Alsaied, T; Bokma, JP; Engel, ME; Kuijpers, JM; Hanke, SP; Zuhlke, L; Zhang, B; Veldtman, GR. Predicting long-term mortality after Fontan procedures: A risk score based on 6707 patients from 28 studies. Congenital Heart Disease. 2017; 12(4):393-398.
This paper is the product of an exciting collaboration among three institutions across the United States, Europe, and Africa. We sought to identify risk factors for mortality with a view of improving meaningful outpatient surveillance of Fontan patients. Through systematic review of the literature, identified of factors associated with mortality through statistical weighting and defining minimum inclusion criteria. We were able to create a mortality risk score based on these identified factors. This risk score will validate in a larger cohort of patients. The score will help identify those at greatest risk and improve appropriate resource utilization in this patient population.
Alten, JA; Klugman, D; Raymond, TT; Cooper, DS; Donohue, JE; Zhang, W; Pasquali, SK; Gaies, MG. Epidemiology and Outcomes of Cardiac Arrest in Pediatric Cardiac ICUs. Pediatric Critical Care Medicine. 2017; 18(10):935-943.
This manuscript is the first contemporary epidemiologic and outcome data for cardiac arrest (CA) occurring in all medical and surgical pediatric cardiac ICU patients from a multicenter clinical registry. The multicenter CA rate across 23 North American pediatric cardiac ICUs was 3.1% - with tremendous variation among sites (ranging from less than 1% to 5.5%). We identified high-risk patient cohorts and periods of time that may serve as targets for research and quality improvement initiatives aimed at cardiac arrest prevention. Data from this study serves as the benchmark for the current 23 center cardiac arrest prevention initiative that Cincinnati Children's Hospital Medical Center is leading.
Lorts, A; Eghtesady, P; Mehegan, M; Adachi, I; Villa, C; Davies, R; Gossett, JG; Kanter, K; Alejos, J; Koehl, D; Cantor, RS; Morales, DLS. Outcomes of children supported with devices labeled as "temporary" or short term: A report from the Pediatric Interagency Registry for Mechanical Circulatory Support. Journal of Heart and Lung Transplantation. 2018; 37(1):54-60.
Finding the right device to support the function of the heart remains a challenge in children and many times adult devices must find innovative ways for use in pediatric patients. Devices that were once coined “temporary” devices and designed for short-term support are now used to support children for longer durations and in novel configurations. This report compiled from a multi-institutional dataset reviewed cases of using these “temporary’’ devices off-label in children and revealed a positive outcome in 71% of this high acuity population. Pediatrics continue to require creative support strategies due to the paucity of device options for small children and we must continue to share our data and experiences amongst institutions to continue to excel.
Michalsky, MP; Inge, TH; Jenkins, TM; Xie, C; Courcoulas, A; Helmrath, M; Brandt, ML; Harmon, CM; Chen, M; Dixon, JB; Urbina, EM; Consortium, T. Cardiovascular Risk Factors After Adolescent Bariatric Surgery. Pediatrics. 2018; 141(2).
We know that severely obese adolescents have numerous cardiovascular disease risk factors (CVRFs) such as high blood pressure, cholesterol and diabetes. Whether these CVRFs improve after bariatric (weight loss) surgery is not known. We evaluated CVRFs in 242 adolescents before and after they underwent bariatric surgery at one of five centers in the “Teen-Longitudinal Assessment of Bariatric Surgery” study. At the start of the study, the subjects were mean 17 years old with a body mass index of 51 kg/m2 which dropped nearly 30% at three years post-operatively. Participants with greater weight loss, or who had surgery at a younger age, were more likely to normalize high cholesterol, elevated BP, inflammation and diabetes. These data may lead to refinements in patient selection and optimal timing of adolescent bariatric surgery.
Whiteside, W; Tretter, JT; Aboulhosn, J; Aldoss, O; Armstrong, AK; Bocks, ML; Gillespie, MJ; Jones, TK; Martin, MH; Meadows, JJ; Metcalf, CM; Turner, ME; Zellers, T; Goldstein, BH. Acute and Midterm Outcomes of Transcatheter Pulmonary Valve Replacement for Treatment of Dysfunctional Left Ventricular Outflow Tract Conduits in Patients With Aortopulmonary Transposition and a Systemic Right Ventricle. Circulation: Cardiovascular Interventions. 2017; 10(8):e004730-e004730.
Transcatheter pulmonary valve replacement (TPVR) has quickly become an established therapy for rehabilitation of dysfunctional right ventricular outflow tract (RVOT) conduits. However, in the setting of aortopulmonary transposition and a systemic right ventricle, TPVR within the dysfunctional left ventricular outflow tract (LVOT) conduit poses unique physiological and anatomic challenges that may influence procedural success. In this multicenter study, we showed that LVOT TPVR does pose additional technical challenges compared with standard RVOT TPVR, with an 85% procedural success rate and 15% incidence of procedural adverse events. Further, although TPVR is successful in improving LVOT conduit function, more than half of the treated patients developed worsening heart function, which occurred more commonly in patients with less post-procedural conduit obstruction. We urge caution in the approach to relief of conduit obstruction during TPVR in the LVOT conduit, with serial post-procedural monitoring of cardiac function.