued wait list mortality on the pediatric lung transplant wait list, the number of young donors may not be a limiting factor. We believe that this dataset provides evidence that management of young pediatric donors is not as consistent or efficient as the management of older donors, potentially limiting the number of life-saving organs for pediatric lung transplant candidates. Across all ages, optimizing donor lung management may increase the potential to transplant multiple other organs.
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Affiliation(s)
- David R Spielberg
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ernestina Melicoff
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Kathleen Hosek
- Department of Quality Assurance, Texas Children's Hospital, Houston, Texas
| | - George B Mallory
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
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Bonilla-Ramirez C, Aggarwal V, Atyam M, Qureshi AM, Heinle JS, McKenzie ED. Decellularized vs Non-decellularized Allogeneic Pulmonary Artery Patches for Pulmonary Arterioplasty. Semin Thorac Cardiovasc Surg 2022; 35:722-730. [PMID: 35878741 DOI: 10.1053/j.semtcvs.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/11/2022]
Abstract
We studied pulmonary artery size, reinterventions, and panel reactive antibodies in patients with single-ventricle physiology who underwent a pulmonary arterioplasty with decellularized (DAPAP) and non-decellularized allogeneic pulmonary artery patches (non-DAPAP). Retrospective review identified 59 patients with single-ventricle physiology who underwent pulmonary arterioplasty from 2008 to 2017: 28 patients underwent arterioplasty with DAPAP and 31 patients with non-DAPAP. Demographic and operative variables were similar between groups. Among patients who underwent a Norwood procedure, a right ventricle to pulmonary artery shunt was more commonly used in the DAPAP group (12/20, 60%) and a modified Blalock-Taussig shunt was more commonly used in the non-DAPAP group (17/22, 77%). On multivariable analysis, the use of DAPAP was associated with higher pre-Fontan angiography Z-scores in right (estimate = 0.17, standard error = 0.04, P = 0.0005) and left pulmonary arteries (estimate = 0.12, standard error = 0.05, P = 0.01). No areas of calcification, discrete coarctation, or pulmonary dilation were noted in any of the pulmonary arteries. On multivariable analysis, the use of DAPAP was associated with higher freedom from pulmonary artery reinterventions (Hazard ratio = 0.36, 95% confidence interval = 0.13-0.9, P = 0.04). The median value for Class I panel reactive antibodies was 0% (IQR 0, 4) in the DAPAP and 23% (IQR 14, 36) in the non-DAPAP group. The median value for Class II panel reactive antibodies was 15% (IQR 0, 17) in the DAPAP and 21% (IQR 10, 22) in the non-DAPAP group. Pulmonary arterioplasty with DAPAP was associated with higher pre-Fontan pulmonary artery Z-scores and higher freedom from pulmonary artery reinterventions.
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Affiliation(s)
- Carlos Bonilla-Ramirez
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Manasa Atyam
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX
| | - E Dean McKenzie
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, TX.
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Achuff BJ, Lemming K, Causey JC, Sembera KA, Checchia PA, Heinle JS, Ghanayem NS. Opioid Weaning Protocol Using Morphine Compared With Nonprotocolized Methadone Associated With Decreased Dose and Duration of Opioid After Norwood Procedure. Pediatr Crit Care Med 2022; 23:361-370. [PMID: 34982761 DOI: 10.1097/pcc.0000000000002885] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Opioids are used to manage pain, comfort, maintain devices, and decrease oxygen consumption around Norwood palliation (NP), but in high dose and prolonged exposure, they increase risk of tolerance and iatrogenic withdrawal syndrome (IAWS). Variability in practice for IAWS prevention potentially increases opioid dose and duration. We hypothesize that protocolized weaning with morphine (MOR) versus nonprotocolized methadone (MTD) is associated with reduction in opioid exposure. DESIGN A before-versus-after study of outcomes of patients weaned with protocolized MOR versus nonprotocolized MTD including subset analysis for those patients with complications postoperatively. Primary endpoints include daily, wean phase, and total morphine milligram equivalent (MMEq) dose, duration, and, secondarily, length of stay (LOS). SETTING Quaternary-care pediatric cardiac ICU. PATIENTS Neonates undergoing single-ventricle palliation. INTERVENTIONS Introduction of IAWS prevention protocol. MEASUREMENTS AND MAIN RESULTS Analysis included 54 patients who underwent the NP in 2017-2018 including the subset analysis of 34 who had a complicated postoperative course. The total and wean phase opioid doses for the MTD group were significantly higher than that for the MOR group: 258 versus 22 and 115 versus 6 MMEq/kg; p < 0.001. Duration of opioid exposure was 63 days in the MTD group and 12 days in MOR group (p < 0.001). Subanalysis of the complicated subset also identifies higher total and wean dose for MTD group (293 vs 41 and 116 vs 7 MMEq/kg; p < 0.001) with a longer duration (65 vs 22 days; p = 0.001). Within the subset, LOS was 55% longer in the MTD group than that in the MOR group (150 vs 67 d; p = 0.01) and not different in the uncomplicated group. CONCLUSIONS After complex NP, a protocolized opioid weaning using MOR versus MTD is associated with 65% shorter opioid duration, 10-fold decreased dose, and shortened LOS.
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Affiliation(s)
| | | | - Jamie C Causey
- Pediatric Critical Care, Baylor College of Medicine, Houston, TX
| | | | - Paul A Checchia
- Pediatric Critical Care, Baylor College of Medicine, Houston, TX
| | - Jeffrey S Heinle
- Pediatric Critical Care, Baylor College of Medicine, Houston, TX
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Colquitt JL, Loar RW, Bolin EH, Ezon DS, Heinle JS, Morris SA. Left heart hypoplasia in the fetus: echocardiographic predictors of outcome. Prenat Diagn 2022; 42:447-460. [PMID: 35040508 DOI: 10.1002/pd.6101] [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] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Fetal left heart hypoplasia (LHH) with an apex-forming left ventricle may require neonatal intervention but it is difficult to predict. METHODS We performed a retrospective study of fetuses with LHH defined as normal segmental anatomy, apex-/near-apex forming left ventricle, and ≥1 left-sided Z-score <-2 between 1997-2014. Fetuses with mitral or aortic atresia, critical aortic stenosis, extracardiac anomalies, or fetal intervention were excluded. Classification and regression tree analyses (CART) were performed to construct algorithms to predict postnatal circulation: no surgery versus biventricular surgery versus single ventricle (SV) palliation. RESULTS Among 138 included fetuses, 52 (37%) underwent neonatal surgery, with 10 (7%) undergoing SV palliation. The strongest single outcome discriminator was exclusively left-to-right flow foramen ovale (FO) flow >32 weeks gestational age (seen in 0% with no surgery, 22% with biventricular surgery, 88% with SV palliation). On CART analysis >32 weeks GA, fetuses with right-to-left FO flow and aortopulmonary ratio >0.76 had 0% probability of neonatal surgery, while those with left-to-right FO flow and mitral valve Z-score <-3.6 had a 70% probability of SV palliation. CONCLUSION SV palliation is an uncommon outcome of fetal LHH. Fetal FO flow and other echocardiographic measures can help determine risk and type of postnatal intervention. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- John L Colquitt
- Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT
| | - Robert W Loar
- Pediatric Cardiology, Cook Children's Medical Center, Fort Worth, TX
| | - Elijah H Bolin
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas
| | - David S Ezon
- Icahn School of Medicine at Mount Sinai, Department of Pediatric Cardiology, Children's Heart Center, Mt. Sinai Hospital, New York, NY
| | - Jeffrey S Heinle
- Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Shaine A Morris
- Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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13
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Burrage LC, Heinle JS, Cerfolio RH, Guillerman RP, Patel KR, Santiago NC, Hoover WC, Mallory GB. Application of lung volume reduction surgery for a child with filamin A (FLNA) mutations. Pediatr Pulmonol 2022; 57:224-230. [PMID: 34882997 DOI: 10.1002/ppul.25681] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/04/2021] [Revised: 08/23/2021] [Accepted: 09/04/2021] [Indexed: 11/07/2022]
Abstract
Diffuse lung disease in early childhood due to mutations in the filamin A gene has been recently reported. Clinical outcomes vary among individuals indicating variability in phenotype but a substantial proportion of reported cases in early life have ended up in death or lung transplantation. We recently encountered a school-aged child in whom the diagnosis of a filamin A mutation was delayed and the natural history of emphysematous lung disease was altered by serial lung volume reduction surgeries. She eventually underwent a bilateral lung transplant and we report the natural history of her disease and treatments applied herein.
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Affiliation(s)
- Lindsay C Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffrey S Heinle
- Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Robert H Cerfolio
- Department of Cardiovascular Surgery, Division of Thoracic Surgery, New York University Langone, New York, New York, USA
| | | | - Kalyani R Patel
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Nahir C Santiago
- Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
| | - Wynton C Hoover
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - George B Mallory
- Department of Pediatrics, Baylor College of Medicine, Section of Pediatric Pulmonology, Houston, Texas, USA
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14
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Wattenbarger L, Howard TS, Melicoff-Portillo E, Miyake CY, Valdes SO, Pham TDN, Rochelson E, Heinle JS, Kim JJ. B-PO05-163 ATRIAL TACHYARRHYTHMIAS AFTER LUNG TRANSPLANTATION IN CHILDREN: A COMMON OCCURRENCE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.1082] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bonilla-Ramirez C, Ibarra C, Binsalamah ZM, Adachi I, Heinle JS, McKenzie ED, Caldarone CA, Imamura M. Right Ventricle to Pulmonary Artery Conduit Size Is Associated with Conduit and Pulmonary Artery Reinterventions After Truncus Arteriosus Repair. Semin Thorac Cardiovasc Surg 2021; 34:1003-1009. [PMID: 34087373 DOI: 10.1053/j.semtcvs.2021.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 01/10/2023]
Abstract
We studied conduit-related risk factors for mortality, conduit reintervention, conduit replacement, and pulmonary artery (PA) reinterventions after truncus repair. Patients who underwent truncus repair at our institution between 1995 and 2019 were studied. Cox proportional hazards modeling evaluated variables for association with mortality, time to conduit reintervention, time to conduit replacement, and time to PA reintervention. Truncus was repaired in 107 patients at median age of 17 days (IQR 9-45). Median follow-up time was 7 years. Aortic homografts were implanted in 57 (53%) patients, pulmonary homograft in 40 (37%), and bovine jugular conduit in 10 (9%). Median conduit size was 11 mm (IQR 10-12) and median conduit Z-score was 1.71 (IQR 1.08-2.34). At 5 years, there was 87% survival, 21% freedom from conduit reinterventions, 37% freedom from conduit replacements, and 55% freedom from PA reinterventions. Conduit size (HR 0.7, 95%CI 0.4-1.4, p=.41) and type (aortic homograft reference; bovine jugular vein graft HR 0.6, 95% CI 0.08-5.2, p=.69; pulmonary homograft HR 0.7, 95% CI 0.2-2.3, p=.58) were not associated with mortality. On multivariate analysis, the hazard for conduit reintervention, conduit replacement, and PA reintervention decreased with increasing conduit Z-score values of 1 to 2.5 (non-linear relationship, p<.01), with little additional reduction in hazard beyond this range. Implantation of a larger conduit within Z-score values of 1 and 2.5 is associated with a decreased hazard for conduit reintervention, conduit replacement, and PA reintervention after truncus repair. The type and size of the conduits did not impact mortality.
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Affiliation(s)
- Carlos Bonilla-Ramirez
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - Christopher Ibarra
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - Ziyad M Binsalamah
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - E Dean McKenzie
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - Christopher A Caldarone
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine; Houston, Texas.
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Ibarra C, Spigel Z, John R, Binsalamah ZM, Adachi I, Heinle JS, Caldarone CA, McKenzie ED, Imamura M. Surgical Techniques in Management of Supravalvular Aortic Stenosis in Children. Ann Thorac Surg 2021; 111:2021-2027. [DOI: 10.1016/j.athoracsur.2020.06.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/13/2020] [Accepted: 06/29/2021] [Indexed: 11/27/2022]
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Spinner JA, Denfield SW, Puri K, Morris SA, Costello JM, Moffett BS, Wang Y, Shekerdemian LS, Tunuguntla HP, Price JF, Heinle JS, Adachi I, Dreyer WJ, Cabrera AG. Hospital outcomes for pediatric heart transplant recipients undergoing tracheostomy: A multi-institutional analysis. Pediatr Transplant 2021; 25:e13904. [PMID: 33179431 DOI: 10.1111/petr.13904] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 11/28/2022]
Abstract
Tracheostomy is associated with increased mortality and resource utilization in children with CHD. However, the prevalence and hospital outcomes of tracheostomy in children with HTx are not known. We describe the prevalence and compare the post-HTx hospital outcomes of pediatric patients with Pre-TT and Post-TT to those without tracheostomy. A multi-institutional retrospective cohort study was performed using the Pediatric Health Information System database. Hospital mortality, mediastinitis, LOS, and costs were compared among patients with Pre-TT, Post-TT, and no tracheostomy. Pre-TT was identified in 29 (1.1%) and Post-TT was identified in 41 (1.6%) of 2603 index HTx hospitalizations. Patients with Pre-TT were younger and more likely to have CHD, a non-cardiac birth defect, or an airway anomaly compared to those without Pre-TT. Pre-TT was not independently associated with increased post-HTx in-hospital mortality. Age at HTx < 1 year, CHD, and Post-TT were associated with increased in-hospital mortality. Pre-TT that occurred during the HTx hospitalization and Post-TT were associated with increased resource utilization. Tracheostomy was not associated with mediastinitis.
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Affiliation(s)
- Joseph A Spinner
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Susan W Denfield
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Kriti Puri
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Shaine A Morris
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - John M Costello
- Department of Pediatrics, The Medical University of South Carolina, Charleston, SC, USA
| | - Brady S Moffett
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Yunfei Wang
- Department of Pediatrics, Cardiovascular Research Core - Section of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Lara S Shekerdemian
- Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Hari P Tunuguntla
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Jack F Price
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Iki Adachi
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - William J Dreyer
- Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric and Congenital Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Antonio G Cabrera
- Division of Pediatric Cardiology, Department of Pediatrics/Primary Children's Hospital Heart Center, University of Utah, Salt Lake City, UT, USA
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Spigel ZA, Edmunds EE, Caldarone CA, Hickey EJ, Binsalamah ZM, Heinle JS. Total anomalous pulmonary venous connection: Influence of heterotaxy and venous obstruction on outcomes. J Thorac Cardiovasc Surg 2021; 163:387-395.e3. [PMID: 33966882 DOI: 10.1016/j.jtcvs.2021.03.058] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies have demonstrated increased early mortality and pulmonary vein reintervention for patients with total anomalous pulmonary venous connection (TAPVC) and heterotaxy syndrome (HTX+) compared with patients with TAPVC without heterotaxy syndrome (HTX-). We aimed to evaluate the longitudinal risk of pulmonary vein reintervention and mortality in HTX + patients. METHODS A retrospective review was performed to identify longitudinal interventions in patients with TAPVC seen at a single center from 1995 to 2019. The mean cumulative interventions were described for all patients using the Nelson-Aalen estimator. Survival with TAPVC was described using Kaplan-Meier estimates. RESULTS A total of 336 patients were identified with TAPVC, of whom 118 (35%) had heterotaxy syndrome. Functional single ventricles were identified in 106 of these 118 HTX + patients (90%) and in 14 of 218 HTX- patients (6%) (P < .001). Obstructed TAPVC (OBS+) was present in 49 of 118 HTX + patients (42%) and in 87 of 218 HTX- patients (40%) (P = .89). The median duration of follow-up was 6.5 years. Five-year survival was 69% for HTX+/OBS + patients, 72% for HTX+/OBS- patients, 86% for HTX-/OBS + patients, and 95% for HTX-/OBS- patients (P < .0001, log-rank test). The mean number of pulmonary vein interventions at the median follow-up time was greater in the HTX+/OBS + patients compared with HTX+/OBS- patients (mean, 2.0 vs 1.1; P = .030), HTX-/OBS + patients (mean, 1.3; P = .033), and HTX-/OBS- patients (mean, 1.3; P = .029). CONCLUSIONS Among the 4 cohorts, HTX+ was associated with a higher rate of mortality, and HTX+/OBS+ was associated with a greater number of pulmonary vein interventions. This may be due in part to the high prevalence of single ventricle physiology in the HTX + cohort.
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Affiliation(s)
- Zachary A Spigel
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Evan E Edmunds
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Christopher A Caldarone
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Edward J Hickey
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Ziyad M Binsalamah
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex.
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Bonilla-Ramirez C, Salciccioli KB, Qureshi AM, Adachi I, Imamura M, Heinle JS, McKenzie ED, Caldarone CA, Allen HD, Binsalamah ZM. Smaller right pulmonary artery is associated with longer survival time without scimitar vein repair. J Card Surg 2021; 36:1352-1360. [PMID: 33604954 DOI: 10.1111/jocs.15405] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/27/2020] [Accepted: 01/29/2021] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The optimal management of scimitar syndrome remains incompletely defined. We (1) evaluated the impact of aortopulmonary collateral (APC) occlusion, (2) compared outcomes according to surgical approach for patients who underwent surgery, and (3) identified anatomic factors associated with longer survival time without scimitar vein repair. METHODS We conducted a single center, retrospective study of 61 patients diagnosed with scimitar syndrome between 1995 and 2019. Right pulmonary artery to total pulmonary artery cross-sectional area (RPA:PA CSA) quantitatively assessed right pulmonary artery size. Anatomical features were analyzed for association with longer survival time without scimitar vein repair. RESULTS Median follow-up time was 6 years (Q1-Q3, 2-12), with 96% 5-year survival. Twenty-three patients underwent APC occlusion, which significantly decreased symptoms of overcirculation (100%-46%; p = .001) and systolic pulmonary artery pressure (median, 34-29 mmHg; p = .004). Twenty-three patients underwent scimitar vein repair; 5-year freedom from scimitar vein stenosis was 90% among patients who underwent a reimplantation compared with 42% in patients with baffle repair (p = .1). Three patients underwent surgery before the first year of age, with lower 5-year freedom from scimitar vein stenosis (0% vs. 84%; p < .001). On multivariate analysis, a lower RPA:PA CSA was associated with longer survival time without scimitar vein repair (p = .003). CONCLUSIONS APC occlusion improves the clinical status of young and hemodynamically unstable patients. Repair at an early age is associated with an increased risk of scimitar vein stenosis. Scimitar vein repair might be avoided in patients with a smaller right pulmonary artery.
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Affiliation(s)
- Carlos Bonilla-Ramirez
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | | | - Athar M Qureshi
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Iki Adachi
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Michiaki Imamura
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jeffrey S Heinle
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - E Dean McKenzie
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | | | - Hugh D Allen
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Ziyad M Binsalamah
- Heart Center, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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Chacon-Portillo MA, Mossad EB, Zea-Vera R, Beckerman Z, Binsalamah ZM, Adachi I, Mery CM, Imamura M, Heinle JS, Fraser CD. Sickle Cell-Related Complications in Patients Undergoing Cardiopulmonary Bypass. World J Pediatr Congenit Heart Surg 2020; 11:565-571. [PMID: 32853076 DOI: 10.1177/2150135120926991] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We aimed to describe our experience with patients with sickle cell trait (SCT) and undergoing surgery on cardiopulmonary bypass (CPB). METHODS Data on all patients with SCT or sickle-α thalassemia who underwent surgery on CPB were collected (1996-2017). RESULTS Overall, 46 patients were included, 37 (80%) had SCT and 9 (20%) had sickle-α thalassemia. A total of 4 (9%) developed a potential sickle cell-related complication. Patients with sickle cell-related complications were significantly older (median 14 years vs 14 months, P = .037) and heavier (median 54 kg vs 9 kg, P = .041). Complications occurred, although without statistical significance, in patients who underwent longer median CPB times (249 minutes vs 137 minutes, P = .069), lower median temperature (31.7 °C vs 33.3 °C, P = .094), and a higher percentage underwent deep hypothermic circulatory arrest (50% vs 7%, P = .053). A total of 30 (65%) patients underwent exchange transfusion (ET) pre-bypass. Patients who underwent ET were significantly older (median 4 years vs 7 months, P = .003) and heavier (median 16 kg vs 6 kg, P = .015) than patients who did not undergo ET. The incidence of complications was comparable between patients who underwent ET (10%) and those who did not (6%). CONCLUSIONS In this retrospective, single-center study, it has been shown that cardiac surgery requiring CPB in patients with SCT and sickle-α thalassemia had a low risk for sickle cell-associated complications. In this cohort of patients, older age, longer CPB times, lower median temperature, and the utilization of deep hypothermic circulatory arrest appear to play an important role in the development of complications.
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Affiliation(s)
- Martin A Chacon-Portillo
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Emad B Mossad
- Division of Pediatric Cardiovascular Anesthesia, 3989Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Ziv Beckerman
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Ziyad M Binsalamah
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Iki Adachi
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, 3984Texas Children's Hospital, Houston, TX, USA.,Michael E. DeBakey Department of Surgery, 3989Baylor College of Medicine, Houston, TX, USA
| | - Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, 441903University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA
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Binsalamah ZM, Ibarra C, Edmunds EE, Qureshi AM, Adachi I, Caldarone CA, Imamura M, Mckenzie ED, Heinle JS, Spigel ZA. Younger Age at Operation Is Associated With Reinterventions After the Warden Procedure. Ann Thorac Surg 2020; 111:2059-2065. [PMID: 32712100 DOI: 10.1016/j.athoracsur.2020.05.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/09/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multiple techniques are available for repair of supracardiac partial anomalous pulmonary venous return (PAPVR); however, most series fail to compare the techniques in contemporary cohorts. This study aimed to describe outcomes of the Warden procedure with a single-patch repair cohort to serve as a control. METHODS A retrospective cohort analysis of all patients at a single institution (Texas Children's Hospital, Houston, TX) included patients undergoing either the Warden procedure or single-patch repair from 1996 to 2019 for PAPVR. Reintervention was defined as any catheter or surgical procedure on the superior vena cava (SVC) or pulmonary veins. Subgroup analysis was performed within the Warden cohort to evaluate for association between an SVC patch and reintervention-free survival. RESULTS In total, 158 patients (122 in the Warden group and 36 in the single-patch group) were identified. The median age at operation was younger for patients in the Warden cohort (5.4 years; interquartile range, 3.3 to 10.2 years) compared with patients in the single-patch cohort (13.3 years; interquartile range, 6.5 to 18.7 years; P < .001). One patient in each cohort died. One patient required reoperation after the Warden procedure for dehiscence of the intracardiac patch. Ten patients required transcatheter reinterventions. Reintervention-free survival was not different between patients in the Warden cohort and patients in the single-patch cohort (P = .54) or within the Warden cohort in patients with an SVC patch (P = .27). When controlling for repair type, older age at repair was associated with longer reintervention-free survival (hazard ratio, 0.81; 95% confidence interval, 0.71 to 0.93; P = .002). CONCLUSIONS The Warden procedure is a viable option for younger patients requiring supracardiac PAPVR repair, although these younger patients are likely at greatest risk for reintervention regardless of surgical technique.
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Affiliation(s)
- Ziyad M Binsalamah
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
| | - Christopher Ibarra
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Evan E Edmunds
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Athar M Qureshi
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Christopher A Caldarone
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - E Dean Mckenzie
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Zachary A Spigel
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
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Lahiri S, Justino H, Heinle JS, Hernandez JA, Miyake CY. Ultrasound-guided intraoperative trans-epicardial needle biopsy of an intracardiac tumor. Ann Pediatr Cardiol 2020; 13:346-348. [PMID: 33311926 PMCID: PMC7727904 DOI: 10.4103/apc.apc_45_20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 11/06/2022] Open
Abstract
We describe the use of a novel interventional approach to the histopathologic diagnosis of a ventricular septal tumor using intraoperative ultrasound-guided trans-epicardial biopsy without the need for cardiopulmonary bypass in a 2-year-old child. This novel approach has not been previously reported. Multidisciplinary collaboration between cardiothoracic surgery, cardiology, cardiac imaging, and interventional radiology provided the ability to perform cardiac biopsy. This technique may be used in specific cases of cardiac tumors where tissue diagnosis is important, but surgical resection is deemed excessively risky or impossible.
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Affiliation(s)
- Subhrajit Lahiri
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
| | - Henri Justino
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
| | - Jeffrey S Heinle
- Department of Cardiothoracic Surgery, Texas Children's Hospital, Houston, TX, USA
| | | | - Christina Y Miyake
- Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA
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Spigel ZA, Kalustian AB, Binsalamah ZM, Caldarone CA, Imamura M, Adachi I, Heinle JS, McKenzie ED. Recurrent Pulmonary Artery Interventions Following the Norwood Procedure Are Not Associated With Conduit Type. Semin Thorac Cardiovasc Surg 2020; 33:195-201. [PMID: 32512161 DOI: 10.1053/j.semtcvs.2020.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 11/11/2022]
Abstract
Given pulmonary artery interventions following the Norwood procedure can recur, the average number of occurrences per patient over time is likely more informative than the crude percentage of patients who required an intervention. Pulmonary artery intervention was defined as any surgical or catheter-based procedure after the Norwood procedure. The number of pulmonary artery interventions for patients with hypoplastic left heart syndrome were compared between patients with modified Blalock-Taussig Shunts (MBTS) and right ventricle-to-pulmonary artery conduits (RVPA) at a single institution from 2011 to 2018. The comparison was replicated using data from the Single Ventricle Reconstruction Trial (SVR), a nonoverlapping dataset. The mean number of pulmonary artery interventions per patient over time (mean cumulative function, MCF) is described using Nelson-Aalen estimates and compared using the pseudo-score test. The number of patients requiring intervention was compared using the chi-square test. Using our institutional dataset, the Norwood operation was performed on 117 patients (59 MBTS, 58 RVPA). In total, 73 patients had a pulmonary artery intervention, including 32 of 58 (55%) after MBTS and 41 of 59 (69%) after RVPA (P= 0.11). The MCF did not vary between cohorts (P = 0.55). Using the SVR trial dataset, 140 of 549 patients required pulmonary artery intervention, including 55 (21%) after MBTS and 85 (30%) after RVPA (P = 0.0090). The MCF did not vary between cohorts (P = 0.067). Although more patients with RVPA than MBTS require pulmonary artery interventions after the Norwood procedure, the MCFs are not different, which may be of greater importance to patients and families.
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Affiliation(s)
- Zachary A Spigel
- Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Alyssa B Kalustian
- Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Ziyad M Binsalamah
- Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Christopher A Caldarone
- Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Michiaki Imamura
- Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Iki Adachi
- Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Jeffrey S Heinle
- Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Emmett D McKenzie
- Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
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Spigel ZA, Zhu H, Qureshi AM, Penny DJ, Caldarone CA, Heinle JS, Binsalamah ZM. Durability of the St. Jude Epic Supra Bioprosthetic Valve in the Pulmonary Position. Semin Thorac Cardiovasc Surg 2020; 33:184-191. [PMID: 32505797 DOI: 10.1053/j.semtcvs.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 11/11/2022]
Abstract
Epic Supra valves have been used off-label in the pulmonary position. We aim to evaluate the durability of Epic valves in the pulmonary position. We performed a retrospective review of all Epic valves placed in the pulmonary position from October 2008 to May 2019. Time-to-event analysis was performed using Kaplan-Meier estimates to evaluate freedom from valve intervention, moderate pulmonary regurgitation, and peak velocity greater than 3.5 m/s. Valve dysfunction was a composite of all 3 end points. A total of 79 patients had Epic valves implanted in the pulmonary position. Median age was 18.5 years (15th-85th percentile 11.2-41.0). In total, 1 (1%) 19 mm valve, 4 (5%) 21 mm valves, 8 (10%) 23 mm valves, 23 (29%) 25 mm valves, and 43 (54%) 27 mm valves were implanted. There were no deaths or transplants. Median follow-up was 3.1 years (interquartile range 1.0-5.5). At 5 years, freedom from valve intervention was 95%, freedom from valve dysfunction was 68%, freedom from moderate pulmonary regurgitation was 73%, and freedom from peak velocity greater than 3.5 m/s was 82%. Epic Supra valves provide an acceptable valve replacement in the pulmonary position for children and adults. Longer follow-up is needed to determine valve durability through the entirety of the valve life expectancy.
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Affiliation(s)
- Zachary A Spigel
- Texas Children's Hospital/Baylor College of Medicine, Department of Surgery, Division of Congenital Heart Surgery, Houston, Texas
| | - Huirong Zhu
- Texas Children's Hospital/Baylor College of Medicine, Department of Surgery, Outcomes and Impact Service, Houston, Texas
| | - Athar M Qureshi
- Texas Children's Hospital/Baylor College of Medicine, Department of Pediatrics, Division of Cardiology, Houston, Texas
| | - Daniel J Penny
- Texas Children's Hospital/Baylor College of Medicine, Department of Pediatrics, Division of Cardiology, Houston, Texas
| | - Christopher A Caldarone
- Texas Children's Hospital/Baylor College of Medicine, Department of Surgery, Division of Congenital Heart Surgery, Houston, Texas
| | - Jeffrey S Heinle
- Texas Children's Hospital/Baylor College of Medicine, Department of Surgery, Division of Congenital Heart Surgery, Houston, Texas
| | - Ziyad M Binsalamah
- Texas Children's Hospital/Baylor College of Medicine, Department of Surgery, Division of Congenital Heart Surgery, Houston, Texas.
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Spigel ZA, Qureshi AM, Morris SA, Mery CM, Sexson-Tejtel SK, Zea-Vera R, Binsalamah ZM, Imamura M, Heinle JS, Adachi I. Right Ventricle-Dependent Coronary Circulation: Location of Obstruction Is Associated With Survival. Ann Thorac Surg 2020; 109:1480-1487. [DOI: 10.1016/j.athoracsur.2019.08.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/20/2022]
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26
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Binsalamah ZM, Ibarra C, Spigel Z, Zea-Vera R, Zink J, Heinle JS, Caldarone CA. Primary Aortic Root Replacement Outcomes and Risk Factors in Pediatric Patients. Ann Thorac Surg 2020; 110:189-197. [PMID: 32251661 DOI: 10.1016/j.athoracsur.2020.02.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/15/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The study sought to identify the optimal aortic root replacement (ARR) strategy for pediatric patients, and a single-center experience was analyzed. METHODS Retrospective review of patients undergoing ARR from 1995 to 2018 was performed. Patients were stratified by surgical strategy (pulmonary autograft [Ross procedure], aortic homograft, mechanical valve conduit [Bentall procedure], or porcine xenograft [Freestyle bioprosthesis]) and aortic annulus size. RESULTS ARR was performed in 206 patients with a median follow-up of 5.0 (interquartile range, 1.4-11.4) years. Root replacements included Ross procedure (n = 98), homograft (n = 83), Bentall procedure (n = 18), and Freestyle bioprosthesis (n = 7). Overall survival was 92%, and freedom from reoperation or death was 81%. Reoperation-free survival was superior in the Ross group when compared with other groups. Because surgical options differ based on the size of the aortic annulus, the analysis was arbitrarily stratified. When the aortic annulus diameter was greater than 19 mm (n = 74), procedures included Ross procedure (n = 23), homograft (n = 29), Bentall procedure (n = 17), and Freestyle bioprosthesis (n = 5). Reoperation-free survival at median follow-up (5 years) was 86%, 58%, 100%, and 100%, respectively. The Bentall procedure offered the longest freedom from reoperation. In the subset with aortic annulus diameter less than 19 mm and a pulmonary valve suitable for a Ross procedure, patients underwent the Ross procedure (n = 75) or homograft ARR (n = 36). At median follow-up (3.8 years), reoperation-free survival was longer after the Ross procedure than after homograft ARR (88% vs 46%; P < .001). CONCLUSIONS In patients with a large aortic annulus, a Bentall ARR offers the longest reoperation-free survival. For patients with small aortic roots, a Ross procedure provides better a reoperation-free survival than does homograft ARR.
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Affiliation(s)
- Ziyad M Binsalamah
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, Texas.
| | - Christopher Ibarra
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Zachary Spigel
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jessica Zink
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Christopher A Caldarone
- Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, Texas
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Fraser CD, Chacon-Portillo MA, Well A, Zea-Vera R, Binsalamah Z, Adachi I, Mery CM, Heinle JS. Twenty-Three-Year Experience With the Arterial Switch Operation: Expectations and Long-Term Outcomes. Semin Thorac Cardiovasc Surg 2020; 32:292-299. [PMID: 31958553 DOI: 10.1053/j.semtcvs.2020.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 11/26/2019] [Accepted: 01/12/2020] [Indexed: 11/11/2022]
Abstract
We aimed to describe the short- and long-term outcomes of patients after an arterial switch operation (ASO) at a single institution during a 23-year period. A retrospective chart review of all patients <18 months of age who underwent an ASO between January 1995 and March 2018 at Texas Children's Hospital, Houston, TX was performed. Primary endpoints include mortality and reintervention. Perioperative mortality was defined as mortality occurring in-hospital and/or <30 days after surgery. Survival and freedom-from-reintervention were analyzed using Kaplan-Meier method, log-rank tests, and Cox regression models. The cohort included 394 patients. Diagnoses included 204 patients (52%) with intact ventricular septum, 137 (35%) with a ventricular septal defect, 17 (4%) with a ventricular septal defect and left ventricular outflow tract obstruction (LVOTO), and 36 (9%) with Taussig-Bing anomaly. Median age at surgery was 8 days (range: 1 day to 17 months) and median weight was 3.4 (range: 0.8-12.0) kg. Overall perioperative mortality was 1.3% (n = 5), 0.3% (n = 1) since 1999. Overall survival at 5, 10, and 15 years was 98.2%, 97.8%, and 97.8%, respectively. Perioperative morality was associated with prematurity (P = 0.012), <2.5 kg (P< 0.001), and longer circulatory arrest (P = 0.024) after univariate analysis. Reintervention was associated with a longer cross-clamp time (P < 0.001), <2.5 kg (P = 0.009), LVOTO resection (P = 0.047), and genetic syndrome (P= 0.011) after multivariable analysis. Current ASO expectations should include a perioperative mortality risk of <1% and good long-term survival. Reinterventions are more frequent in patients <2.5 kg, concomitant LVOTO resection, a genetic syndrome, and longer cross-clamp time.
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Affiliation(s)
- Charles D Fraser
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Texas.
| | - Martin A Chacon-Portillo
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Andrew Well
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Texas
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ziyad Binsalamah
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Children's Medical Center, University of Texas Dell Medical School, Austin, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Adachi I, Spinner JA, Tunuguntla HP, Elias BA, Heinle JS. The miniaturized pediatric continuous-flow device: A successful bridge to heart transplant. J Heart Lung Transplant 2019; 38:789-793. [PMID: 31109819 DOI: 10.1016/j.healun.2019.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Iki Adachi
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| | - Joseph A Spinner
- Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Hari P Tunuguntla
- Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Barbara A Elias
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Fraser CD, Chacon-Portillo MA, Zea-Vera R, John R, Elias BA, Heinle JS, Mery CM, Tunuguntla HP, Cabrera AG, Price JF, Denfield SW, Dreyer WJ, Qureshi AM, Adachi I. Ventricular Assist Device Support: Single Pediatric Institution Experience Over Two Decades. Ann Thorac Surg 2019; 107:829-836. [DOI: 10.1016/j.athoracsur.2018.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/30/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022]
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Bangalore H, Checchia PA, Ocampo EC, Heinle JS, Minard CG, Shekerdemian LS. Cortisol Response in Children After Second Cardiopulmonary Bypass. Pediatr Cardiol 2019; 40:47-52. [PMID: 30167750 DOI: 10.1007/s00246-018-1959-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 05/04/2018] [Accepted: 08/09/2018] [Indexed: 12/29/2022]
Abstract
A surge in cortisol levels is seen after surgery with cardiopulmonary bypass (CPB). Based on evidence of attenuation of the cortisol response to repeated stress in other settings, we hypothesized that the magnitude of cortisol increase in children after a second exposure to CPB would be reduced. Serial cortisol levels were measured at three time points after each CPB: immediately (day 0), on the first morning (day 1), and second morning (day 2). Forty-six children underwent two surgeries with CPB during the study period. The mean age (standard deviation) at first and second surgery was 3.5 (6.3) months and 10.4 (9.9) months, respectively. Cortisol levels at the first surgery were 109 (105) µg/dl, 29 (62) µg/dl, and 17 (12) µg/dl on day 0, 1, and 2, respectively; similarly at second surgery, it was 61 (57) µg/dl on day 0 to 20 (16) µg/dl and 11 (10) µg/dl on day 1 and 2, respectively. After log-transformation and adjusting for time interval between surgeries, cortisol levels at the second surgery were lower by 42% on day 0 (p = 0.02), and 46% lower on day 2 (p = 0.02). A second exposure to CPB in children with congenital heart disease is associated with an attenuated cortisol release.
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Affiliation(s)
- Harish Bangalore
- Department of Pediatrics, Section of Critical Care, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St. Suite W6006, Houston, TX, 77030, USA
| | - Paul A Checchia
- Department of Pediatrics, Section of Critical Care, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St. Suite W6006, Houston, TX, 77030, USA
| | - Elena C Ocampo
- Department of Pediatrics, Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Charles G Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Lara S Shekerdemian
- Department of Pediatrics, Section of Critical Care, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St. Suite W6006, Houston, TX, 77030, USA.
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Dhillon GS, Fernandes CJ, Khan A, Heinle JS, Lopez KN. Transposition of the great arteries: When echocardiography does not match the clinical picture. J Clin Ultrasound 2018; 46:617-622. [PMID: 30160304 PMCID: PMC6710829 DOI: 10.1002/jcu.22615] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/01/2018] [Accepted: 06/10/2018] [Indexed: 06/08/2023]
Abstract
Aortopulmonary window (APW) is a rare form of congenital heart disease seen in isolation or with complex cardiac lesions. APW has been associated with other cardiac defects such as interrupted aortic arch and Tetralogy of Fallot, but few cases have been reported of APW associated with transposition of the great arteries (TGA). In a newborn with TGA and intact ventricular septum, diagnosis of APW requires a high index of suspicion. This article reviews the literature on TGA with APW and illustrates the importance of additional evaluation in neonates with TGA when oxygen saturation and PaO2 do not match predicted clinical values.
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Affiliation(s)
- Gurpreet S. Dhillon
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Caraciolo J. Fernandes
- Section of Neonatology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Asra Khan
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey S. Heinle
- Division of Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Keila N. Lopez
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
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Chacon-Portillo MA, Zea-Vera R, Zhu H, Dickerson HA, Adachi I, Heinle JS, Fraser CD, Mery CM. Pulsatile Glenn as long-term palliation for single ventricle physiology patients. CONGENIT HEART DIS 2018; 13:927-934. [PMID: 30280502 DOI: 10.1111/chd.12664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/17/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE There are limited studies analyzing pulsatile Glenn as a long-term palliation strategy for single ventricle patients. This study sought to determine their outcomes at a single institution. DESIGN A retrospective review was performed. SETTING Study performed at a single pediatric hospital. PATIENTS All single ventricle patients who underwent pulsatile Glenn from 1995 to 2016 were included. OUTCOME MEASURES Pulsatile Glenn failure was defined as takedown, transplant, or death. Further palliation was defined as Fontan, 1.5, or biventricular repair. Risk factors were assessed by Cox multivariable competing risk analyses. RESULTS Seventy-eight patients underwent pulsatile Glenn at age 9 months (interquartile range, 5-14). In total, 28% had heterotaxy, 18% had a genetic syndrome, and 24% had an abnormal inferior vena cava. There were 3 (4%) perioperative mortalities. Further palliation was performed in 41 (53%) patients with a median time-to-palliation of 4 years (interquartile range, 3-5). Pulsatile Glenn failure occurred in 10 (13%) patients with 8 total mortalities. Five- and 10-year transplant-free survival were 91% and 84%, respectively. At a median follow-up of 6 years (interquartile range, 2-8), 27 patients (35%) remained with PG (age 7 years [interquartile range, 3-11], oxygen saturation 83% ± 4%). Preoperative moderate-severe atrioventricular valve regurgitation (AVVR) (hazard ratio 7.77; 95% confidence interval 1.80-33.43; P =.005) and higher pulmonary vascular resistance (hazard ratio 2.59; 95% confidence interval 1.08-6.15; P =.031) were predictors of pulsatile Glenn failure after adjusting for covariates. Reaching further palliation was less likely in patients with preoperative moderate-severe AVVR (hazard ratio 0.22, 95% confidence interval 0.08-0.59; P =.002). CONCLUSION Pulsatile Glenn can be an effective tool to be used in challenging circumstances, these patients can have a favorable long-term prognosis without reducing their suitability for further palliation.
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Affiliation(s)
- Martin A Chacon-Portillo
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Huirong Zhu
- Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas
| | - Heather A Dickerson
- Division of Pediatric Cardiology, Texas Children's Hospital, Houston, Texas.,Baylor College of Medicine, Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Carlos M Mery
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
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Mery CM, Zea-Vera R, Chacon-Portillo MA, Zhu H, Kyle WB, Adachi I, Heinle JS, Fraser CD. Contemporary Outcomes After Repair of Isolated and Complex Complete Atrioventricular Septal Defect. Ann Thorac Surg 2018; 106:1429-1437. [PMID: 30009807 DOI: 10.1016/j.athoracsur.2018.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 01/31/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Contemporary outcomes of complete atrioventricular septal defect (CAVSD) repair, particularly for defects with associated abnormalities, is unclear. The goal of this study is to report an all-inclusive experience of CAVSD repair using a consistent surgical approach. METHODS All patients undergoing CAVSD repair between 1995 and 2016 at our institution were included. Patients were divided into 2 groups: isolated and complex (tetralogy of Fallot, aortic arch repair, double outlet right ventricle, and total anomalous pulmonary venous return). Survival and reoperation were analyzed using log-rank test and Gray's test, respectively. Multivariable analysis was performed with Cox regression. RESULTS Overall, 406 patients underwent repair: 350 (86%) isolated and 56 (14%) complex CAVSD (tetralogy of Fallot: 34, double outlet right ventricle: 7, aortic arch repair: 12, total anomalous pulmonary venous return: 3). Median age at repair was 5 months (range, 10 days to 16 years); 339 (84%) had trisomy 21. A 2-patch repair was used in 395 (97%) and the zone of apposition was completely closed in 305 (75%). Perioperative mortality was 2% and 4% in the isolated and complex groups, respectively. Perioperative mortality since 2006 was 0.9%. Median follow-up was 7 years. Overall 10-year survival and incidence of any reoperation were 92% and 11%, respectively. Complex anatomy was not a risk factor for mortality (p = 0.35), but it was for reoperation (hazard ratio [HR]: 2.6; p < 0.01). Risk factors for left atrioventricular valve reoperation were a second bypass run (HR: 2.7) and preoperative moderate or worse regurgitation (HR: 2.3). CONCLUSIONS Mortality after CAVSD repair is low, yet reoperation remains a significant problem. Repair of complex CAVSD can be performed with similar mortality rates.
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Affiliation(s)
- Carlos M Mery
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
| | - Rodrigo Zea-Vera
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Martin A Chacon-Portillo
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Huirong Zhu
- Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas
| | - William B Kyle
- Division of Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
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Fraser CD, Watrin C, Carberry KE, Dyer K, Adachi I, Mery CM, McKenzie ED, Heinle JS. Contemporary Outcomes in Pediatric and Congenital Heart Surgery in a Dedicated Surgical Program. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.231] [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: 11/17/2022]
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Georgopoulos R, Hill C, Heinle JS, Mehta D. Congenital right bronchial stenosis with high bifurcation: Successful management with side to side tracheobronchial anastomosis. Int J Pediatr Otorhinolaryngol 2018; 111:180-182. [PMID: 29958606 DOI: 10.1016/j.ijporl.2018.06.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 11/26/2022]
Abstract
Congenital bronchial stenosis is a rare entity [1,2]. While there are some reports of congenital bronchial anomalies and their repair in the thoracic literature this is first report in the literature of a bronchial take off just below the larynx managed with surgical success. Here we present a case of a former 33-weeker born with a tracheoesophageal fistula, Tetralogy of Fallot, and a high bifurcation of the right mainstem bronchus with a concomitant long segment bronchial stenosis. Preoperative planning included printing 3-D reconstructed models of the airway to analyze various treatment options. At 3 months of age the patient was taken to the operating room for surgical repair of the Tetralogy of Fallot and side-to-side tracheobroncheoplasty. The patient was extubated on postoperative day 3 and was discharged home without need for any ventilatory support.
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Affiliation(s)
- Rachel Georgopoulos
- Department of Pediatric Otolaryngology Texas Children's Hospital, United States.
| | - Courtney Hill
- Department of Pediatric Otolaryngology Texas Children's Hospital, United States
| | - Jeffrey S Heinle
- Department of Cardiovascular Surgery Texas Children's Hospital, United States
| | - Deepak Mehta
- Department of Pediatric Otolaryngology Texas Children's Hospital, United States
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36
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Binsalamah ZM, Greenleaf CE, Heinle JS. Type A interrupted aortic arch and type III aortopulmonary window with anomalous origin of the right pulmonary artery from the aorta. J Card Surg 2018; 33:344-347. [PMID: 29749109 DOI: 10.1111/jocs.13717] [Citation(s) in RCA: 4] [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] [Indexed: 11/28/2022]
Abstract
Interruption of the aortic arch, aortopulmonary window, and anomalous origin of the right pulmonary artery from the ascending aorta are very rare congenital anomalies. It is even rarer to have all three anomalies in the same setting. We present a case of a newborn who was diagnosed with these lesions and describe the primary repair of these anomalies.
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Affiliation(s)
- Ziyad M Binsalamah
- Congenital Heart Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Christopher E Greenleaf
- Congenital Heart Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Congenital Heart Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
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37
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Binsalamah ZM, Chacon-Portillo MA, Sanyahumbi A, Adachi I, Heinle JS, Fraser CD, Mery CM. Circumflex aorta with double aortic arch in an infant. J Card Surg 2018; 33:292-295. [PMID: 29664156 DOI: 10.1111/jocs.13604] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Circumflex aorta and double aortic arch are two forms of rare vascular rings. We present a case of an infant who was diagnosed with circumflex aorta and double aortic arch, and describe the surgical management of this rare anomaly.
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Affiliation(s)
- Ziyad M Binsalamah
- Congenital Heart Surgery and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Martin A Chacon-Portillo
- Congenital Heart Surgery and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Amy Sanyahumbi
- Congenital Heart Surgery and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Iki Adachi
- Congenital Heart Surgery and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Congenital Heart Surgery and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Charles D Fraser
- Congenital Heart Surgery and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Carlos M Mery
- Congenital Heart Surgery and Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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38
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Binsalamah ZM, Marcano J, Zea-Vera R, Tunuguntla H, Kearney DL, Heinle JS, Fraser CD, Mery CM. Acute humoral rejection in an infant without risk factors after heart transplantation. J Card Surg 2018; 33:126-128. [PMID: 29399877 DOI: 10.1111/jocs.13532] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Graft rejection is the most common factor that limits graft survival after transplantation. During infancy, the humoral immune system is partially suppressed and humoral rejection of a cardiac allograft has not been reported in the absence of risk factors such as prior transplantation, blood transfusions, ventricular assist devices, and elevation of panel reactive antibodies. We present a case of an infant with dilated cardiomyopathy who developed multiple episodes of acute humoral rejection after heart transplantation in the absence of risk factors.
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Affiliation(s)
- Ziyad M Binsalamah
- Congenital Heart Surgery and Pediatric Cardiology, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Juan Marcano
- Congenital Heart Surgery and Pediatric Cardiology, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Rodrigo Zea-Vera
- Congenital Heart Surgery and Pediatric Cardiology, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Hari Tunuguntla
- Congenital Heart Surgery and Pediatric Cardiology, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Debra L Kearney
- Pathology and Immunology, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Congenital Heart Surgery and Pediatric Cardiology, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Charles D Fraser
- Congenital Heart Surgery and Pediatric Cardiology, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Carlos M Mery
- Congenital Heart Surgery and Pediatric Cardiology, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
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39
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Puri K, Morris SA, Mery CM, Wang Y, Moffett BS, Heinle JS, Rodriguez JR, Shekerdemian LS, Cabrera AG. Characteristics and outcomes of children with ductal-dependent congenital heart disease and esophageal atresia/tracheoesophageal fistula: A multi-institutional analysis. Surgery 2018; 163:847-853. [PMID: 29325785 DOI: 10.1016/j.surg.2017.09.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/10/2017] [Accepted: 09/23/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Extracardiac birth defects are associated with worse outcomes in congenital heart disease (CHD). The impact of esophageal atresia/trachea-esophageal fistula (EA/TEF) on outcomes after surgery for ductal-dependent CHD is unknown. METHODS Retrospective matched cohort study using the Pediatric Health Information System database from 07/2004 to 06/2015. Hospitalizations with ductal-dependent CHD and EA/TEF, undergoing CHD surgery were included as cases. Admissions with ductal-dependent CHD without EA/TEF were matched 3:1 for age at admission and Risk Adjustment for Congenital Heart Surgery-1 classification. Comparisons were performed using generalized estimating equations. RESULTS There were 124 cases and 372 controls. Cases included 32 (25.8%) low-risk, 86 (69.3%) intermediate-risk, and 6 (4.8%) high-risk patients. Cases had more females compared to controls (53.2% vs 41.1%, P = .022). Cases were more likely to be premature (28.2% vs 13.7%, P = .001) and low birth weight (29.8% vs 11.8%, P < .001). Cases had a similar frequency of Down syndrome, and DiGeorge/Velocardiofacial syndrome, but a higher frequency of anorectal malformations (4.3% vs 2.4%, P < .001) and renal anomalies (27.4% vs 9.9%, P < .001) than controls. Cases had a higher mortality on univariate (22.0% vs 8.4%, P < .001) and multivariable analysis (odds ratio 2.45, 95%, confidence interval 1.34 - 4.49). Prematurity also was significantly associated with mortality on multivariable analysis. Cases had a longer duration of mechanical ventilation, longer hospital duration of stay, and higher total cost than controls (all P < .001). CONCLUSION In children with ductal-dependent CHD, EA/TEF is associated with increased morbidity, mortality and resource utilization. A majority of patients undergo EA/TEF repair prior to congenital heart disease surgery. (Surgery 2017;160:XXX-XXX.).
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Affiliation(s)
- Kriti Puri
- Section of Cardiology, Department of Pediatrics, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Shaine A Morris
- Section of Cardiology, Department of Pediatrics, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Carlos M Mery
- Division of Congenital Heart Surgery, Department of Surgery, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Yunfei Wang
- Cardiovascular Research Core-Section of Cardiology, Department of Pediatrics, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Brady S Moffett
- Section of Cardiology, Department of Pediatrics, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - J Ruben Rodriguez
- Division of Pediatric Surgery, Department of Surgery, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Lara S Shekerdemian
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Antonio G Cabrera
- Section of Cardiology, Department of Pediatrics, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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Mery CM, De León LE, Rodriguez JR, Nieto RM, Zhang W, Adachi I, Heinle JS, Kane LC, McKenzie ED, Fraser CD. Effect of Gastrointestinal Malformations on the Outcomes of Patients With Congenital Heart Disease. Ann Thorac Surg 2017; 104:1590-1596. [DOI: 10.1016/j.athoracsur.2017.04.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/10/2017] [Accepted: 04/17/2017] [Indexed: 12/18/2022]
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Burrage LC, Guillerman RP, Das S, Singh S, Schady DA, Morris SA, Walkiewicz M, Schecter MG, Heinle JS, Lotze TE, Lalani SR, Mallory GB. Lung Transplantation for FLNA-Associated Progressive Lung Disease. J Pediatr 2017; 186:118-123.e6. [PMID: 28457522 PMCID: PMC5534178 DOI: 10.1016/j.jpeds.2017.03.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 11/23/2016] [Revised: 01/10/2017] [Accepted: 03/17/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe a series of patients with pathogenic variants in FLNA and progressive lung disease necessitating lung transplantation. STUDY DESIGN We conducted a retrospective chart review of 6 female infants with heterozygous presumed loss-of-function pathogenic variants in FLNA whose initial presentation was early and progressive respiratory failure. RESULTS Each patient received lung transplantation at an average age of 11 months (range, 5-15 months). All patients had pulmonary arterial hypertension and chronic respiratory failure requiring tracheostomy and escalating levels of ventilator support before transplantation. All 6 patients survived initial lung transplantation; however, 1 patient died after a subsequent heart-lung transplant. The remaining 5 patients are living unrestricted lives on chronic immunosuppression at most recent follow-up (range, 19 months to 11.3 years post-transplantation). However, in all patients, severe ascending aortic dilation has been observed with aortic regurgitation. CONCLUSIONS Respiratory failure secondary to progressive obstructive lung disease during infancy may be the presenting phenotype of FLNA-associated periventricular nodular heterotopia. We describe a cohort of patients with progressive respiratory failure related to a pathogenic variant in FLNA and present lung transplantation as a viable therapeutic option for this group of patients.
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Affiliation(s)
- Lindsay C. Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine,Texas Children’s Hospital
| | | | - Shailendra Das
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine
| | - Shipra Singh
- Division of Pulmonology, Department of Pediatrics, State University of New York - Buffalo
| | | | - Shaine A. Morris
- Section of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine
| | | | - Marc G. Schecter
- Division of Pulmonary Medicine, Department of Pediatrics, University of Cincinnati School of Medicine
| | - Jeffrey S. Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Baylor College of Medicine
| | - Timothy E. Lotze
- Section of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine
| | - Seema R. Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine,Texas Children’s Hospital
| | - George B. Mallory
- Section of Pediatric Pulmonology, Department of Pediatrics, Baylor College of Medicine
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Rana A, Fraser CD, Scully BB, Heinle JS, McKenzie ED, Dreyer WJ, Kueht M, Liu H, Brewer ED, Rosengart TK, O'Mahony CA, Goss JA. Inferior Outcomes on the Waiting List in Low-Volume Pediatric Heart Transplant Centers. Am J Transplant 2017; 17:1515-1524. [PMID: 28251816 DOI: 10.1111/ajt.14252] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 10/07/2016] [Revised: 02/12/2017] [Accepted: 02/17/2017] [Indexed: 01/25/2023]
Abstract
Low case volume has been associated with poor outcomes in a wide spectrum of procedures. Our objective was to study the association of low case volume and worse outcomes in pediatric heart transplant centers, taking the novel approach of including waitlist outcomes in the analysis. We studied a cohort of 6482 candidates listed in the Organ Procurement and Transplantation Network for pediatric heart transplantation between 2002 and 2014; 4665 (72%) of the candidates underwent transplantation. Candidates were divided into groups according to the average annual transplantation volume of the listing center during the study period: more than 10, six to 10, three to five, or fewer than three transplantations. We used multivariate Cox regression analysis to identify independent risk factors for waitlist and posttransplantation mortality. Of the 6482 candidates, 24% were listed in low-volume centers (fewer than three annual transplantations). Of these listed candidates in low-volume centers, only 36% received a transplant versus 89% in high-volume centers (more than 10 annual transplantations) (p < 0.001). Listing at a low-volume center was the most significant risk factor for waitlist death (hazard ratio [HR] 4.5, 95% confidence interval [CI] 3.5-5.7 in multivariate Cox regression and HR 5.6, CI 4.4-7.3 in multivariate competing risk regression) and was significant for posttransplantation death (HR 1.27, 95% CI 1.0-1.6 in multivariate Cox regression). During the study period, one-fourth of pediatric transplant candidates were listed in low-volume transplant centers. These children had a limited transplantation rate and a much greater risk of dying while on the waitlist.
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Affiliation(s)
- A Rana
- Division of Abdominal Transplantation, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - C D Fraser
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - B B Scully
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - J S Heinle
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - E D McKenzie
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - W J Dreyer
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Houston, TX
| | - M Kueht
- Division of Abdominal Transplantation, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - H Liu
- Dan L. Duncan Cancer Center, Department of Biostatistics, Baylor College of Medicine, Houston, TX
| | - E D Brewer
- Division of Pediatric Nephrology, Department of Nephrology, Texas Children's Hospital, Houston, TX
| | - T K Rosengart
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - C A O'Mahony
- Division of Abdominal Transplantation, Department of Surgery, Texas Children's Hospital, Houston, TX
| | - J A Goss
- Division of Abdominal Transplantation, Department of Surgery, Texas Children's Hospital, Houston, TX
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De León LE, Mery CM, Verm RA, Trujillo-Díaz D, Patro A, Guzmán-Pruneda FA, Adachi I, Heinle JS, Kane LC, McKenzie ED, Fraser CD. Mid-Term Outcomes in Patients with Congenitally Corrected Transposition of the Great Arteries: A Single Center Experience. J Am Coll Surg 2017; 224:707-715. [PMID: 28088601 DOI: 10.1016/j.jamcollsurg.2016.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Optimal management of patients with congenitally corrected transposition of the great arteries (ccTGA) is unclear. The goal of this study was to compare the outcomes in patients with ccTGA undergoing different management strategies. STUDY DESIGN Patients with ccTGA believed suitable for biventricular circulation, treated between 1995 and 2016, were included. The cohort was divided into 4 groups: systemic right ventricle (RV) (patients without surgical intervention or with a classic repair), anatomic repair, Fontan palliation, and patients receiving only a pulmonary artery band (PAB) or a shunt. Transplant-free survival from presentation was calculated for each group. RESULTS The cohort included 97 patients: 45 (46%) systemic RV, 26 (27%) anatomic repair, 9 (9%) Fontan, and 17 (18%) PAB/shunt. Median age at presentation was 2 months (range 0 days to 69 years) and median follow-up was 10 years (1 month to 28 years). At initial presentation, 10 (11%) patients had any RV dysfunction (8 mild, 2 severe), and 16 (18%) patients had moderate or severe tricuspid regurgitation (TR). During the study, 10 (10%) patients died, and 3 (3%) patients underwent transplantation. At last follow-up, 11 (11%) patients were in New York Heart Association class III/IV, 5 (5%) had moderate or severe systemic ventricle dysfunction, and 16 (16%) had moderate or severe systemic atrioventricular valve regurgitation. Transplant-free survivals at 10 years were 93%, 86%, 100%, and 79% for systemic RV, anatomic repair, Fontan palliation, and PAB/shunt, respectively (p = 0.33). On multivariate analysis, only systemic RV dysfunction was associated with a higher risk for death or transplant (p = 0.001). CONCLUSIONS Transplant-free survival in ccTGA appears to be similar between patients with a systemic RV, anatomic repair, and Fontan procedure. Systemic RV dysfunction is a risk factor for death and transplant.
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Affiliation(s)
- Luis E De León
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
| | - Carlos M Mery
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Raymond A Verm
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Daniel Trujillo-Díaz
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Ankita Patro
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Francisco A Guzmán-Pruneda
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Iki Adachi
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Lauren C Kane
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - E Dean McKenzie
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, and Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
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Mery CM, Nieto RM, De León LE, Morris SA, Zhang W, Colquitt JL, Adachi I, Kane LC, Heinle JS, McKenzie ED, Fraser CD. The Role of Echocardiography and Intracardiac Exploration in the Evaluation of Candidacy for Biventricular Repair in Patients With Borderline Left Heart Structures. Ann Thorac Surg 2016; 103:853-861. [PMID: 27717424 DOI: 10.1016/j.athoracsur.2016.07.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 01/27/2016] [Revised: 06/13/2016] [Accepted: 07/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Predictors for single ventricle palliation (SVP) or successful biventricular repair (BVR) in patients with borderline left-side heart structures are not well defined. The goal was to evaluate the role of echocardiography and intracardiac exploration in determining feasibility of BVR. METHODS All neonates surgically treated from 1995 to 2015 with mitral valve (MV), aortic valve, or left ventricle end-diastolic dimension z score of -2 or less for whom management was controversial were included. Data were analyzed using Fisher's exact test, Kruskal-Wallis test, and Kaplan-Meier analysis. RESULTS The cohort consisted of 42 patients: 7 SVP (17%) and 35 BVR (83%). Median follow-up was 7 years (range, 6 months to 18 years). Intracardiac exploration was performed in 29 patients (69%). There was poor correlation between echocardiographic and intraoperative MV measurements (intraclass correlation coefficient 0.14). Preoperative echocardiography significantly underestimated MV size in 14 patients (54%). Two BVR patients were converted to SVP, and 4 (including 1 converted patient) had cardiac-related deaths. All patients with MV greater than 8 mm on preoperative echocardiography had successful BVR. An intraoperative MV less than 8 mm and an abnormal subvalvar apparatus was present in 5 of 6 SVP (83%) and 3 of 3 (100%) failed BVR patients who had intracardiac exploration, and in only 1 of 20 successful BVR patients (5%) who had an intracardiac exploration. CONCLUSIONS The decision to proceed to BVR in patients with borderline left-side heart structures should not rely strictly on echocardiographic measurements. Intracardiac exploration of the MV and subvalvar apparatus is useful before committing a patient to SVP. Patients with low MV z scores, especially those with a normal subvalvar apparatus, may undergo BVR with good outcomes.
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Affiliation(s)
- Carlos M Mery
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
| | - R Michael Nieto
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Luis E De León
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Shaine A Morris
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Wei Zhang
- Outcomes and Impact Service, Texas Children's Hospital, Houston, Texas
| | - John L Colquitt
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Lauren C Kane
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - E Dean McKenzie
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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Busch DR, Rusin CG, Miller-Hance W, Kibler K, Baker WB, Heinle JS, Fraser CD, Yodh AG, Licht DJ, Brady KM. Continuous cerebral hemodynamic measurement during deep hypothermic circulatory arrest. Biomed Opt Express 2016; 7:3461-3470. [PMID: 27699112 PMCID: PMC5030024 DOI: 10.1364/boe.7.003461] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 05/03/2023]
Abstract
While survival of children with complex congenital heart defects has improved in recent years, roughly half suffer neurological deficits suspected to be related to cerebral ischemia. Here we report the first demonstration of optical diffuse correlation spectroscopy (DCS) for continuous and non-invasive monitoring of cerebral microvascular blood flow during complex human neonatal or cardiac surgery. Comparison between DCS and Doppler ultrasound flow measurements during deep hypothermia, circulatory arrest, and rewarming were in good agreement. Looking forward, DCS instrumentation, alone and with NIRS, could provide access to flow and metabolic biomarkers needed by clinicians to adjust neuroprotective therapy during surgery.
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Affiliation(s)
- David R. Busch
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Craig G. Rusin
- Departments of Pediatrics and Cardiology, Baylor College of Medicine, Houston, TX, 77030 USA
| | - Wanda Miller-Hance
- Department of Pediatric Cardiovascular Anesthesiology, Baylor College of Medicine, Houston, TX, 77030 USA
| | - Kathy Kibler
- Department of Pediatrics, Texas Children’s Hospital, Houston, TX, 77030, USA
| | - Wesley B. Baker
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jeffrey S. Heinle
- Department of Surgery, Texas Children’s Hospital, Houston, TX, 77030, USA
| | - Charles D. Fraser
- Department of Surgery, Texas Children’s Hospital, Houston, TX, 77030, USA
| | - Arjun G. Yodh
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel J. Licht
- Division of Neurology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Kenneth M. Brady
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, 77030, USA
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McKenzie ED, Roeser ME, Thompson JL, De León LE, Adachi I, Heinle JS, Mery CM, Fraser CD. Descending Aortic Translocation for Relief of Distal Tracheal and Proximal Bronchial Compression. Ann Thorac Surg 2016; 102:859-862. [DOI: 10.1016/j.athoracsur.2016.02.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 10/21/2022]
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Mery CM, Guzmán-Pruneda FA, De León LE, Zhang W, Terwelp MD, Bocchini CE, Adachi I, Heinle JS, McKenzie ED, Fraser CD. Risk factors for development of endocarditis and reintervention in patients undergoing right ventricle to pulmonary artery valved conduit placement. J Thorac Cardiovasc Surg 2016; 151:432-9, 441.e1-2. [DOI: 10.1016/j.jtcvs.2015.10.069] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/29/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
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Guzman-Pruneda FA, Orr Y, Trost JG, Zhang W, Das S, Melicoff E, Maddox J, Nugent M, Mery CM, Adachi I, Schecter MG, Mallory GB, Morales DL, Heinle JS, McKenzie ED. Bronchial artery revascularization and en bloc lung transplant in children. J Heart Lung Transplant 2016; 35:122-129. [DOI: 10.1016/j.healun.2015.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/11/2015] [Accepted: 08/22/2015] [Indexed: 10/23/2022] Open
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Mery CM, Guzmán-Pruneda FA, Trost JG, McLaughlin E, Smith BM, Parekh DR, Adachi I, Heinle JS, McKenzie ED, Fraser CD. Contemporary Results of Aortic Coarctation Repair Through Left Thoracotomy. Ann Thorac Surg 2015. [PMID: 26209490 DOI: 10.1016/j.athoracsur.2015.04.129] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [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: 10/23/2022]
Abstract
BACKGROUND Although surgical results for repair of coarctation of the aorta (CoA) have steadily improved, management of this condition remains controversial. The purposes of this study were to analyze the long-term outcomes of patients undergoing CoA repair through left thoracotomy and to define risk factors for reintervention. METHODS All patients who were less than 18 years old and who underwent initial repair of CoA through left thoracotomy from 1995 to 2013 at Texas Children's Hospital (Houston, TX) were included. Patients were classified into 3 groups: 143 (42%) neonates (0 to 30 days old), 122 (36%) infants (31 days to 1 year old), and 78 (23%) older children (1 to 18 years old). Univariate and multivariate analyses were performed. RESULTS A total of 343 patients (129 [38%] girls) with median age of 53 days (interquartile range [IQR],12 days to 9 months) and weight of 4.1 kg (IQR, 3.1 to 8.0) underwent repair with extended end-to-end anastomosis (291 patients [85%]), end-to-end anastomosis (44 patients [13%]), interposition graft (2 patients [0.6%]), or subclavian flap (6 patients [2%]). Concomitant diagnoses included genetic abnormalities (48 patients [14%]), isolated ventricular septal defects (58 patients [17%]), small left-sided structures (53 patients,16%), or other complex congenital heart disease (18 patients [5%]). Perioperative mortality was 1% (n = 4, all neonates). At a median follow-up of 6 years (7 days to 19 years), only 14 (4%) patients required reintervention (10 catheter-based procedures, 6 surgical repairs). A postoperative peak velocity of 2.5 m/s or greater was an independent risk factor for reintervention (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.4 to 11.6). Within the cohort, 95 (33%) patients were hypertensive or remained on cardiac medications a median of 12 years (6 months to 19 years) after the surgical procedure. Development of perioperative hypertension was associated with higher risk of chronic hypertension or cardiac medication dependency (OR, 1.9; 95% CI, 1.1 to 3.3). CONCLUSIONS CoA repair through left thoracotomy is associated with low rates of morbidity, mortality, and reintervention. Aortic arch obstruction should be completely relieved at the time of surgical intervention to minimize the risk of long-term recoarctation.
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Affiliation(s)
- Carlos M Mery
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas.
| | - Francisco A Guzmán-Pruneda
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Jeffrey G Trost
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Ericka McLaughlin
- Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas
| | - Brendan M Smith
- Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas
| | - Dhaval R Parekh
- Division of Pediatric Cardiology, Texas Children's Hospital; Department of Pediatrics, Baylor College of Medicine; Houston, Texas
| | - Iki Adachi
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Jeffrey S Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - E Dean McKenzie
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
| | - Charles D Fraser
- Division of Congenital Heart Surgery, Texas Children's Hospital; Michael E. DeBakey Department of Surgery, Baylor College of Medicine; Houston, Texas
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Adachi I, Khan MS, Guzmán-Pruneda FA, Fraser CD, Mery CM, Denfield SW, Dreyer WJ, Morales DL, McKenzie ED, Heinle JS, Fraser CD. Evolution and Impact of Ventricular Assist Device Program on Children Awaiting Heart Transplantation. Ann Thorac Surg 2015; 99:635-40. [DOI: 10.1016/j.athoracsur.2014.10.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/22/2014] [Accepted: 10/03/2014] [Indexed: 11/29/2022]
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