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Neurodevelopmental disability is common after operations for congenital heart defects. We previously showed that patient and preoperative factors, center, and calendar year of birth explained less than 30% of the variance for the Psychomotor Development Index (PDI) and the Mental Development Index (MDI) of the Bayley Scales of Infant Development-Second Edition. Here we investigate how much additional variance in PDI and MDI is contributed by operative variables and postoperative events.We analyzed neurodevelopmental outcomes after operations with cardiopulmonary bypass at age 9 months or younger between 1996 and 2009. We used linear regression to investigate the effect of operative factors (age, weight, and cardiopulmonary bypass variables) and postoperative events on neurodevelopmental outcomes, adjusting for center, type of congenital heart defect, year of birth, and preoperative factors.We analyzed 1,770 children from 22 institutions with neurodevelopmental testing at age 13.3 months (range, 6 to 30 months). Among operative factors, longer total support time was associated with lower PDI and MDI (p0.05). When postoperative events were added, use of either extracorporeal membrane oxygenation or ventricular assist device support, and longer postoperative length of stay were associated with lower PDI and MDI (p0.05). Longer total support time was not a significant predictor in these models. After adjusting for patient, preoperative, intraoperative, and postoperative factors, measured intraoperative and postoperative factors accounted for 5% of the variances in PDI and MDI.Operative factors may be less important than innate patient and preoperative factors and postoperative events in predicting early neurodevelopmental outcomes after cardiac operations in infants. Neurodevelopmental outcomes improved over calendar time when adjusted for patient and medical variables.

ObjectiveThe purpose of this analysis was to evaluate a novel strategy for reporting adverse events in the Pediatric Heart Network’s randomized surgical trial of systemic–pulmonary artery shunt versus right ventricle–pulmonary artery conduit in infants with hypoplastic left heart syndrome. The strategy was developed to align the reporting process with the needs of a surgical trial while maintaining participant safety.MethodsAdverse event reporting was analyzed for 2 groups of study subjects: those randomized to a trial arm during a period in which a standard adverse event reporting system was used (period 1) and those randomized after institution of a system that focused serious adverse event reporting on 6 sentinel events (period 2). The analysis encompassed the period from randomization (Norwood surgery) to hospital discharge from stage II surgery. Adverse event rates were compared using a Poisson regression model for the number of events per subject.ResultsFrom period 1 to period 2, the rate of serious adverse events requiring expedited reporting decreased as expected (0.42 vs 0.14/subject/month of follow-up; P

Although previously described in patients undergoing staged palliation for univentricular heart disease, the mechanism by which hepatic venous flow prevents development of pulmonary arteriovenous malformations is still not completely understood. We present a case in which successful H-type Fontan revision with rerouting of hepatic venous flow through a hemiazygous vein successfully reversed the progression of severe left pulmonary arteriovenous malformations.

In the Single Ventricle Reconstruction trial, infants with hypoplastic left heart syndrome (HLHS) who received a right-ventricle-to-pulmonary-artery shunt (RVPAS) versus a modified Blalock-Taussig shunt (MBTS) had lower early postoperative mortality, but more complications at 14 months. We explored the effect of shunt type and other patient, medical, and surgical factors on postoperative length of stay (LOS) after the Fontan operation.Fontan postoperative course was ascertained from medical record review. Cox proportional hazards modeling was used to identify factors associated with LOS.Of 327 subjects who underwent Fontan, 323 were analyzed (1 death, 1 biventricular repair, 2 with missing data). Median age and weight at Fontan were 2.8 years (interquartile range [IQR]: 2.3, 3.4) and 12.7 kg (IQR: 11.4, 14.1), respectively. Fontan type was extracardiac in 55% and lateral tunnel in 45%; 87% were fenestrated. The RVPAS and MBTS subjects had similar LOS (median 11 days [IQR: 9, 18] vs 10 days [IQR: 9, 13]; P = .23). Independent risk factors for longer LOS were treatment center (P.01), LOS at stage II (hazard ratio [HR] 1.02 for each additional day; P.01), and pre-Fontan complications (HR 1.03 for each additional complication; P = .04). Use of deep hypothermic circulatory arrest at Fontan (HR 0.64; P = .02) was independently associated with shorter LOS. When center was excluded from the model, pre-Fontan complications and use of circulatory arrest were no longer significant; instead, older age at stage II (HR 1.08 for each additional month; P = .01) predicted longer LOS. In 254 subjects who had a pre-Fontan echocardiogram, at least moderate tricuspid regurgitation was independently associated with longer LOS, both with center (HR 1.72; P.01) and without center in the model (HR 1.49; P = .02).In this multicenter prospective cohort of subjects with HLHS, Norwood shunt type was not associated with Fontan LOS. Rather, global measures of earlier medical complexity indicate greater likelihood of longer LOS after the Fontan operation.

W ITH THE INTRODUCTION of minimally invasive surgical techniques for patent ductus arteriosus (PDA) ligation, the length of hospital stay after the surgery has been substantially reduced.1,2 Regional anesthesia combined with light general anesthesia may further facilitate rapid recovery from surgery and anesthesia, allowing for same-day discharge, or fast-tracking.3 The authors report their initial experience of fast-tracking PDA ligation.

The Journal of Heart and Lung Transplantation Volume 25, Number 2S Abstracts Reasons for Declining Hearts (n Inotropic Support Haemodynamic Instability ECG Changes Age Past Medical History Abnormal CXR g Smoking Other Primary Reason% Secondary Reason% S117 groups was comparable (5.4%/year; 4.0%/year; 4.5%/year; all P⬎0.05). Conclusion: Donor screening without coronary angiogram over- looks significant atherosclerotic lesions in a considerable number of cases (7.0%). Therefore, angiographic screening should be performed in all donors ⱖ40 years old. Donor grafts with single-vessel CAS may be accepted as marginal hearts; however, in our opinion revascular- ization (CABG, PTCA) should be considered. Grafts with diffuse CAS have a serious risk for early graft failure. Beyond the first year the outcome of healthy grafts and grafts with donor-transmitted coronary atherosclerosis are comparable. CORRELATES OF FATIGUE IN ADVANCED HEART FAILURE PATIENTS L.S. Evangelista, 1 N. Pike, 1 A. Ter-Galstanyan, 1 M.A. Hamilton, 2 G.C. Fonarow, 2 1 School of Nursing, University of California, Los Angeles, Los Angeles, CA; 2 School of Medicine, University of California, Los Angeles, Los Angeles, CA Conclusions: This study demonstrates that hearts declined on medical grounds by one centre can safely be transplanted and should be offered out nationally. CORONARY ATHEROSCLEROSIS OF THE DONOR HEART O. Grauhan, 1 J. Pazurek, 1 H. Siniawski, 1 M. Dandel, 1 H. Lehmkuhl, 1 C. Knosalla, 1 M. Pasic, 1 M. Huebler, 1 Y. Weng, 1 R. Hetzer, 1 1 Thoracic and Cardiovascular Surgery, German Heart Institute, Berlin, Germany Objectives: Due to the shortage of donor hearts, the criteria for organ acceptability have been considerably extended and donor grafts with coronary atherosclerosis are among those offered. This study evalu- ated whether and to what degree pre-existing coronary atherosclero- sis may be acceptable. Methods: A total of 1253 consecutive HTx recipients were investi- gated retrospectively for donor-transmitted coronary atherosclerosis (DCAS). DCAS was defined as focal atherosclerosis with stenosis of at least 50%. Inclusion criteria were absence of pre-HTx angiogram but performance of angiogram or autopsy within 6 months after HTx. Hazard function and Kaplan-Meier analysis were used. Results: Eight-five out of 1253 (6.8%) cases were excluded, since coronary evaluation was not performed within 6 months (n⫽45) or hearts had undergone pre-transplant angiography (n⫽40). In 1086 patients no DCAS was found (NDCAS group) and in 82 patients (7%) DCAS was diagnosed by angiography (n⫽49) or autopsy (n⫽33). Single-vessel DCAS was found in 53/82 patients (DCAS1 group) and double- or triple-vessel DCAS in 26/82 patients (DCAS2/3 group). Three of the 82 patients with DCAS were excluded since the autopsy report was unclear regarding degree of DCAS. Early after HTx the instantaneous risk of death in the NDCAS and DCAS1 groups was 0.05 vs. 0.07 (P⬍0.05) whereas in the DCAS2/3 group it was 0.42 (P⬎0.05). However, beyond the first year the annual decrease in all Background: Fatigue is one of the most common symptoms associ- ated with heart failure (HF), and is an important impediment to maintain an active lifestyle. Unfortunately, factors associated with fatigue are poorly understood. We conducted this study to identify the significant demographic, clinical, and psychological correlates of fatigue in HF patients. Methods: One hundred and fifty HF patients (73% male, 68% Caucasian, mean age 55.4 years), from a single HF center, completed the Profile of Mood States – Fatigue Subscale, the Minnesota Living with Heart Failure, and the Beck Depression Inventory to assess levels of fatigue, quality of life (QOL), physical health, emotional health, and depression. Descriptive statistics and step-wise multiple regression were used to analyze data. Level of significance was set at 0.05. Results: Reported mean scores were as follows: fatigue, 2.4 ⫾ 1.0; QOL, 42.2 ⫾ 27.0; physical health, 18.0 ⫾ 12.0; emotional health, 8.4 ⫾ 7.0; and depression 9.9 ⫾ 8.2. Ergometry work rate (watts), lipid-lowering medication, QOL, physical health, emotional health, and depression scores were highly correlated with fatigue (p ⬍ 0.01). Additional demographic and clinical variables were not significantly related to levels of fatigue. In a multivariate model, watts, physical health, emotional health, and depression explained 51% of the variance in fatigue (p ⬍ 0.001). Conclusions: Fatigue significantly impacts QOL in physical and emotional domains. Our findings suggest the need for multiple risk factor interventions to decrease fatigue and possibly improve physical and emotional health; patients on lipid-lowering medications and depression warrant increased scrutiny and may be at high risk for this debilitating symptom of HF. ANXIETY AND QUALITY OF LIFE IN CHF PATIENTS AND THEIR CAREGIVERS D.M. Weisshaar, 1 E.L. Heiges, 1 1 CHF/Transplant Service, Kaiser Permanente Santa Teresa, San Jose, CA Background: Caregivers of CHF patients face difficult issues includ- ing concern for the patient’s physical symptoms, financial stress, and disruption in their social life. These challenges contribute to anxiety, stress, and a decrease in the perception of quality of life (QOL). Many studies have focused on depression in CHF patients and their caregivers, but few have looked into anxiety. Methods: Patients and their primary caregivers were recruited by mail from a private insured advanced outpatient CHF clinic. 65 patient and 52 caregiver respondents produced 48 patient/caregiver