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Mavroudis CD, Grasty MA, Restaino K, Montgomery CM, Pettit AN, O'Connor MJ, Wittlieb-Weber C, Edelson JB, Edwards J, Berger J, Lin K, Rossano J, Maeda K. A novel intracorporeal right ventricular assist device implantation technique in a young patient. JTCVS Tech 2024; 23:89-91. [PMID: 38352008 PMCID: PMC10859569 DOI: 10.1016/j.xjtc.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/03/2023] [Accepted: 10/15/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Constantine D. Mavroudis
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Madison A. Grasty
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Kathryn Restaino
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Catherine M. Montgomery
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Alee N. Pettit
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Matthew J. O'Connor
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Carol Wittlieb-Weber
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jonathan B. Edelson
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jonathan Edwards
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Justin Berger
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Kimberly Lin
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Joseph Rossano
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Katsuhide Maeda
- Divisions of Cardiothoracic Surgery and Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
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Conway J, Amdani S, Morales DLS, Lorts A, Rosenthal DN, Jacobs JP, Rossano J, Koehl D, Kirklin JK, Auerbach SR. Widening care gap in VAD therapy. J Heart Lung Transplant 2023; 42:1710-1724. [PMID: 37591455 DOI: 10.1016/j.healun.2023.08.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/24/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The removal of the HeartWare ventricular assist device (HVAD) due to pump malfunctions and inferior outcomes compared to HeartMate 3 (HM3) in adults has created a care gap for younger patients. It is unclear if the reported HVAD survival differs by age and if the initial experience with HM3 can bridge the gap. METHODS Using the Society of Thoracic Surgeons (STS) Intermacs and Pedimacs registries, durable ventricular assist device (VAD) implants between September 2012 and December 2021 were identified. Young adults (YA) were defined as <40 years old in Intermacs. Patients were excluded if they had an isolated right VAD (RVAD) or were implanted as destination therapy (DT). Survival analysis by Kaplan-Meier (KM) and competing outcomes curves was performed, and 1-year survival is reported. RESULTS The Intermacs cohort consisted of YA (n = 1226; HVAD 818; HM3 408) with a median age of YA of 32.07 (26.66-36.27) years and weight (wt) of 83.2 (68-104.2) kg. Most had cardiomyopathy (CM) (92.2%). The Pedimacs cohort was 668 patients (median age 9.47 [1.82-14.23] years, wt 27.2 [10-57.05] kg), and most also had CM (70.5%). Device breakdown included HVAD (n = 326), Berlin EXCOR (n = 277), and HM3 (n = 65). HVAD survival differed by age in adults, with YA fairing better than adults >40 years old (88.8% vs 79.4% at 1 year, p < 0.0001). YA survival was also better compared to Pedimacs patient (88.9% vs 83.7%, p = 0.0002), but when competing events were analyzed, mortality was similar to YA (9.2% vs 9.6%, p = 0.1) with a higher proportion of patient undergoing transplant at 1 year in Pedimacs (74% vs 31.3%, p < 0.0001). Survival by device differed between HVAD and HM3 in YA (88.8% vs 94.4%, p = 0.0025). This difference in device survival was not seen in all children (83.7% vs 87.3%, p = 0.21), including those ≥25 kg. Adverse event profiles also differed across the groups with adults seeing less adverse events with the HM3, but the same was not found (including stroke) in the pediatric cohort. Survival outcomes for patients between 10 and 25 kg were similar with the HVAD compared to the Berlin Heart EXCOR (p = 0.4290), with similarities in stroke risk. CONCLUSION The removal of the HVAD device may result in a care gap in younger patient whose survival outcomes do not mirror that of older adults. The HM3 can fill a portion of this gap with good survival, but there remains a subset of pediatric patients that, based on initial HM3 use, will no longer have access to intracorporeal support and therefore, despite reasonable outcomes with the Berlin Heart EXCOR, will not be able to be discharged home. Lastly, it is essential that future changes to the availability of devices take into account the various patient populations that utilize the device to avoid unintended consequences of access inequality.
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Affiliation(s)
- Jennifer Conway
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
| | - Shahnawaz Amdani
- Division of Pediatric Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - David L S Morales
- Cincinnati Children's Hospital Medical Center, The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Angela Lorts
- Cincinnati Children's Hospital Medical Center, The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David N Rosenthal
- Department of Pediatrics, Stanford University and Lucille Packard Children's Hospital, Palo Alto, California
| | - Jeffrey P Jacobs
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Joseph Rossano
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Scott R Auerbach
- Division of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Balsara SL, Burstein D, Ittenbach RF, Kaplinski M, Gardner MM, Ravishankar C, Rossano J, Goldberg DJ, Mahle M, O'Connor MJ, Mascio CE, Gaynor JW, Preminger TJ. Combined ventricular dysfunction and atrioventricular valve regurgitation after the Norwood procedure are associated with attrition prior to superior cavopulmonary connection. JTCVS Open 2023; 16:714-725. [PMID: 38204707 PMCID: PMC10775094 DOI: 10.1016/j.xjon.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/03/2023] [Accepted: 09/21/2023] [Indexed: 01/12/2024]
Abstract
Background Infants with hypoplastic left heart syndrome (HLHS) or a variant are at risk of ventricular dysfunction (VD) and atrioventricular valve regurgitation (AVVR) prior to superior cavopulmonary connection (SCPC). Although the impact of these complications in isolation has been described, their effect in combination on attrition is poorly defined. Methods A retrospective observational study of patients with HLHS or variants undergoing a Norwood procedure between 2008 and 2020 at a single center was performed. VD and AVVR were defined as moderate or severe when seen on 2 sequential echocardiograms outside the perioperative period. Attrition was defined as death, listing for heart transplant, or unsuitability for SCPC or transplant. Descriptive statistics and regression models were used for analysis. Results A total of 397 patients were included, of whom 75% had HLHS and 57% had received a Blalock-Thomas-Taussig shunt. Isolated VD occurred in 9% of patients, AVVR occurred in 13%, and both occurred in 6%. Attrition prior to SCPC occurred in 19% of the overall cohort, in 52% of patients with combined VD and AVVR (odds ratio [OR], 5.2; 95% confidence interval [CI], 2.3-12.0; P < .01), 26% of those with VD (OR, 1.5; 95% CI, 0.7-3.3; P = .32), 25% of those with AVVR (OR, 1.5; 95% CI, 0.7-2.9; P = .27), and 15% in those with neither (OR, 0.3; 95% CI, 0.2-0.6; P < .01). Other factors associated with attrition included prematurity, total bypass time at Norwood, and extracorporeal membrane oxygenation after Norwood, whereas later year of Norwood was protective (P < .01 for all). Conclusions The presence of combined VD and AVVR markedly increases the likelihood of attrition prior to SCPC, identifying a high-risk group.
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Affiliation(s)
| | - Danielle Burstein
- The Children's Hospital of Philadelphia, Philadelphia, Pa
- University of Vermont Medical Center, Burlington, Vt
| | | | | | | | | | - Joseph Rossano
- The Children's Hospital of Philadelphia, Philadelphia, Pa
| | | | - Marlene Mahle
- The Children's Hospital of Philadelphia, Philadelphia, Pa
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Hirschhorn MD, Lawley JEM, Roof AJ, Johnson APT, Stoddard WA, Stevens RM, Rossano J, Arabia F, Tchantchaleishvili V, Massey HT, Day SW, Throckmorton AL. Next Generation Development of Hybrid Continuous Flow Pediatric Total Artificial Heart Technology: Design-Build-Test. ASAIO J 2023; 69:1090-1098. [PMID: 37774695 DOI: 10.1097/mat.0000000000002043] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
To address the unmet clinical need for pediatric circulatory support, we are developing an operationally versatile, hybrid, continuous-flow, total artificial heart ("Dragon Heart"). This device integrates a magnetically levitated axial and centrifugal blood pump. Here, we utilized a validated axial flow pump, and we focused on the development of the centrifugal pump. A motor was integrated to drive the centrifugal pump, achieving 50% size reduction. The motor design was simulated by finite element analysis, and pump design improvement was attained by computational fluid dynamics. A prototype centrifugal pump was constructed from biocompatible 3D printed parts for the housing and machined metal parts for the drive system. Centrifugal prototype testing was conducted using water and then bovine blood. The fully combined device ( i.e. , axial pump nested inside of the centrifugal pump) was tested to ensure proper operation. We demonstrated the hydraulic performance of the two pumps operating in tandem, and we found that the centrifugal blood pump performance was not adversely impacted by the simultaneous operation of the axial blood pump. The current iteration of this design achieved a range of operation overlapping our target range. Future design iterations will further reduce size and incorporate complete and active magnetic levitation.
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Affiliation(s)
- Matthew D Hirschhorn
- From the BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania
| | - Jonathan E M Lawley
- Departments of Biomedical and Mechanical Engineering, Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, New York
| | - Andrew J Roof
- Departments of Biomedical and Mechanical Engineering, Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, New York
| | - Arthur P T Johnson
- Departments of Biomedical and Mechanical Engineering, Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, New York
| | - William A Stoddard
- Departments of Biomedical and Mechanical Engineering, Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, New York
| | - Randy M Stevens
- Division of Pediatrics, College of Medicine, St. Christopher's Hospital for Children, Drexel University, Philadelphia, Pennsylvania
| | - Joseph Rossano
- Division of Cardiology, Pediatric Heart Failure & Transplant Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Francisco Arabia
- Advanced Heart Program, Banner University Medical Group, Division of Cardiothoracic Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - H Todd Massey
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Steven W Day
- Departments of Biomedical and Mechanical Engineering, Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, New York
| | - Amy L Throckmorton
- From the BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, Pennsylvania
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Ashfaq A, Lorts A, Rosenthal D, Adachi I, Rossano J, Davies R, Simpson KE, Maeda K, Wisotzkey B, Koehl D, Cantor RS, Jacobs JP, Peng D, Kirklin JK, Morales DLS. Survival in Pediatric Patients With Ventricular Assist Devices: A Special Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report. Ann Thorac Surg 2023; 116:972-979. [PMID: 37573991 DOI: 10.1016/j.athoracsur.2023.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/05/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) provides detailed understanding on pediatric patients supported with ventricular assist devices (VADs). We sought to identify important variables affecting mortality in pediatric VADs. METHODS Patients aged <19 years, from 2012 to 2021, were included. Survival analyses were performed using Kaplan-Meier. Parametric hazard modeling was used to identify risk factors for death. RESULTS Of the 1109 patients, the most common devices were implantable continuous (IC, 448 [40%]), followed by paracorporeal pulsatile (PP, 306 [28%]), paracorporeal continuous (PC, 293 [26%]), and percutaneous (58 [5%]). Patients with percutaneous device, infants, congenital heart disease, biventricular support, and Interagency Registry for Mechanically Assisted Circulatory Support profile 1 had worse overall survival at 6 months. Positive outcome was 83% at 6 months. Consistent with their cohort composition, device type positive outcomes at 6 months were IC, 92%; PP, 84%; and PC, 69%. Parametric hazard modeling for overall survival showed an early hazard for death with biventricular support, congenital heart disease (CHD), intubation before implantation, PC device, and renal impairment, whereas a constant hazard was associated with ascites. For patients <10 kg, parametric modeling showed an early hazard for CHD, intubation, and renal impairment. Modeling in CHD patients showed an early hazard for biventricular support, renal impairment, and use of PC/PP devices. CONCLUSIONS This multivariable analysis of the complete Pedimacs database demonstrates that illness at VAD implantation, diagnosis, and strategy of support affect survival and differ by device type. We hope this is the first step in creating a predictive tool to help providers and families have informed expectations.
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Affiliation(s)
- Awais Ashfaq
- Heart Institute, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | - Angela Lorts
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Rosenthal
- Department of Pediatric Cardiology, Lucile Salter Packard Children's Hospital, Palo Alto, California
| | - Iki Adachi
- Department of Pediatric Cardiac Surgery, Texas Children's Hospital, Houston, Texas
| | - Joseph Rossano
- Department of Pediatric Cardiology and Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ryan Davies
- Department of Pediatric Cardiac Surgery, UT Southwestern, Dallas, Texas
| | - Kathleen E Simpson
- Department of Pediatric Cardiology, Children's Hospital of Colorado, Aurora, Colorado
| | - Katsuhide Maeda
- Department of Pediatric Cardiology and Cardiac Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Bethany Wisotzkey
- Department of Pediatric Cardiology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey P Jacobs
- Congenital Heart Center, Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - David Peng
- Congenital Heart Center, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - David L S Morales
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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Stack KO, Schluger C, Roberts AL, Lawrence K, Balsara S, Hunt M, Kaplinski M, Gardner MM, Ravishankar C, Rossano J, Goldberg DJ, Mahle M, O'Connor MJ, Mascio CE, Gaynor JW, Burstein D. Impact of Ventricular Dysfunction and Atrioventricular Valve Regurgitation on Pre-Fontan Attrition. Ann Thorac Surg 2023; 116:778-785. [PMID: 37429514 DOI: 10.1016/j.athoracsur.2023.05.046] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/18/2023] [Accepted: 05/30/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND There is a significant incidence of pre-Fontan attrition-defined as failure to undergo Fontan completion-after superior cavopulmonary connection. This study investigated the impact of at least moderate ventricular dysfunction (VD) and atrioventricular valve regurgitation (AVVR) on pre-Fontan attrition. METHODS This single-center retrospective cohort study included all infants who underwent Norwood palliation from 2008 to 2020 and subsequently underwent superior cavopulmonary connection. Pre-Fontan attrition was defined as death, listing for heart transplantation before Fontan completion, or unsuitability for Fontan completion. The study's secondary outcome was transplant-free survival. RESULTS Pre-Fontan attrition occurred in 34 of 267 patients (12.7%). Isolated VD was not associated with attrition. However, patients with isolated AVVR had 5 times the odds of attrition (odds ratio, 5.4; 95% CI 1.8-16.2), and patients with both VD and AVVR had 20 times the odds of attrition (odds ratio, 20.1; 95% CI 7.7-52.8) compared with patients without VD or AVVR. Only patients with both VD and AVVR had significantly worse transplant-free survival compared with patients without VD or AVVR (hazard ratio, 7.7; 95% CI 2.8-21.6). CONCLUSIONS The additive effect of VD and AVVR is a powerful contributor to pre-Fontan attrition. Future research investigating therapies that can mitigate the degree of AVVR may help improve Fontan completion rates and long-term outcomes.
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Affiliation(s)
- Kathryn O Stack
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Charlotte Schluger
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy L Roberts
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kendall Lawrence
- Division of Cardiothoracic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sheri Balsara
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mallory Hunt
- Division of Cardiothoracic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michelle Kaplinski
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | - Monique M Gardner
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Cardiac Critical Care, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Chitra Ravishankar
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph Rossano
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David J Goldberg
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marlene Mahle
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew J O'Connor
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher E Mascio
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - J William Gaynor
- Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Danielle Burstein
- Division of Pediatric Cardiology, Department of Pediatrics, Larner College of Medicine at University of Vermont, Burlington, Vermont
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Edwards J, Mejia E, Boyle C, Ha L, O'Connor M, Joshi P, White R, Rossano J, Berger J, Wittlieb-Weber C, Lin K, Maeda K, Edelson J. Donor Derived Cell Free DNA is Correlated with DSA and Rejection in Pediatric Heart Transplant Recipients. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1339] [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: 04/05/2023] Open
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Lynch A, Tatangelo M, Ahuja S, Steve Fan CP, Min S, Lafreniere-Roula M, Papaz T, Zhou V, Armstrong K, Aziz PF, Benson LN, Butts R, Dragulescu A, Gardin L, Godown J, Jeewa A, Kantor PF, Kaufman BD, Lal AK, Parent JJ, Richmond M, Russell MW, Balaji S, Stephenson EA, Villa C, Jefferies JL, Whitehill R, Conway J, Howard TS, Nakano SJ, Rossano J, Weintraub RG, Mital S. Risk of Sudden Death in Patients With RASopathy Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2023; 81:1035-1045. [PMID: 36922089 DOI: 10.1016/j.jacc.2023.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 09/26/2022] [Revised: 11/29/2022] [Accepted: 01/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Genetic defects in the RAS/mitogen-activated protein kinase pathway are an important cause of hypertrophic cardiomyopathy (RAS-HCM). Unlike primary HCM (P-HCM), the risk of sudden cardiac death (SCD) and long-term survival in RAS-HCM are poorly understood. OBJECTIVES The study's objective was to compare transplant-free survival, incidence of SCD, and implantable cardioverter-defibrillator (ICD) use between RAS-HCM and P-HCM patients. METHODS In an international, 21-center cohort study, we analyzed phenotype-positive pediatric RAS-HCM (n = 188) and P-HCM (n = 567) patients. The between-group differences in cumulative incidence of all outcomes from first evaluation were compared using Gray's tests, and age-related hazard of all-cause mortality was determined. RESULTS RAS-HCM patients had a lower median age at diagnosis compared to P-HCM (0.9 years [IQR: 0.2-5.0 years] vs 9.8 years [IQR: 2.0-13.9 years], respectively) (P < 0.001). The 10-year cumulative incidence of SCD from first evaluation was not different between RAS-HCM and P-HCM (4.7% vs 4.2%, respectively; P = 0.59). The 10-year cumulative incidence of nonarrhythmic deaths or transplant was higher in RAS-HCM compared with P-HCM (11.0% vs 5.4%, respectively; P = 0.011). The 10-year cumulative incidence of ICD insertions, however, was 5-fold lower in RAS-HCM compared with P-HCM (6.9% vs 36.6%; P < 0.001). Nonarrhythmic deaths occurred primarily in infancy and SCD primarily in adolescence. CONCLUSIONS RAS-HCM was associated with a higher incidence of nonarrhythmic death or transplant but similar incidence of SCD as P-HCM. However, ICDs were used less frequently in RAS-HCM compared to P-HCM. In addition to monitoring for heart failure and timely consideration of advanced heart failure therapies, better risk stratification is needed to guide ICD practices in RAS-HCM.
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Affiliation(s)
- Aine Lynch
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada
| | - Mark Tatangelo
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Sachin Ahuja
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Chun-Po Steve Fan
- Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Sandar Min
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Myriam Lafreniere-Roula
- Applied Health Research Centre, St Michael's Hospital of Unity Health Toronto, Toronto, Ontario, Canada
| | - Tanya Papaz
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Vivian Zhou
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn Armstrong
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Peter F Aziz
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Lee N Benson
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada
| | - Ryan Butts
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Andreea Dragulescu
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada
| | - Letizia Gardin
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Justin Godown
- Department of Pediatrics, Monroe Carrell Jr Children's Hospital at Vanderbilt University, Nashville, Tennessee, USA
| | - Aamir Jeewa
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada
| | - Paul F Kantor
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Beth D Kaufman
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - Ashwin K Lal
- Department of Pediatrics, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | - John J Parent
- Department of Pediatrics, Riley Children's Hospital, Indianapolis, Indiana, USA
| | - Marc Richmond
- Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Mark W Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Seshadri Balaji
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Elizabeth A Stephenson
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada
| | - Chet Villa
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio, USA
| | - John L Jefferies
- Department of Pediatrics, University of Tennessee Health Sciences Centre, Memphis, Tennessee, USA
| | - Robert Whitehill
- Department of Pediatrics, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jennifer Conway
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Taylor S Howard
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas, USA
| | - Stephanie J Nakano
- Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Joseph Rossano
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert G Weintraub
- Department of Cardiology, The Royal Children's Hospital of Melbourne, Melbourne, Victoria, Australia
| | - Seema Mital
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto Ontario, Canada; Ted Rogers Computational Program, Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada; Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada.
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Burstein D, Kimmel S, Putt M, Rossano J, VanderPluym C, Ankola A, Lorts A, Maeda K, O'Connor M, Edelson J, Lin K, Buchholz H, Conway J. Cost-effectiveness of bivalirudin in pediatric ventricular assist devices. J Heart Lung Transplant 2023; 42:390-397. [PMID: 36333207 DOI: 10.1016/j.healun.2022.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/14/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Despite recent data suggesting improved outcomes with bivalirudin vs heparin in pediatric Ventricular assist devices (VAD), higher costs remain a barrier. This study quantified trends in bivalirudin use and compared outcomes, resource utilization, and cost-effectiveness associated with bivalirudin vs heparin. METHODS Children age 0 to 6 year who received VAD from 2009 to 2021 were identified in Pediatric Health Information System. Bivalirudin use was evaluated using trend analysis and outcomes were compared using Fine-Gray subdistrubtion hazard ratios (SHR). Daily-level hospital costs were compared due to differences in length of stay. Cost-effectiveness was evaluated using incremental cost-effectiveness ratio (ICER). RESULTS Of 691 pediatric VAD recipients (median age 1 year, IQR 0-2), 304 (44%) received bivalirudin with 90% receiving bivalirudin in 2021 (trend p-value <0.01). Bivalirudin had lower hospital mortality (26% vs 32%; adjusted SHR 0.57, 95% CI 0.40-0.83) driven by lower VAD mortality (20% vs 27%; adjusted SHR 0.46, 95% CI 0.32-0.77) after adjusting for year, age, diagnosis, and center VAD volume. Post-VAD length of stay was longer for bivalirudin than heparin (median 91 vs 64 days, respectively, p < 0.001). Median daily-level costs were lower among bivalirudin (cost ratio 0.87, 95% CI 0.79-0.96) with higher pharmacy costs offset by lower imaging, laboratory, supply, and room/board costs. Estimated ICER for bivalirudin vs heparin was $61,192 per quality-adjusted life year gained with a range of $27,673 to $131,243. CONCLUSIONS Bivalirudin use significantly increased over the past decade and is now used in 90% young pediatric VAD recipients. Bivalirudin was associated with significantly lower hospital mortality and an ICER <$65,000, making it a cost-effective therapy for pediatric VAD recipients.
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Affiliation(s)
- Danielle Burstein
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Stephen Kimmel
- Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainsville, Florida
| | - Mary Putt
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joseph Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Ashish Ankola
- Division of Cardiology, Texas Children's Hospital, Houston, Texas
| | - Angela Lorts
- Division of Cardiology, Cincinnati Children's Medical Center, Cincinnati, Ohio
| | - Katsuhide Maeda
- Department of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew O'Connor
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan Edelson
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberly Lin
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Holger Buchholz
- Division of Cardiothoracic Surgery, University of Alberta, Edmonton, Alberta, California
| | - Jennifer Conway
- Division of Cardiology, University of Alberta, Edmonton, Alberta, California
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10
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Conway J, Min S, Villa C, Weintraub RG, Nakano S, Godown J, Tatangelo M, Armstrong K, Richmond M, Kaufman B, Lal AK, Balaji S, Power A, Baez Hernandez N, Gardin L, Kantor PF, Parent JJ, Aziz PF, Jefferies JL, Dragulescu A, Jeewa A, Benson L, Russell MW, Whitehill R, Rossano J, Howard T, Mital S. The Prevalence and Association of Exercise Test Abnormalities With Sudden Cardiac Death and Transplant-Free Survival in Childhood Hypertrophic Cardiomyopathy. Circulation 2023; 147:718-727. [PMID: 36335467 PMCID: PMC9977414 DOI: 10.1161/circulationaha.122.062699] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) can be associated with an abnormal exercise response. In adults with HCM, abnormal results on exercise stress testing are predictive of heart failure outcomes. Our goal was to determine whether an abnormal exercise response is associated with adverse outcomes in pediatric patients with HCM. METHODS In an international cohort study including 20 centers, phenotype-positive patients with primary HCM who were <18 years of age at diagnosis were included. Abnormal exercise response was defined as a blunted blood pressure response and new or worsened ST- or T-wave segment changes or complex ventricular ectopy. Sudden cardiac death (SCD) events were defined as a composite of SCD and aborted sudden cardiac arrest. Using Kaplan-Meier survival, competing outcomes, and Cox regression analyses, we analyzed the association of abnormal exercise test results with transplant and SCD event-free survival. RESULTS Of 724 eligible patients, 630 underwent at least 1 exercise test. There were no major differences in clinical characteristics between those with or without an exercise test. The median age at exercise testing was 13.8 years (interquartile range, 4.7 years); 78% were male and 39% were receiving beta-blockers. A total of 175 (28%) had abnormal test results. Patients with abnormal test results had more severe septal hypertrophy, higher left atrial diameter z scores, higher resting left ventricular outflow tract gradient, and higher frequency of myectomy compared with participants with normal test results (P<0.05). Compared with normal test results, abnormal test results were independently associated with lower 5-year transplant-free survival (97% versus 88%, respectively; P=0.005). Patients with exercise-induced ischemia were most likely to experience all-cause death or transplant (hazard ratio, 4.86 [95% CI, 1.69-13.99]), followed by those with an abnormal blood pressure response (hazard ratio, 3.19 [95% CI, 1.32-7.71]). Exercise-induced ischemia was also independently associated with lower SCD event-free survival (hazard ratio, 3.32 [95% CI, 1.27-8.70]). Exercise-induced ectopy was not associated with survival. CONCLUSIONS Exercise abnormalities are common in childhood HCM. An abnormal exercise test result was independently associated with lower transplant-free survival, especially in those with an ischemic or abnormal blood pressure response with exercise. Exercise-induced ischemia was also independently associated with SCD events. These findings argue for routine exercise testing in childhood HCM as part of ongoing risk assessment.
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Affiliation(s)
- Jennifer Conway
- Department of Pediatrics, Stollery Children’s Hospital, Edmonton, Canada (J.C.)
| | - Sandar Min
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada (S. Min, S. Mital)
| | - Chet Villa
- Department of Pediatrics, Cincinnati Children’s Hospital, OH (C.V.)
| | - Robert G. Weintraub
- Department of Cardiology, The Royal Children’s Hospital, Melbourne, Australia (R.G.W.)
| | - Stephanie Nakano
- Department of Pediatrics, Children’s Hospital Colorado, Aurora (S.N.)
| | - Justin Godown
- Department of Pediatrics, Monroe Carrell Jr Children’s Hospital at Vanderbilt, Nashville, TN (J.G.)
| | - Mark Tatangelo
- Ted Rogers Computational Program, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (M.T.)
| | - Kathryn Armstrong
- Department of Pediatrics, BC Children’s Hospital, Vancouver, British Columbia, Canada (K.A.)
| | - Marc Richmond
- Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University Medical Centre, New York, NY (M.R.)
| | - Beth Kaufman
- Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (B.K.)
| | - Ashwin K. Lal
- Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City (A.K.L.)
| | - Seshadri Balaji
- Department of Pediatrics, Oregon Health and Science University, Portland (S.B.)
| | - Alyssa Power
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.P., N.B.H.)
| | - Nathanya Baez Hernandez
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX (A.P., N.B.H.)
| | - Letizia Gardin
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Canada (L.G.)
| | - Paul F. Kantor
- Department of Pediatrics, Children’s Hospital of Los Angeles, CA (P.F.K.)
| | - John J. Parent
- Department of Pediatrics, Riley Children’s Hospital, Indianapolis, IN (J.J.P.)
| | - Peter F. Aziz
- Department of Pediatrics, Cleveland Clinic Children’s Hospital, OH (P.F.A.)
| | - John L. Jefferies
- Department of Pediatrics, University of Tennessee Health Sciences Centre, Memphis (J.L.J.)
| | - Andreea Dragulescu
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada (A.D., A.J., L.B., S. Mital)
| | - Aamir Jeewa
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada (A.D., A.J., L.B., S. Mital)
| | - Lee Benson
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada (A.D., A.J., L.B., S. Mital)
| | - Mark W. Russell
- Department of Pediatrics, University of Michigan Health System, Ann Arbor (M.W.R.)
| | - Robert Whitehill
- Department of Pediatrics, Children’s Healthcare of Atlanta, GA (R.W.)
| | - Joseph Rossano
- Department of Pediatrics, Children’s Hospital of Philadelphia, PA (J.R.)
| | - Taylor Howard
- Department of Pediatrics, Texas Children’s Hospital, Houston (T.H.)
| | - Seema Mital
- Genetics and Genome Biology, Hospital for Sick Children, Toronto, Canada (S. Min, S. Mital).,Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada (A.D., A.J., L.B., S. Mital).,Ted Rogers Centre for Heart Research, Toronto, Canada (S. Mital)
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11
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Ritter A, Leonard J, Gray C, Izumi K, Levinson K, Nair DR, O'Connor M, Rossano J, Shankar V, Chowns J, Marzolf A, Owens A, Ahrens-Nicklas RC. MYH7 variants cause complex congenital heart disease. Am J Med Genet A 2022; 188:2772-2776. [PMID: 35491958 DOI: 10.1002/ajmg.a.62766] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/01/2022] [Accepted: 04/09/2022] [Indexed: 01/25/2023]
Abstract
MYH7, encoding the myosin heavy chain sarcomeric β-myosin heavy chain, is a common cause of both hypertrophic and dilated cardiomyopathy. Additionally, families with left ventricular noncompaction cardiomyopathy (LVNC) and congenital heart disease (CHD), typically septal defects or Ebstein anomaly, have been identified to have heterozygous pathogenic variants in MHY7. One previous case of single ventricle CHD with heart failure due to a MYH7 variant has been identified. Herein, we present a single center's experience of complex CHD due to MYH7 variants. Three probands with a history of CHD, LVNC, and/or arrhythmias were identified to have MYH7 variants through multigene panel testing or exome sequencing. These three patients collectively had 12 affected family members, four with a history of Ebstein anomaly and seven with a history of LVNC. These findings suggest a wider phenotypic spectrum in MYH7-related CHD than previously understood. Further investigation into the possible role of MYH7 in CHD and mechanism of disease is necessary to fully delineate the phenotypic spectrum of MYH7-related cardiac disease. MYH7 should be considered for families with multiple individuals with complex CHD in the setting of a family history of LVNC or arrhythmias.
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Affiliation(s)
- Alyssa Ritter
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jacqueline Leonard
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christopher Gray
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kosuke Izumi
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Katharine Levinson
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Divya R Nair
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew O'Connor
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joseph Rossano
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Venkat Shankar
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jessica Chowns
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Amy Marzolf
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Anjali Owens
- Center for Inherited Cardiovascular Disease, Division of Cardiology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Rebecca C Ahrens-Nicklas
- Division of Human Genetics, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Fox CS, Palazzolo T, Hirschhorn M, Stevens RM, Rossano J, Day SW, Tchantchaleishvili V, Throckmorton AL. Development of the Centrifugal Blood Pump for a Hybrid Continuous Flow Pediatric Total Artificial Heart: Model, Make, Measure. Front Cardiovasc Med 2022; 9:886874. [PMID: 35990958 PMCID: PMC9386069 DOI: 10.3389/fcvm.2022.886874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Clinically-available blood pumps and total artificial hearts for pediatric patients continue to lag well behind those developed for adults. We are developing a hybrid, continuous-flow, magnetically levitated, pediatric total artificial heart (TAH). The hybrid TAH design integrates both an axial and centrifugal blood pump within a single, compact housing. The centrifugal pump rotates around the separate axial pump domain, and both impellers rotate around a common central axis. Here, we concentrate our development effort on the centrifugal blood pump by performing computational fluid dynamics (CFD) analysis of the blood flow through the pump. We also conducted transient CFD analyses (quasi-steady and transient rotational sliding interfaces) to assess the pump's dynamic performance conditions. Through modeling, we estimated the pressure generation, scalar stress levels, and fluid forces exerted on the magnetically levitated impellers. To further the development of the centrifugal pump, we also built magnetically-supported prototypes and tested these in an in vitro hydraulic flow loop and via 4-h blood bag hemolytic studies (n = 6) using bovine blood. The magnetically levitated centrifugal prototype delivered 0–6.75 L/min at 0–182 mmHg for 2,750–4,250 RPM. Computations predicted lower pressure-flow performance results than measured by testing; axial and radial fluid forces were found to be <3 N, and mechanical power usage was predicted to be <5 Watts. Blood damage indices (power law weighted exposure time and scalar stress) were <2%. All data trends followed expectations for the centrifugal pump design. Six peaks in the pressure rise were observed in the quasi-steady and transient simulations, correlating to the blade passage frequency of the 6-bladed impeller. The average N.I.H value (n = 6) was determined to be 0.09 ± 0.02 g/100 L, which is higher than desired and must be addressed through design improvement. These data serve as a strong foundation to build upon in the next development phase, whereby we will integrate the axial flow pump component.
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Affiliation(s)
- Carson S. Fox
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Thomas Palazzolo
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Matthew Hirschhorn
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States
| | - Randy M. Stevens
- St. Christopher's Hospital for Children, Philadelphia, PA, United States
| | - Joseph Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Steven W. Day
- Department of Biomedical Engineering, Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, NY, United States
| | | | - Amy L. Throckmorton
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, United States
- *Correspondence: Amy L. Throckmorton
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13
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Vetter VL, Griffis H, Dalldorf KF, Naim MY, Rossano J, Vellano K, McNally B, Glatz AC. Impact of State Laws: CPR Education in High Schools. J Am Coll Cardiol 2022; 79:2140-2143. [PMID: 35618352 DOI: 10.1016/j.jacc.2022.03.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/01/2022] [Accepted: 03/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Victoria L Vetter
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Heather Griffis
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Katherine F Dalldorf
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maryam Y Naim
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph Rossano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Bryan McNally
- CARES Surveillance Group; Emory University, Woodruff Health Sciences Center, Atlanta, Georgia, USA; Rollins School of Public Health, Atlanta, Georgia, USA
| | - Andrew C Glatz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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14
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Amdani S, Marino BS, Rossano J, Lopez R, Schold JD, Tang WHW. Burden of Pediatric Heart Failure in the United States. J Am Coll Cardiol 2022; 79:1917-1928. [PMID: 35550689 DOI: 10.1016/j.jacc.2022.03.336] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 01/13/2022] [Revised: 02/18/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are currently limited accurate national estimates for pediatric heart failure (HF). OBJECTIVES This study aims to describe the current burden of primary and comorbid pediatric HF in the United States. METHODS International Classification of Diseases, Clinical Modification codes were used to identify HF cases and comorbidities from the Kids' Inpatient Database, National Inpatient Sample, National Emergency Department (ED) Sample, and National Vital Statistics System for 2012 and 2016. To describe HF events, all visits/events among pediatric and adult subjects were included in the analysis. HF events were classified into 1 of 3 groups: 1) no HF; 2) primary HF; or 3) comorbid HF. We compared patients with and without HF and calculated unique event rates with age and sex standardization. RESULTS Congenital heart disease, conduction disorders/arrhythmias, and cardiomyopathy were responsible for the majority of pediatric HF-related ED visits and hospitalizations. Compared to 2012, in 2016, there was an increase in comorbid HF ED visits (rate ratio: 1.93; P < 0.001) and primary HF hospitalizations (rate ratio: 1.14; P = 0.002). Pediatric HF burden was lower compared to adult HF; however, deaths in the ED and in-hospital were significantly more likely in children presenting with HF than adults. CONCLUSIONS The burden of pediatric HF continues to increase. Compared to adults with HF presenting to the ED and in-hospital, outcomes are inferior and per patient resource use is higher for children hospitalized with HF. National initiatives to understand risk factors for morbidity and mortality in pediatric HF and continued surveillance and mitigation of preventable risk factors may attenuate this uptrend.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA.
| | - Bradley S Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio, USA
| | - Joseph Rossano
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rocio Lopez
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jesse D Schold
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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15
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Palazzolo T, Hirschhorn M, Garven E, Day S, Stevens RM, Rossano J, Tchantchaleishvili V, Throckmorton AL. Technology Landscape of Pediatric Mechanical Circulatory Support Devices- A Systematic Review 2010-2021. Artif Organs 2022; 46:1475-1490. [PMID: 35357020 PMCID: PMC9256769 DOI: 10.1111/aor.14242] [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] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/17/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mechanical circulatory support (MCS) devices, such as ventricular assist devices (VADs) and total artificial hearts (TAHs), have become a vital therapeutic option in the treatment of end-stage heart failure for adult patients. Such therapeutic options continue to be limited for pediatric patients. Clinicians initially adapted or scaled existing adult devices for pediatric patients; however, these adult devices are not designed to support the anatomical structure and varying flow capacities required for this population and are generally operated "off-design", which risks complications such as hemolysis and thrombosis. Devices designed specifically for the pediatric population that seek to address these shortcomings are now emerging and gaining FDA approval. METHODS To analyze the competitive landscape of pediatric MCS devices, we conducted a systematic literature review. Approximately 27 devices were studied in detail: 8 were established or previously approved designs, and 19 were under development (11 VADs, 5 Fontan assist devices, and 3 TAHs). RESULTS Despite significant progress, there is still no pediatric pump technology that satisfies the unique and distinct design constraints and requirements to support pediatric patients, including the wide range of patient sizes, increased cardiovascular demand with growth, and anatomic and physiologic heterogeneity of congenital heart disease. CONCLUSIONS Forward-thinking design solutions are required to overcome these challenges and to ensure the translation of new therapeutic MCS devices for pediatric patients.
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Affiliation(s)
- Thomas Palazzolo
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Matthew Hirschhorn
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Ellen Garven
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Steven Day
- Department of Biomedical Engineering, Kate Gleason College of Engineering, Rochester Institute of Technology, Rochester, NY, USA
| | - Randy M Stevens
- College of Medicine, St. Christopher's Hospital for Children, Drexel University, Philadelphia, PA, USA
| | - Joseph Rossano
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Amy L Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
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16
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Norrish G, Qu C, Field E, Cervi E, Khraiche D, Klaassen S, Ojala TH, Sinagra G, Yamazawa H, Marrone C, Popoiu A, Centeno F, Schouvey S, Olivotto I, Day SM, Colan S, Rossano J, Wittekind SG, Saberi S, Russell M, Helms A, Ingles J, Semsarian C, Elliott PM, Ho CY, Omar RZ, Kaski JP. External validation of the HCM Risk-Kids model for predicting sudden cardiac death in childhood hypertrophic cardiomyopathy. Eur J Prev Cardiol 2022; 29:678-686. [PMID: 34718528 PMCID: PMC8967478 DOI: 10.1093/eurjpc/zwab181] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/22/2021] [Indexed: 11/24/2022]
Abstract
AIMS Sudden cardiac death (SCD) is the most common mode of death in childhood hypertrophic cardiomyopathy (HCM). The newly developed HCM Risk-Kids model provides clinicians with individualized estimates of risk. The aim of this study was to externally validate the model in a large independent, multi-centre patient cohort. METHODS AND RESULTS A retrospective, longitudinal cohort of 421 patients diagnosed with HCM aged 1-16 years independent of the HCM Risk-Kids development and internal validation cohort was studied. Data on HCM Risk-Kids predictor variables (unexplained syncope, non-sustained ventricular tachycardia, maximal left ventricular wall thickness, left atrial diameter, and left ventricular outflow tract gradient) were collected from the time of baseline clinical evaluation. The performance of the HCM Risk-Kids model in predicting risk at 5 years was assessed. Twenty-three patients (5.4%) met the SCD end-point within 5 years, with an overall incidence rate of 2.03 per 100 patient-years [95% confidence interval (CI) 1.48-2.78]. Model validation showed a Harrell's C-index of 0.745 (95% CI 0.52-0.97) and Uno's C-index 0.714 (95% 0.58-0.85) with a calibration slope of 1.15 (95% 0.51-1.80). A 5-year predicted risk threshold of ≥6% identified 17 (73.9%) SCD events with a corresponding C-statistic of 0.702 (95% CI 0.60-0.81). CONCLUSIONS This study reports the first external validation of the HCM Risk-Kids model in a large and geographically diverse patient population. A 5-year predicted risk of ≥6% identified over 70% of events, confirming that HCM Risk-Kids provides a method for individualized risk predictions and shared decision-making in children with HCM.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | | | - Sabine Klaassen
- Department of Paediatric Cardiology, Charite – Universitatsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Centre (ECRC), a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Centre for Molecular Medicine (MDC), Charite – Universitatsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Tiina H Ojala
- Department of Paediatric Cardiology, New Children’s Hospital, University of Helsinki, Helsinki, Finland
| | - Gianfranco Sinagra
- Heart Muscle Disease Registry Trieste, University of Trieste, Trieste, Italy
| | - Hirokuni Yamazawa
- Department of Paediatrics, Faculty of Medicine and Graduate school of Medicine, Hokkaido University Hospital, Sapporo, Japan
| | | | - Anca Popoiu
- Department of Paediatrics, Children’s Hospital ‘Louis Turcanu’, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
| | | | | | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Sharlene M Day
- Department of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steve Colan
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph Rossano
- Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samuel G Wittekind
- Cincinnati Children's Hospital Medical Center, Heart Institute, Cincinnati, OH, USA
| | - Sara Saberi
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Russell
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Adam Helms
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
| | - Perry M Elliott
- Institute of Cardiovascular Sciences, University College London, London, UK
- St Bartholomew’s Centre for Inherited Cardiovascular Diseases, St Bartholomew’s Hospital, West Smithfield, London, UK
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
| | - Juan P Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
- Institute of Cardiovascular Sciences, University College London, London, UK
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17
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Mejia EJ, O'Connor MJ, Samelson-Jones BJ, Mavroudis CD, Giglia TM, Keashen R, Rossano J, Naim MY, Maeda K. Successful Treatment of Intracardiac Thrombosis in the Presence of Fulminant Myocarditis Requiring ECMO associated with COVID-19. J Heart Lung Transplant 2022; 41:849-851. [PMID: 35370032 PMCID: PMC8908727 DOI: 10.1016/j.healun.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
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18
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Burstein DS, Wittlieb-Weber C, Maeda K, Rossano J. Commentary: Intraoperative hemorrhage in Fontan transplantation—a common and potentially modifiable challenge? JTCVS Open 2021; 8:574-575. [PMID: 36004077 PMCID: PMC9390638 DOI: 10.1016/j.xjon.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Katsumeda Maeda
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Joseph Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pa
- Address for reprints: Joseph Rossano, MD, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104.
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19
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Potena L, Rossano J. Development of post-transplant risk scores: Dancing to off-key tunes. J Heart Lung Transplant 2021; 40:1668-1669. [PMID: 34656417 DOI: 10.1016/j.healun.2021.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Luciano Potena
- Heart Failure and Heart Transplant Unit - IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Joseph Rossano
- The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Keating BJ, Mukhtar EH, Elftmann ED, Eweje FR, Gao H, Ibrahim LI, Kathawate RG, Lee AC, Li EH, Moore KA, Nair N, Chaluvadi V, Reason J, Zanoni F, Honkala AT, Al‐Ali AK, Abdullah Alrubaish F, Ahmad Al‐Mozaini M, Al‐Muhanna FA, Al‐Romaih K, Goldfarb SB, Kellogg R, Kiryluk K, Kizilbash SJ, Kohut TJ, Kumar J, O'Connor MJ, Rand EB, Redfield RR, Rolnik B, Rossano J, Sanchez PG, Alavi A, Bahmani A, Bogu GK, Brooks AW, Metwally AA, Mishra T, Marks SD, Montgomery RA, Fishman JA, Amaral S, Jacobson PA, Wang M, Snyder MP. Early detection of SARS-CoV-2 and other infections in solid organ transplant recipients and household members using wearable devices. Transpl Int 2021; 34:1019-1031. [PMID: 33735480 PMCID: PMC8250335 DOI: 10.1111/tri.13860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/14/2022]
Abstract
The increasing global prevalence of SARS-CoV-2 and the resulting COVID-19 disease pandemic pose significant concerns for clinical management of solid organ transplant recipients (SOTR). Wearable devices that can measure physiologic changes in biometrics including heart rate, heart rate variability, body temperature, respiratory, activity (such as steps taken per day) and sleep patterns, and blood oxygen saturation show utility for the early detection of infection before clinical presentation of symptoms. Recent algorithms developed using preliminary wearable datasets show that SARS-CoV-2 is detectable before clinical symptoms in >80% of adults. Early detection of SARS-CoV-2, influenza, and other pathogens in SOTR, and their household members, could facilitate early interventions such as self-isolation and early clinical management of relevant infection(s). Ongoing studies testing the utility of wearable devices such as smartwatches for early detection of SARS-CoV-2 and other infections in the general population are reviewed here, along with the practical challenges to implementing these processes at scale in pediatric and adult SOTR, and their household members. The resources and logistics, including transplant-specific analyses pipelines to account for confounders such as polypharmacy and comorbidities, required in studies of pediatric and adult SOTR for the robust early detection of SARS-CoV-2, and other infections are also reviewed.
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21
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Lorts A, Conway J, Schweiger M, Adachi I, Amdani S, Auerbach SR, Barr C, Bleiweis MS, Blume ED, Burstein DS, Cedars A, Chen S, Cousino-Hood MK, Daly KP, Danziger-Isakov LA, Dubyk N, Eastaugh L, Friedland-Little J, Gajarski R, Hasan A, Hawkins B, Jeewa A, Kindel SJ, Kogaki S, Lantz J, Law SP, Maeda K, Mathew J, May LJ, Miera O, Murray J, Niebler RA, O'Connor MJ, Özbaran M, Peng DM, Philip J, Reardon LC, Rosenthal DN, Rossano J, Salazar L, Schumacher KR, Simpson KE, Stiller B, Sutcliffe DL, Tunuguntla H, VanderPluym C, Villa C, Wearden PD, Zafar F, Zimpfer D, Zinn MD, Morales IRD, Cowger J, Buchholz H, Amodeo A. ISHLT consensus statement for the selection and management of pediatric and congenital heart disease patients on ventricular assist devices Endorsed by the American Heart Association. J Heart Lung Transplant 2021; 40:709-732. [PMID: 34193359 DOI: 10.1016/j.healun.2021.04.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 01/17/2023] Open
Affiliation(s)
- Angela Lorts
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
| | | | - Martin Schweiger
- Universitäts-Kinderspitals Zürich - Herzchirurgie, Zurich, Switzerland
| | - Iki Adachi
- Texas Children's Hospital, Houston, Texas
| | | | - Scott R Auerbach
- Anschutz Medical Campus, Children's Hospital of Colorado, University of Colorado Denver, Aurora, Colorado
| | - Charlotte Barr
- The Royal Children's Hospital, Victoria Melbourne, Australia
| | - Mark S Bleiweis
- Shands Children's Hospital, University of Florida Health, Gainesville, Florida
| | | | | | - Ari Cedars
- Children's Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sharon Chen
- Stanford Children's Health and Lucile Packard Children's Hospital, Palo Alto, California
| | | | - Kevin P Daly
- Boston Children's Hospital, Boston, Massachusetts
| | - Lara A Danziger-Isakov
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Nicole Dubyk
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Lucas Eastaugh
- The Royal Children's Hospital, Victoria Melbourne, Australia
| | | | | | - Asif Hasan
- Freeman Hospital, Newcastle upon Tyne, UK
| | - Beth Hawkins
- Boston Children's Hospital, Boston, Massachusetts
| | - Aamir Jeewa
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Steven J Kindel
- Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Winscoin
| | | | - Jodie Lantz
- Children's Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sabrina P Law
- Morgan Stanley Children's Hospital of New York Presbyterian, New York, New York
| | - Katsuhide Maeda
- Stanford Children's Health and Lucile Packard Children's Hospital, Palo Alto, California
| | - Jacob Mathew
- The Royal Children's Hospital, Victoria Melbourne, Australia
| | | | | | - Jenna Murray
- Stanford Children's Health and Lucile Packard Children's Hospital, Palo Alto, California
| | - Robert A Niebler
- Department of Pediatrics, Medical College of Wisconsin and Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, Winscoin
| | | | | | - David M Peng
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Joseph Philip
- Shands Children's Hospital, University of Florida Health, Gainesville, Florida
| | | | - David N Rosenthal
- Stanford Children's Health and Lucile Packard Children's Hospital, Palo Alto, California
| | - Joseph Rossano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Kurt R Schumacher
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | | | - David L Sutcliffe
- Children's Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | - Chet Villa
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | - Farhan Zafar
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | - Matthew D Zinn
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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22
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Amdani S, Boyle G, Rossano J, Scheel J, Richmond M, Arrigain S, Schold JD. Association of low center performance evaluations and pediatric heart transplant center behavior in the United States. J Heart Lung Transplant 2021; 40:831-840. [PMID: 34078559 DOI: 10.1016/j.healun.2021.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To date, no study has evaluated the effects of low center performance evaluations (CPE) on pediatric heart transplant center behavior. We sought to assess the impact of low CPE flags on pediatric heart transplant center listing and transplant volumes and center recipient and donor characteristics. METHODS We included centers performing at least 10 pediatric (age <18 years) transplants during the Scientific Registry of Transplant Recipients reporting period January 2009-June 2011 and evaluated consecutive biannual program specific reports until the last reporting period January 2016-June 2018. We evaluated changes in center behavior at following time points: a year before flagging, a year and two years after the flag; and at last reporting period. RESULTS During our study period, 24 pediatric centers were non-flagged and 6 were flagged. Compared to non-flagged centers, there was a decline in candidate listings in flagged centers at the last reporting period (mean increase of 5.5 ± 12.4 listings vs"?> mean decrease of 14.0 ± 14.9 listings; p = .003). Similarly, the number of transplants declined in flagged centers (mean increase of 2.6 ± 9.6 transplants vs"?> mean decrease of 10.0 ± 12.8 transplants; p = .012). Flagged centers had declines in listings for patients with restrictive cardiomyopathy, re-transplant, renal dysfunction, those on mechanical ventilation and extracorporeal membrane oxygenation. There was no significant change in donor characteristics between flagged and non-flagged centers. CONCLUSIONS Low CPE may have unintended negative consequences on center behavior leading to declines in listing and transplant volumes and potentially leading to decreased listing for higher risk recipients.
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Affiliation(s)
- Shahnawaz Amdani
- Department of Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio.
| | - Gerard Boyle
- Department of Cardiology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Joseph Rossano
- Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janet Scheel
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Marc Richmond
- Department of Pediatrics, Division of Pediatric Cardiology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Susana Arrigain
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jesse D Schold
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
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23
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Lynch A, Ahuja S, Miron A, Nakano S, Howard T, Villa C, Armstrong K, Kaufman B, Gardin L, Whitehill R, Parent J, Godown J, Henderson H, Aziz P, Colan S, Seshadri B, Kantor P, Russell M, Lal A, Butts R, Richmond M, Conway J, Weintraub R, Rossano J, Mital S. Sudden Cardiac Death and ICD Use in Rasopathy-Associated Hypertrophic Cardiomyopathy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1821] [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: 11/30/2022] Open
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24
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Sarkisyan H, Stevens R, Tchantchaleishvili V, Rossano J, Throckmorton A. Integrated long-term multifunctional pediatric mechanical circulatory assist device. Artif Organs 2020; 45:E65-E78. [PMID: 33191508 DOI: 10.1111/aor.13863] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 10/11/2020] [Accepted: 11/03/2020] [Indexed: 11/27/2022]
Abstract
There continues to be limited, viable ventricular assist device technology options to support the dysfunctional states of pediatric heart failure. To address this need, we are developing a magnetically suspended, versatile pumping technology that uniquely integrates two blood pumps in a series configuration within a single device housing. This device enables operational switching from the usage of one pump to another as needed for clinical management or to support growth and development of the pediatric patient. Here, we present the initial design where we conducted a virtual fit study, the Taguchi Design Optimization Method, iterative design to develop pump geometries. Computational tools were used to estimate the pressure generation, capacity delivery, hydraulic efficiency, fluid stress levels, exposure time to stresses, blood damage index, and fluid forces on the impellers. Prototypes of the pumps were tested in a flow loop using a water-glycerin solution. Both designs demonstrated the capability to generate target pressures and flows. Blood damage estimations were below threshold levels and achieved design requirements; however, maximum scalar stress levels were above the target limit. Radial and axial forces were less than 1 N and 10 N, respectively. The performance data trends for physical prototypes correlated with theoretical expectations. The centrifugal prototype was able to generate slightly higher pressure rises than numerical predictions. In contrast, the axial prototype outperformed the computational studies. Experimental data were both repeatable and reproducible. The findings from this research are promising, and development will continue.
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Affiliation(s)
- Harutyun Sarkisyan
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Randy Stevens
- Pediatrics, College of Medicine, Drexel University, Philadelphia, PA, USA.,Heart Center for Children, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | | | - Joseph Rossano
- Division of Cardiology, Pediatric Heart Failure & Transplant Program, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amy Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
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25
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VanderPluym CJ, Cantor RS, Machado D, Boyle G, May L, Griffiths E, Niebler RA, Lorts A, Rossano J, Sutcliffe DL, Lytrivi ID, Buchholz H, Fynn-Thompson F, Hawkins B, Conway J. Utilization and Outcomes of Children Treated with Direct Thrombin Inhibitors on Paracorporeal Ventricular Assist Device Support. ASAIO J 2020; 66:939-945. [PMID: 32740356 DOI: 10.1097/mat.0000000000001093] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 11/26/2022] Open
Abstract
Thrombotic and bleeding complications have historically been major causes of morbidity and mortality in pediatric ventricular assist device (VAD) support. Standard anticoagulation with unfractionated heparin is fraught with problems related to its heterogeneous biochemical composition and unpredictable pharmacokinetics. We sought to describe the utilization and outcomes in children with paracorporeal VAD support who are treated with direct thrombin inhibitors (DTIs) antithrombosis therapy. Retrospective multicenter review of all pediatric patients (aged <19 years) treated with a DTI (bivalirudin or argatroban) on paracorporeal VAD support, examining bleeding and thrombotic adverse events. From May 2012 to 2018, 43 children (21 females) at 10 centers in North America, median age 9.5 months (0.1-215 months) weighing 8.6 kg (2.8-150 kg), were implanted with paracorporeal VADs and treated with a DTI. Diagnoses included cardiomyopathy 40% (n = 17), congenital heart disease 37% (n = 16; single ventricle n = 5), graft vasculopathy 9% (n = 4), and other 14% (n = 6). First device implanted included Berlin Heart EXCOR 49% (n = 21), paracorporeal continuous flow device 44% (n = 19), and combination of devices in 7% (n = 3). Adverse events on DTI therapy included; major bleeding in 16% (n = 7) (2.6 events per 1,000 patient days of support on DTI), and stroke 12% (n = 5) (1.7 events per 1,000 patient days of support on DTI). Overall survival to transplantation (n = 30) or explantation (n = 8) was 88%. This is the largest multicenter experience of DTI use for anticoagulation therapy in pediatric VAD support. Outcomes are encouraging with lower major bleeding and stroke event rate than that reported in literature using other anticoagulation agents in pediatric VAD support.
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Affiliation(s)
- Christina J VanderPluym
- From the Department of Cardiology, Boston Children's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama at Birmingham, Birmingham, Alabama
| | - Desiree Machado
- Department of Pediatrics and Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Congenital Heart Center, University of Florida, Gainesville, Florida
| | - Gerald Boyle
- Center for Pediatric and Congenital Heart Disease, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lindsay May
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Eric Griffiths
- Division of Cardiothoracic Surgery, University of Utah Health Care, Salt Lake City, Utah
| | - Robert A Niebler
- Department of Pediatrics, Section of Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Angela Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph Rossano
- Division of Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David L Sutcliffe
- Division of Cardiology, Children's Health Dallas, UT Southwestern Medical Center, Dallas, Texas
| | - Irene D Lytrivi
- From the Department of Cardiology, Boston Children's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Holger Buchholz
- Department of Cardiovascular Surgery, University of Alberta, Edmonton, Alberta
| | - Francis Fynn-Thompson
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Beth Hawkins
- From the Department of Cardiology, Boston Children's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Jennifer Conway
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta
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26
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Edwards J, Edelson J, Katcoff H, Mondal A, Reza N, Griffis H, Ravishankar C, Rossano J, Lin K, Birati E. Age-Dependent Emergency Department Resource Utilization in Patients with a Ventricular Assist Device. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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27
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Hirschhorn M, Tchantchaleishvili V, Stevens R, Rossano J, Throckmorton A. Fluid–structure interaction modeling in cardiovascular medicine – A systematic review 2017–2019. Med Eng Phys 2020; 78:1-13. [DOI: 10.1016/j.medengphy.2020.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/18/2020] [Accepted: 01/26/2020] [Indexed: 01/06/2023]
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28
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Edelson J, Matesanz S, Iacobellis K, Mejia E, Rossano J, O'Connor MJ, Burstein D, Brandsema J, Griffis H, Okunowo O, Lin K. HEALTHCARE UTILIZATION IN PEDIATRIC PATIENTS WITH MUSCULAR DYSTROPHY IN THE UNITED STATES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31723-x] [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: 11/25/2022]
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29
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Rychik J, Dodds KM, Goldberg D, Glatz AC, Fogel M, Rossano J, Chen J, Pinto E, Ravishankar C, Rand E, Rome JJ, Dori Y. Protein Losing Enteropathy After Fontan Operation: Glimpses of Clarity Through the Lifting Fog. World J Pediatr Congenit Heart Surg 2019; 11:92-96. [DOI: 10.1177/2150135119890555] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Fontan-associated protein losing enteropathy is a challenge to treat and is a major contributor to morbidity and mortality in patients with palliated single ventricle. Numerous strategies for management have been proposed, with confusion as to how best to stratify and implement care among the many treatments available. Medical management can be helpful in some, while novel lymphatic interventions hold potential for remission with good results. We review our institutional approach to protein losing enteropathy after Fontan operation and provide a suggested algorithm and pathway for effective care.
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Affiliation(s)
- Jack Rychik
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kathryn M. Dodds
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - David Goldberg
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew C. Glatz
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark Fogel
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Joseph Rossano
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan Chen
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Erin Pinto
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chitra Ravishankar
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth Rand
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jonathan J. Rome
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Yoav Dori
- Cardiac Center at The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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30
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Axelsson Raja A, Shi L, Day SM, Russell M, Zahka K, Lever H, Colan SD, Margossian R, Hall EK, Becker J, Jefferies JL, Patel AR, Choudhury L, Murphy AM, Canter C, Bach R, Taylor M, Mestroni L, Wheeler MT, Benson L, Owens AT, Rossano J, Lin KY, Pahl E, Pereira AC, Bundgaard H, Lewis GD, Vargas JD, Cirino AL, McMurray JJV, MacRae CA, Solomon SD, Orav EJ, Braunwald E, Ho CY. Baseline Characteristics of the VANISH Cohort. Circ Heart Fail 2019; 12:e006231. [PMID: 31813281 DOI: 10.1161/circheartfailure.119.006231] [Citation(s) in RCA: 5] [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] [Indexed: 01/03/2023]
Abstract
BACKGROUND The VANISH trial (Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy) targeted young sarcomeric gene mutation carriers with early-stage hypertrophic cardiomyopathy (HCM) to test whether valsartan can modify disease progression. We describe the baseline characteristics of the VANISH cohort and compare to previous trials evaluating angiotensin receptor blockers. METHODS Applying a randomized, double-blinded, placebo-controlled design, 178 participants with nonobstructive HCM (age, 23.3±10.1 years; 61% men) were randomized in the primary cohort and 34 (age, 16.5±4.9 years; 50% men) in the exploratory cohort of sarcomeric mutation carriers without left ventricular hypertrophy. RESULTS In the primary cohort, maximal left ventricular wall thickness was 17±4 mm for adults and Z score 7.0±4.5 for children. Nineteen percent had late gadolinium enhancement on cardiac magnetic resonance. Mean peak oxygen consumption was 33 mL/kg per minute, and 92% of participants were New York Heart Association functional class I. New York Heart Association class II was associated with older age, MYH7 variants, and more prominent imaging abnormalities. Six previous trials of angiotensin receptor blockers in HCM enrolled a median of 24 patients (range, 19-133) with mean age of 51.2 years; 42% of patients were in New York Heart Association class ≥II, and sarcomeric mutations were not required. CONCLUSIONS The VANISH cohort is much larger, younger, less heterogeneous, and has less advanced disease than prior angiotensin receptor blocker trials in HCM. Participants had relatively normal functional capacity and mild HCM features. New York Heart Association functional class II symptoms were associated with older age, more prominent imaging abnormalities, and MYH7 variants, suggesting both phenotype and genotype contribute to disease manifestations. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01912534.
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Affiliation(s)
| | - Ling Shi
- New England Research Institutes, Watertown, MA (L.S.)
| | | | - Mark Russell
- University of Michigan, Ann Arbor (S.M.D., M.R.)
| | | | | | | | | | | | - Jason Becker
- Vanderbilt University Medical Center, Nashville, TN (J.B.)
| | | | | | | | - Anne M Murphy
- Johns Hopkins University School of Medicine, Baltimore, MD (A.M.M.)
| | - Charles Canter
- Washington University School of Medicine, St. Louis, MO (C.C., R.B.)
| | - Richard Bach
- Washington University School of Medicine, St. Louis, MO (C.C., R.B.)
| | - Matthew Taylor
- University of Colorado Anschutz Medical Campus, Aurora (M.T., L.M.)
| | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora (M.T., L.M.)
| | | | - Lee Benson
- Toronto Hospital for Sick Children, ON, Canada (L.B.)
| | - Anjali T Owens
- University of Pennsylvania Perelman School of Medicine, Philadelphia (A.T.O.)
| | | | | | - Elfriede Pahl
- Ann & Robert H. Lurie Children's Hospital of Chicago, IL (E.P.)
| | - Alexandre C Pereira
- Heart Institute, University of São Paulo Medical School (Instituto do Coração), Brazil (A.C.P.)
| | - Henning Bundgaard
- Copenhagen University Hospital Rigshospitalet, Denmark (A.A.R., H.B.)
| | | | - Jose D Vargas
- MedStar Georgetown University Hospital, National Institutes of Health, Bethesda, MD (J.D.V.)
| | - Allison L Cirino
- Brigham and Women's Hospital, Boston, MA (A.L.C., C.A.M., S.D.S., E.J.O., E.B., C.Y.H.)
| | | | - Calum A MacRae
- Brigham and Women's Hospital, Boston, MA (A.L.C., C.A.M., S.D.S., E.J.O., E.B., C.Y.H.)
| | - Scott D Solomon
- Brigham and Women's Hospital, Boston, MA (A.L.C., C.A.M., S.D.S., E.J.O., E.B., C.Y.H.)
| | - E John Orav
- Brigham and Women's Hospital, Boston, MA (A.L.C., C.A.M., S.D.S., E.J.O., E.B., C.Y.H.)
| | - Eugene Braunwald
- Brigham and Women's Hospital, Boston, MA (A.L.C., C.A.M., S.D.S., E.J.O., E.B., C.Y.H.)
| | - Carolyn Y Ho
- Brigham and Women's Hospital, Boston, MA (A.L.C., C.A.M., S.D.S., E.J.O., E.B., C.Y.H.)
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Rychik J, Cohen M, Rossano J, Chen J. Special Issue Editorial. Progress in Pediatric Cardiology 2019. [DOI: 10.1016/j.ppedcard.2019.101147] [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: 10/26/2022]
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Edwards JJ, Seliktar N, White R, Heron SD, Lin K, Rossano J, Monos D, Sesok-Pizzini D, O'Connor MJ. Impact and predictors of positive response to desensitization in pediatric heart transplant candidates. J Heart Lung Transplant 2019; 38:1206-1213. [PMID: 31672220 DOI: 10.1016/j.healun.2019.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/03/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Desensitization, the process of reducing anti-human leukocyte antigen (HLA) antibodies in sensitized patients awaiting heart transplantation (HT), has unclear efficacy in pediatric HT candidates. METHODS Pediatric HT candidates listed at our institution between January 1, 2013 and June 30, 2018 were retrospectively evaluated. Sensitization was defined as the calculated panel reactive antibody (cPRA) ≥ 10% with ≥ 1 a strong positive antibody. The desensitization response was defined as a ≥ 25% reduction in the mean fluorescence intensity (MFI) for ≥ 90% of the strong positive antibodies on follow-up panel reactive antibody (PRA) testing before waitlist removal, HT, or death (data available for 13 patients). RESULTS The HT candidates were categorized as sensitized receiving desensitization therapy (ST, n = 14), sensitized not receiving therapy (SNT, n = 18), or non-sensitized (n = 55). A desensitization response was observed in 8 (62%) of the ST upon repeat PRA testing, with the ST responders receiving more doses of intravenous immunoglobulin (IVIG) (8 vs 2, p < 0.05). The anti-HLA class I antibodies were particularly resistant for non-responders (p = 1.9 × 10-4). The combination of homograft and ventricular assist device was more sensitizing than either alone (p = 3.1 × 10-4). However, these sensitization risk factors did not impact the desensitization response. The ST was associated with a higher likelihood of remaining listed and a longer waitlist time without substantially impacting the HT rate, waitlist mortality, or early post-HT outcomes. CONCLUSIONS Most ST patients had a favorable response to desensitization, with a dose-dependent response observed for IVIG. The anti-HLA class likely impacts the ST response, whereas traditional sensitization risk factors had no impact on the response.
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Affiliation(s)
- Jonathan J Edwards
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | | | - Rachel White
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Steven D Heron
- Immunogenetics Laboratory, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberly Lin
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph Rossano
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dimitri Monos
- Immunogenetics Laboratory, Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Deborah Sesok-Pizzini
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew J O'Connor
- Department of Pediatrics, Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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33
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Fox C, Sarkisyan H, Stevens R, Arabia F, Fischer W, Rossano J, Throckmorton A. New versatile dual‐support pediatric heart pump. Artif Organs 2019; 43:1055-1064. [DOI: 10.1111/aor.13507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/30/2019] [Accepted: 05/30/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Carson Fox
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems Drexel University Philadelphia Pennsylvania
| | - Harutyun Sarkisyan
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems Drexel University Philadelphia Pennsylvania
| | - Randy Stevens
- St. Christopher's Hospital for Children, Tenet Healthcare Corporation Philadelphia Pennsylvania
| | | | - Wade Fischer
- Osceola Regional Medical Center Florida Heart and Lung Institute Kissimmee Florida
| | - Joseph Rossano
- Division of Pediatric Cardiology The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Amy Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems Drexel University Philadelphia Pennsylvania
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34
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Menachem JN, Lindenfeld J, Schlendorf K, Shah AS, Bichell DP, Book W, Brinkley DM, Danter M, Frischhertz B, Keebler M, Kogon B, Mettler B, Rossano J, Sacks SB, Young T, Wigger M, Zalawadiya S. Center volume and post-transplant survival among adults with congenital heart disease. J Heart Lung Transplant 2018; 37:1351-1360. [DOI: 10.1016/j.healun.2018.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 12/18/2022] Open
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Burstein DS, Maude S, Grupp S, Griffis H, Rossano J, Lin K. Cardiac Profile of Chimeric Antigen Receptor T Cell Therapy in Children: A Single-Institution Experience. Biol Blood Marrow Transplant 2018; 24:1590-1595. [DOI: 10.1016/j.bbmt.2018.05.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
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36
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Getz KD, He C, Li Y, Huang YSV, Burstein DS, Rossano J, Aplenc R. Successful merging of data from the United Network for Organ Sharing and the Pediatric Health Information System databases. Pediatr Transplant 2018; 22:e13168. [PMID: 29635813 PMCID: PMC6047917 DOI: 10.1111/petr.13168] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 12/24/2022]
Abstract
Data routinely collected through United Network for Organ Sharing (UNOS) lack the detailed information on medical resource utilization and treatment costs required to accomplish for center-level comparisons of quality of care and cost for pediatric heart transplantation. We aimed to overcome this limitation by merging UNOS with the Pediatric Health Information System (PHIS) database, an administrative database containing inpatient, emergency department, ambulatory surgery, and observation unit information from over 40 not-for-profit, tertiary care pediatric hospitals. Utilizing a probabilistic match based on center, date of birth, recipient gender, and transplant date within ±2 days, more than 90% of eligible UNOS patients (N = 2264) were successfully merged to their corresponding PHIS records. Thirty-day and 1-year mortality rates observed for the merged cohort (3.2% and 9.0%, respectively) were compared with those previously reported for pediatric heart transplants, as were the significant predictors of increased mortality. These results demonstrate that the established UNOS-PHIS cohort will provide a valid platform for subsequent research aimed at identifying center-level differences that could be exploited to optimize quality of care while minimizing cost across institutions.
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Affiliation(s)
- Kelly D. Getz
- The Children’s Hospital of Philadelphia, Division of Oncology, 2716 South Street, Office 10291, Philadelphia, PA 19146, USA, Telephone: (267) 426-9719, Fax: (267)425-5839,
| | - Christy He
- Drexel University College of Medicine, 2900 W Queen Lane, Philadelphia, PA 19129, USA, Telephone: (610) 308-1788,
| | - Yimei Li
- The Children’s Hospital of Philadelphia, Division of Oncology, 3501 Civic Center Blvd, Philadelphia, PA 19104, USA, Telephone: (267) 425-3084,
| | - Yuan-Shung V. Huang
- The Children’s Hospital of Philadelphia, Healthcare Analytics Unit, Philadelphia, PA, USA, 2716 South Street, Philadelphia, PA 19146, USA, Telephone: (267) 426-7748,
| | - Danielle S. Burstein
- The Children’s Hospital of Philadelphia, Division of Cardiology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA, Telephone: (215) 590-3548,
| | - Joseph Rossano
- The Children’s Hospital of Philadelphia, Division of Cardiology, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA, Telephone: (215) 590-4040,
| | - Richard Aplenc
- The Children’s Hospital of Philadelphia, Division of Oncology, 3501 Civic Center Blvd, Philadelphia, PA 19104, USA, Telephone: (267) 426-7252,
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37
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Robinson M, Rossano J, Cherikh W, Kucheryavaya A, Oliveira G, Stehlik J. Outcomes in Heart Transplantation for Adults with Congenital Heart Disease- Contemporary Analysis and Development of a Risk Model - ReDoT Score. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.218] [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: 11/27/2022] Open
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38
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Fox C, Chopski S, Murad N, Allaire P, Mentzer R, Rossano J, Arabia F, Throckmorton A. Hybrid Continuous-Flow Total Artificial Heart. Artif Organs 2018; 42:500-509. [PMID: 29349805 DOI: 10.1111/aor.13080] [Citation(s) in RCA: 16] [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: 08/11/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 12/18/2022]
Abstract
Clinical studies using total artificial hearts (TAHs) have demonstrated that pediatric and adult patients derive quality-of-life benefits from this form of therapy. Two clinically-approved TAHs and other pumps under development, however, have design challenges and limitations, including thromboembolic events, neurologic impairment, infection risk due to large size and percutaneous drivelines, and lack of ambulation, to name a few. To address these limitations, we are developing a hybrid-design, continuous-flow, implantable or extracorporeal, magnetically-levitated TAH for pediatric and adult patients with heart failure. This TAH has only two moving parts: an axial impeller for the pulmonary circulation and a centrifugal impeller for the systemic circulation. This device will utilize the latest generation of magnetic bearing technology. Initial geometries were established using pump design equations, and computational modeling provided insight into pump performance. The designs were the basis for prototype manufacturing and hydraulic testing. The study results demonstrate that the TAH is capable of delivering target blood flow rates of 1-6.5 L/min with pressure rises of 1-92 mm Hg for the pulmonary circulation and 24-150 mm Hg for the systemic circulation at 1500-10 000 rpm. This initial design of the TAH was successful and serves as the foundation to continue its development as a novel, more compact, nonthrombogenic, and effective therapeutic alternative for infants, children, adolescents, and adults with heart failure.
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Affiliation(s)
- Carson Fox
- The BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Steven Chopski
- The BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Nohra Murad
- The BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Paul Allaire
- Rotor Bearing Solutions International, Charlottesville, VA, USA
| | | | - Joseph Rossano
- Division of Pediatric Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Amy Throckmorton
- The BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA
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Kleinmahon JA, Patel SS, Auerbach SR, Rossano J, Everitt MD. Hearts transplanted after circulatory death in children: Analysis of the International Society for Heart and Lung Transplantation registry. Pediatr Transplant 2017; 21. [PMID: 28940999 DOI: 10.1111/petr.13064] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2017] [Indexed: 11/25/2022]
Abstract
We aimed to describe worldwide DCD HT experience in children using the International Society for Heart and Lung Transplantation Registry. The Registry was queried for primary HT performed in children (2005-2014). Kaplan-Meier analysis was used to assess survival for recipients grouped by DCD or DBD hearts. Recipient characteristics were compared between DCD and DBD and between survivors and non-survivors of DCD HT. Among 3877 pediatric HT performed, 21 (0.5%) were DCD. DCD 1-year survival was 61% vs 91% DBD, P < .01. DCD recipients were more often supported by ECMO pre-HT (24% vs 6%, P < .001) and more often receiving inhaled nitric oxide (10% vs 0.6%, P < .001) compared to DBD. Older DCD recipients had significantly lower 1-year survival of 57% vs 93% for DBD, P < .01. Survival for infant DCD recipients was not statistically different to DBD recipients (survival 62% at 1 year and 62% at 5 years for DCD vs 85% at 1 year and 77% at 5 years for DBD, P = .15). Recipients of DCD HT who died were more often supported by ECMO pre-HT (56% non-survivors vs 0% survivors, P = .004) and receiving mechanical ventilation (44% vs 0%, P = .012). DCD HT is uncommon in children. DCD-independent factors in recipients may have contributed to worse survival as DCD recipients who died were more often supported by ECMO and mechanical ventilation. More research is needed to identify donor factors and recipient factors that contribute to mortality after DCD HT.
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Affiliation(s)
- Jake A Kleinmahon
- Division of Cardiology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Sonali S Patel
- Division of Cardiology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Scott R Auerbach
- Division of Cardiology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Joseph Rossano
- Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Melanie D Everitt
- Division of Cardiology, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
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40
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Shaddy R, Canter C, Halnon N, Kochilas L, Rossano J, Bonnet D, Bush C, Zhao Z, Kantor P, Burch M, Chen F. Design for the sacubitril/valsartan (LCZ696) compared with enalapril study of pediatric patients with heart failure due to systemic left ventricle systolic dysfunction (PANORAMA-HF study). Am Heart J 2017; 193:23-34. [PMID: 29129252 DOI: 10.1016/j.ahj.2017.07.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 06/08/2017] [Accepted: 07/12/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sacubitril/valsartan (LCZ696) is an angiotensin receptor neprilysin inhibitor approved for the treatment of adult heart failure (HF); however, the benefit of sacubitril/valsartan in pediatric HF patients is unknown. STUDY DESIGN This global multi-center study will use an adaptive, seamless two-part design. Part 1 will assess the pharmacokinetics/pharmacodynamics of single ascending doses of sacubitril/valsartan in pediatric (1 month to <18 years) HF patients with systemic left ventricle and reduced left ventricular systolic function stratified into 3 age groups (Group 1: 6 to <18 years; Group 2: 1 to <6 years; Group 3: 1 month to <1 year). Part 2 is a 52-week, efficacy and safety study where 360 eligible patients will be randomized to sacubitril/valsartan or enalapril. A novel global rank primary endpoint derived by ranking patients (worst-to-best outcome) based on clinical events such as death, initiation of mechanical life support, listing for urgent heart transplant, worsening HF, measures of functional capacity (NYHA/Ross scores), and patient-reported HF symptoms will be used to assess efficacy. CONCLUSION The PANORAMA-HF study, which will be the largest prospective pediatric HF trial conducted to date and the first to use a global rank primary endpoint, will determine whether sacubitril/valsartan is superior to enalapril for treatment of pediatric HF patients with reduced systemic left ventricular systolic function.
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Affiliation(s)
| | | | - Nancy Halnon
- University of California Los Angeles, Los Angeles, CA
| | | | - Joseph Rossano
- The Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Ziqiang Zhao
- Novartis Pharmaceuticals Corporation, Shanghai, China
| | | | - Michael Burch
- Great Ormond Street Hospital for Children, London, UK
| | - Fabian Chen
- Novartis Pharmaceuticals Corporation, Shanghai, China.
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41
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Burstein D, Shamszad P, Almond C, Price J, Lin K, O'Connor M, Shaddy R, Mascio C, Rossano J. Significant mortality and resource utilization associated with advanced heart failure hospitalizations in congenital heart disease. Progress in Pediatric Cardiology 2017. [DOI: 10.1016/j.ppedcard.2017.07.005] [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: 11/16/2022]
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42
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Kirmani S, Woodard P, Canter CE, Shi L, Commean P, Everitt M, Paul E, Chung WK, Rossano J, Molina K, Czachor J, Wilkinson JD, Hill A, Wuebbles J, Razoky H, Lipshultz SE. Analysis of myocardial fibrosis in children with hypertrophic cardiomyopathy: A report from the pediatric cardiomyopathy registry. Progress in Pediatric Cardiology 2017. [DOI: 10.1016/j.ppedcard.2017.07.004] [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: 11/26/2022]
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43
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Rossano J, Kantor P, Shaddy R, Shi L, Wilkinson J, Jefferies J, Depre C, Wirtz H, Lipshultz S. 965Increased heart rate is independently associated with worse survival in pediatric patients with dilated cardiomyopathy: a multicenter study from the pediatric cardiomyopathy registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J. Rossano
- University of Pennsylvania, Philadelphia, United States of America
| | - P. Kantor
- Stollery Children's Hospital Foundation, Edmonton, Canada
| | - R. Shaddy
- University of Pennsylvania, Philadelphia, United States of America
| | - L. Shi
- New England Research Institute, Watertown, United States of America
| | - J. Wilkinson
- Wayne State University, Detroit, United States of America
| | - J. Jefferies
- Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America
| | - C. Depre
- Amgen, Inc., Thousand Oaks, United States of America
| | - H. Wirtz
- Amgen, Inc., Thousand Oaks, United States of America
| | - S. Lipshultz
- Wayne State University, Detroit, United States of America
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44
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Butto A, Rossano J, Nandi D, Ravishankar C, Lin K, O'Connor M, Shaddy R, Shamszad P. Peak Troponin I Is Associated with Death and Extracorporeal Membrane Oxygenation in Pediatric Myocarditis. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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45
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Kleinmahon J, Patel S, Auerbach S, Stehlik J, Rossano J, Everitt M. Hearts Transplanted After Circulatory Death in Children: Analysis of the International Society for Heart and Lung Transplantation Registry. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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46
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Mathew J, Villa CR, Morales D, Chin C, Zafar F, Rossano J, Lake M, Lorts A. Favorable Waitlist and Posttransplant Outcomes in Children and Adolescent Patients Supported With Durable Continuous-Flow Ventricular Assist Devices. Am J Transplant 2016; 16:2352-9. [PMID: 26841727 DOI: 10.1111/ajt.13745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 08/20/2015] [Accepted: 01/20/2016] [Indexed: 01/25/2023]
Abstract
Pediatric centers are implanting durable adult continuous-flow ventricular assist devices (CFVADs) in children who are smaller than the industry-recommended size. Waitlist and posttransplant outcomes data in pediatric patients supported with CFVADs as a bridge to transplant are limited. We analyzed the United Network of Organ Sharing and Organ Procurement and Transplantation Network registry to identify patients aged ≤18 years with a CFVAD at the time of listing or transplantation. Patients were stratified by body surface area (BSA; >1.5 vs. ≤1.5 m(2) ) at time of listing. We identified 138 patients with a durable CFVAD during the listing period (100 with BSA >1.5 m(2) , 38 with BSA ≤1.5 m(2) ). Patients with BSA ≤1.5 m(2) were more likely to have a noncardiomyopathy diagnosis (18% vs. 4%, p = 0.007) and to be implanted with a centrifugal-flow rather than an axial-flow device (74% vs. 30%, p = 0.001). There was no difference in failure-free waitlist survival between BSA groups (p = 0.99) among patients with a CFVAD at listing. Posttransplantation survival was 100% and 88% at 1 and 5 years, respectively, for the entire cohort and did not differ by BSA group (p = 0.99). Consequently, waitlist and posttransplant outcomes are favorable for pediatric CFVAD recipients. Small patients (≤1.5 m(2) ) had pre- and posttransplant outcomes similar to those of larger patients that met the industry-recommended size for implantation.
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Affiliation(s)
- J Mathew
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - C R Villa
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - D Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - C Chin
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - F Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - J Rossano
- The Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, PA
| | - M Lake
- Integrated Solid Organ Transplantation, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - A Lorts
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Almond CS, Lorts A, Daly K, Liu E, Rosenthal D, Bulic A, Gurvitz M, Shin A, Rossano J, Price J. MOVING TOWARD A NATIONAL CONSENSUS ON PEDIATRIC HEART FAILURE QUALITY MEASURES: THE ACC QUALITY METRICS WORKING GROUP INITIATIVE. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31003-8] [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: 11/29/2022]
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48
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Lipshultz S, Wilkinson J, Shi L, Towbin J, Canter C, Hsu D, Webber S, Kantor P, Everitt M, Pahl E, Jefferies J, Rossano J, Addonizio L, Dodd D, Ware S, Molina K, Colan S. THE CARDIAC BIOMARKERS IN CHILDREN WITH CARDIOMYOPATHY MULTICENTER STUDY: PRELIMINARY RESULTS FOR PEDIATRIC HYPERTROPHIC CARDIOMYOPATHY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31510-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kaddourah A, Goldstein SL, Lipshultz SE, Wilkinson JD, Sleeper LA, Lu M, Colan SD, Towbin JA, Aydin SI, Rossano J, Everitt MD, Gossett JG, Rusconi P, Kantor PF, Singh RK, Jefferies JL. Prevalence, predictors, and outcomes of cardiorenal syndrome in children with dilated cardiomyopathy: a report from the Pediatric Cardiomyopathy Registry. Pediatr Nephrol 2015; 30. [PMID: 26210985 PMCID: PMC4626312 DOI: 10.1007/s00467-015-3165-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The association of cardiorenal syndrome (CRS) with mortality in children with dilated cardiomyopathy (DCM) is unknown. METHODS With a modified Schwartz formula, we estimated glomerular filtration rates (eGFR) for children ≥1 year of age with DCM enrolled in the Pediatric Cardiomyopathy Registry at the time of DCM diagnosis and annually thereafter. CRS was defined as an eGFR of <90 mL/min/1.73 m(2). Children with and without CRS were compared on survival and serum creatinine concentrations (SCr). The association between eGFR and echocardiographic measures was assessed with linear mixed-effects regression models. RESULTS Of 285 eligible children with DCM diagnosed at ≥1 year of age, 93 were evaluable. CRS was identified in 57 of these 93 children (61.3%). Mean (standard deviation) eGFR was 62.0 (22.6) mL/min/1.73 m(2) for children with CRS and 108.0 (14.0) for those without (P < 0.001); median SCr concentrations were 0.9 and 0.5 mg/dL, respectively (P < 0.001). The mortality hazard ratio of children with CRS versus those with no CRS was 2.4 (95% confidence interval 0.8-7.4). eGFR was positively correlated with measures of left ventricular function and negatively correlated with age. CONCLUSIONS CRS in children newly diagnosed with DCM may be associated with higher 5-year mortality. Children with DCM, especially those with impaired left ventricular function, should be monitored for renal disease.
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Affiliation(s)
- Ahmad Kaddourah
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Steven E Lipshultz
- Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI, USA,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - James D Wilkinson
- Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI, USA
| | | | - Minmin Lu
- New England Research Institutes, Watertown, MA, USA
| | | | - Jeffrey A Towbin
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Scott I Aydin
- Montefiore Medical Center, New York City, New York, USA
| | - Joseph Rossano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Jeffrey G Gossett
- Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Paolo Rusconi
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Paul F Kantor
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Rakesh K Singh
- Columbia University Medical Center, New York City, New York, USA
| | - John L Jefferies
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. ML 2003, Cincinnati, OH, 45229, USA.
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O’Connor M, Wang N, Long J, Huang Y, Lin K, Singh T, Jefferies J, Shaddy R, Rossano J. Variability in Cardiomyopathy Admissions and Transplant Volume at US Children’s Hospitals. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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