First name
Christopher
Last name
Mascio

Title

Influence of Antegrade Pulmonary Blood Flow on Outcomes of Superior Cavopulmonary Connection.

Year of Publication

2022

Date Published

2022 Mar 24

ISSN Number

1552-6259

Abstract

<p><strong>BACKGROUND: </strong>We sought to characterize short- and long-term outcomes following superior cavopulmonary connection (SCPC) in children eligible for inclusion of antegrade pulmonary blood flow (APBF) in the SCPC circuit, exploring whether maintaining APBF was associated with outcomes.</p>

<p><strong>METHODS: </strong>This was a retrospective cohort study of patients with single ventricle heart disease and APBF who underwent SCPC at our center between 1/1/00 and 9/30/17. Patients were divided into two groups: APBF eliminated (APBF (-)), and APBF maintained (APBF (+)) at the time of SCPC.</p>

<p><strong>RESULTS: </strong>Of 149 patients, 108 (72.5%) were in APBF (-) and 41 (27.5%) were in APBF (+). Of those in APBF (+), 5 (12.2%) subsequently had APBF eliminated after SCPC. Patients in APBF (+) had a higher prevalence of chest tube duration &gt; 10 days and underwent more interventions during the post-SCPC hospitalization (1.9% v. 12%, p=0.008 for both), but had shorter surgical support times at SCPC (p&lt;0.0001). There were no differences in post-SCPC intensive care unit or hospital lengths of stay82 patients (76%) in APBF (-) and 22 patients (54%) in APBF (+) underwent Fontan completion during the study period. Patients in APBF (+) had a greater weight gain from SCPC to Fontan [6.7 (1.8-22) v. 8.15 (4.4-20.6) kg, p=0.012] and a shorter hospital length of stay after Fontan [9 (4-107) v. 7.5 (4-14) days, p=0.044].</p>

<p><strong>CONCLUSIONS: </strong>Short term morbidity associated with maintaining APBF at the time of SCPC is modest, but longer-term outcomes suggest potential benefits in those in whom APBF can be successfully maintained.</p>

DOI

10.1016/j.athoracsur.2022.03.011

Alternate Title

Ann Thorac Surg

PMID

35341786

Title

Impact of Age on Emergency Resource Utilization and Outcomes in Pediatric and Young Adult Patients Supported with a Ventricular Assist Device.

Year of Publication

2021

Date Published

2021 Nov 03

ISSN Number

1538-943X

Abstract

<p>There are minimal data describing outcomes in ambulatory pediatric and young adult ventricular assist device (VAD)-supported patient populations. We performed a retrospective analysis of encounter-level data from 2006 to 2017 Nationwide Emergency Department Sample (NEDS) to compare emergency department (ED) resource utilization and outcomes for pediatric (≤18 years, n = 494) to young adult (19-29 years, n = 2,074) VAD-supported patient encounters. Pediatric encounters were more likely to have a history of congenital heart disease (11.3% vs. 4.8%). However, Pediatric encounters had lower admission/transfer rates (37.8% vs. 57.8%) and median charges ($3,334 (IQR $1,473-$19,818) vs. $13,673 ($3,331-$45,884)) (all p &lt; 0.05). Multivariable logistic regression modeling revealed that age itself was not a predictor of admission, instead high acuity primary diagnoses and medical complexity were: (adjusted odds ratio; 95% confidence intervals): cardiac (3.0; 1.6-5.4), infection (3.4; 1.7-6.5), bleeding (3.9; 1.7-8.8), device complication (7.2; 2.7-18.9), and ≥1 chronic comorbidity (4.1; 2.5-6.7). In this largest study to date describing ED resource use and outcomes for pediatric and young adult VAD-supported patients, we found that, rather than age, high acuity presentations and comorbidities were primary drivers of clinical outcomes. Thus, reducing morbidity in this population should target comorbidities and early recognition of VAD-related complications.</p>

DOI

10.1097/MAT.0000000000001603

Alternate Title

ASAIO J

PMID

34743138

Title

Accuracy of transesophageal echocardiography in the identification of postoperative intramural ventricular septal defects.

Year of Publication

2016

Number of Pages

688-95

Date Published

2016 09

ISSN Number

1097-685X

Abstract

<p><strong>BACKGROUND: </strong>Intramural ventricular septal defects (VSDs), residual interventricular communications occurring after repair of conotruncal defects, are associated with poor postoperative outcomes. The ability of intraoperative transesophageal echocardiography (TEE) to identify intramural VSDs has not yet been evaluated.</p>

<p><strong>METHODS: </strong>Intraoperative TEE and postoperative transthoracic echocardiography (TTE) data in all patients undergoing all biventricular repair of conotruncal anomalies in our hospital between January 1, 2006, and June 30, 2013, were reviewed. The ability of TEE to accurately identify residual defects was assessed using postoperative TTE as the reference imaging modality.</p>

<p><strong>RESULTS: </strong>Intramural VSDs occurred in 34 of 337 patients evaluated; 19 were identified by both TTE and TEE, and 15 were identified by TTE only. Sensitivity was 56% and specificity was 100% for TEE to identify intramural VSDs. Peripatch VSDs were identified in 90 patients by both TTE and TEE, in 53 by TTE only, and in 15 by TEE only, yielding a sensitivity of 63% and specificity of 92%. Of the VSDs requiring catheterization or surgical reintervention, 6 of 7 intramural VSDs and all 5 peripatch VSDs were identified by intraoperative TEE. TEE guided the intraoperative decision to return to cardiopulmonary bypass (CPB) in an attempt to close residual defects in 12 patients with intramural VSDs and in 4 patients with peripatch VSDs seen after initial CPB; of these, 10 intramural VSDs and all 4 peripatch VSDs resolved or became smaller on final intraoperative TEE.</p>

<p><strong>CONCLUSIONS: </strong>TEE has modest sensitivity but high specificity for identifying intramural VSDs and can detect most defects requiring reintervention. Repeat attempts at closure in the index operation may successfully correct intramural VSDs identified by TEE.</p>

DOI

10.1016/j.jtcvs.2016.04.026

Alternate Title

J. Thorac. Cardiovasc. Surg.

PMID

27183884

Title

Reintervention Burden and Vessel Growth After Surgical Reimplantation of a Pulmonary Artery During Childhood.

Year of Publication

2018

Number of Pages

390-397

Date Published

2018 Feb

ISSN Number

1432-1971

Abstract

<p>Children requiring reimplantation of a branch pulmonary artery (PA) are at risk for postoperative stenosis and impaired growth of the reimplanted PA. Outcomes and risk factors for reintervention and impaired growth are incompletely described. We reviewed data on patients who underwent reimplantation of a branch PA between 1/1/99 and 5/1/15 at a single center. The primary outcome was reintervention to treat postoperative stenosis. The secondary outcome was "catch-up" growth (faster diameter growth of the affected PA compared with the unaffected PA from the preoperative to follow-up measurements.). Twenty-six patients were identified with a total follow-up of 102.2 patient-years (median 2.5&nbsp;years). Diagnoses included LPA sling (n&nbsp;=&nbsp;12) and isolated PA of ductal origin with (n&nbsp;=&nbsp;7) or without (n&nbsp;=&nbsp;7) tetralogy of Fallot (ToF). All had primary repair of the anomalous PA. Seventeen (65%) had reintervention with median time to first reintervention of 69 (range 1-1005) days and median of 1.5 (range 1-6) reinterventions. 94% of reinterventions were transcatheter (53% balloon and 41% stent angioplasty). Patients with reintervention were younger (hazard ratio 0.75 per log-day, p&nbsp;=&nbsp;0.02) and lower weight (hazard ratio 0.18 per log-kg, p&nbsp;=&nbsp;0.02) at initial repair. Of the 18 with PA growth data, 8 (44%) had catch-up growth. There were no identified differences between those who did and did not demonstrate catch-up growth. Despite a practice of primary reimplantation and aggressive postoperative reintervention, these results suggest that changes in strategy are needed or that there are intrinsic patient factors that have more influence on longer-term reimplanted PA growth.</p>

DOI

10.1007/s00246-017-1767-6

Alternate Title

Pediatr Cardiol

PMID

29098350

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