138 results on '"James D. St Louis"'
Search Results
2. TGA + IVS + LVOTO: patterns of practice and outcomes
- Author
-
Husain Esmaeil, Jeffrey P. Jacobs, Christo I. Tchervenkov, Andrzej Kansy, Bohdan Maruszewski, Zdzislaw Tobota, James D. St. Louis, James K. Kirklin, David M. Overman, Vladimiro Vida, Claudia Herbst, Awais Ashfaq, Zohair Al-Halees, and George E. Sarris
- Subjects
Pediatrics, Perinatology and Child Health ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Purpose:Transposition of great arteries with intact ventricular septum and left ventricular outflow tract obstruction (TGA + IVS + LVOTO) is uncommon. We reviewed operations performed in patients with TGA + IVS + LVOTO in the European Congenital Heart Surgeons Association Congenital Database (ECHSA-CD).Methods:All 109 patients with a diagnosis of TGA + IVS + LVOTO in ECHSA-CD who underwent cardiac surgery during a 21-year period (01/2000-02/2021, inclusive) were included. Preoperative variables, operative data, and postoperative outcomes were collected.Results:These 109 patients underwent 176 operations, including 37 (21.0%) arterial switch operations (ASO), 26 (14.2%) modified Blalock-Taussig-Thomas shunts (MBTTS), 11 (6.2%) Rastelli operations, and 13 (7.3%) other palliative operations (8 superior cavopulmonary anastomosis[es], 4 Fontan, and 1 other palliative procedure). Of 37 patients undergoing ASO, 22 had a concomitant procedure.There were 68 (38.6%) reoperations, including 11 pacemaker procedures and 8 conduit operations. After a systemic-to-pulmonary artery shunt, reoperations included shunt reoperation (n = 4), Rastelli (n = 4), and superior cavopulmonary anastomosis (n = 3).Overall Operative Mortality was 8.2% (9 deaths), including three following ASO, two following “Nikaidoh, Kawashima, or LV-PA conduit” procedures, and two following Rastelli. Postoperative complications occurred after 36 operations (20.4%). The most common complications were delayed sternal closure (n = 11), postoperative respiratory insufficiency requiring mechanical ventilation >7 days (n = 9), and renal failure requiring temporary dialysis (n = 8).Conclusion:TGA + IVS + LVOTO is rare (109 patients in ECHSA-CD over 21 years). ASO, MBTTS, and Rastelli are the most common operations performed for TGA + IVS + LVOTO. Larger international studies with long-term follow-up are needed to better define the anatomy of the LVOTO and to determine the optimal surgical strategy.
- Published
- 2023
3. Variation in Case-Mix Across Hospitals: Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database
- Author
-
Jeffrey Phillip Jacobs, S. Ram Kumar, James D. St. Louis, Zohair Y. Al-Halees, Robert H. Habib, Niharika Parsons, Kevin D. Hill, Sara K. Pasquali, J. William Gaynor, Christopher E. Mascio, David M. Overman, Joseph A. Dearani, John E. Mayer, David M. Shahian, and Marshall L. Jacobs
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database was queried to document variation of patient characteristics, procedure types, and programmatic case-mix.All index cardiac operations in patients less than 18 years of age in the STS Congenital Heart Surgery Database (July 2016 to June 2020) were eligible for inclusion except patients weighing ≤2.5 kg undergoing isolated patent ductus arteriosus closure. At the hospital level, we describe variations in patient and procedural characteristics known from previous analyses to be associated with outcomes. We also report variations across hospitals of programmatic case-mix.Data were analyzed from 117 sites (90 322 total operations, 87 296 total index cardiac operations eligible for STAT [STS-European Association for Cardio-Thoracic Surgery] 2020 Mortality Score). The median annual total index cardiac operations eligible for STAT 2020 Mortality Score per hospital was 157 (interquartile range [IQR], 94-276). Wide variability was documented in total annual index cardiac operations eligible for STAT 2020 Mortality Score per hospital (ratio 90th/10th percentile = 9.01), operations in neonates weighing2.5 kg (ratio 90th/10th percentile = 4.09), operations in patients with noncardiac anatomic abnormalities (ratio 90th/10th percentile = 3.46), and operations in patients with preoperative mechanical ventilation (ratio 90th/10th percentile = 3.97). At the hospital level, the median percentage of all index cardiac operations in STAT 2020 Mortality Category 5 was 3.7% (IQR, 1.7%-4.9%), the median percentage of all index cardiac operations in STAT 2020 Mortality Category 4 or 5 was 24.4% (IQR, 19.0%-28.4%), the median hospital-specific mean STAT Mortality Category was 2.39 (IQR, 2.20-2.47), and the median hospital-specific mean STAT Mortality Score was 0.86 (IQR, 0.73-0.91).Substantial variation of patient characteristics, procedure types, and case-mix exists across pediatric and congenital cardiac surgical programs. Knowledge about programmatic case-mix augments data about indirectly standardized programmatic observed-to-expected (O/E) mortality. Indirectly standardized O/E ratios do not provide a complete description of a given pediatric and congenital cardiac surgical program. The indirectly standardized programmatic O/E ratios associated with a given program apply only to its specific case-mix of patients and may represent a quite different case-mix than that of another program.
- Published
- 2023
4. The World Database for Pediatric and Congenital Heart Surgery: Use of an International Congenital Database in South Korea
- Author
-
James D. St. Louis, Cheul Lee, Hiromi Kurosawa, Richard A. Jonas, Sakamoto Kisaburo, Christo I. Tchervenkov, Jeffery P. Jacobs, and James K. Kirklin
- Subjects
Surgery ,RD1-811 - Published
- 2018
- Full Text
- View/download PDF
5. Multi-institutional Analysis of 505 Patients With Coronavirus Disease-2019 Supported With Extracorporeal Membrane Oxygenation: Predictors of Survival
- Author
-
Celeste A. Hall, Jeffrey P. Jacobs, Alfred H. Stammers, James D. St. Louis, J.W. Awori Hayanga, Michael S. Firstenberg, Linda B. Mongero, Eric A. Tesdahl, Keshava Rajagopal, Faisal H. Cheema, Kirti Patel, Tom Coley, Anthony K. Sestokas, Marvin J. Slepian, and Vinay Badhwar
- Subjects
Adult ,Coronavirus ,Pulmonary and Respiratory Medicine ,Extracorporeal Membrane Oxygenation ,COVID-19 ,Humans ,Bayes Theorem ,Surgery ,Middle Aged ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
We reviewed our experience with 505 patients with confirmed coronavirus disease-2019 (COVID-19) supported with extracorporeal membrane oxygenation (ECMO) at 45 hospitals and estimated risk factors for mortality.A multi-institutional database was created and used to assess all patients with COVID-19 who were supported with ECMO. A Bayesian mixed-effects logistic regression model was estimated to assess the effect on survival of multiple potential risk factors for mortality, including age at cannulation for ECMO as well as days between diagnosis of COVID-19 and intubation and days between intubation and cannulation for ECMO.Median time on ECMO was 18 days (interquartile range, 10-29 days). All 505 patients separated from ECMO: 194 patients (38.4%) survived and 311 patients (61.6%) died. Survival with venovenous ECMO was 184 of 466 patients (39.5%), and survival with venoarterial ECMO was 8 of 30 patients (26.7%). Survivors had lower median age (44 vs 51 years, P.001) and shorter median time interval from diagnosis to intubation (7 vs 11 days, P = .001). Adjusting for several confounding factors, we estimated that an ECMO patient intubated on day 14 after the diagnosis of COVID-19 vs day 4 had a relative odds of survival of 0.65 (95% credible interval, 0.44-0.96; posterior probability of negative effect, 98.5%). Age was also negatively associated with survival: relative to a 38-year-old patient, we estimated that a 57-year-old patient had a relative odds of survival of 0.43 (95% credible interval, 0.30-0.61; posterior probability of negative effect,99.99%).ECMO facilitates salvage and survival of select critically ill patients with COVID-19. Survivors tend to be younger and have shorter time from diagnosis to intubation. Survival of patients supported with only venovenous ECMO was 39.5%.
- Published
- 2022
6. Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction
- Author
-
Madison B. Argo, David J. Barron, Igor Bondarenko, Aaron Eckhauser, Peter J. Gruber, Linda M. Lambert, Tharini Paramananthan, Maha Rahman, David S. Winlaw, Can Yerebakan, Bahaaldin Alsoufi, William M. DeCampli, Osami Honjo, James K. Kirklin, Carol Prospero, Karthik Ramakrishnan, James D. St. Louis, Joseph W. Turek, James E. O'Brien, Christian Pizarro, Petros V. Anagnostopoulos, Eugene H. Blackstone, Marshall L. Jacobs, Anusha Jegatheeswaran, Tara Karamlou, Elizabeth H. Stephens, Anastasios C. Polimenakos, Marcus P. Haw, and Brian W. McCrindle
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
7. Multi-institutional Analysis of 200 COVID-19 Patients Treated With Extracorporeal Membrane Oxygenation: Outcomes and Trends
- Author
-
James D. St. Louis, Vinay Badhwar, Jeffrey P. Jacobs, Marvin J. Slepian, Eric A. Tesdahl, Keshava Rajagopal, Kirti Patel, Tom Coley, Faisal H. Cheema, Anthony K. Sestokas, J.W. Awori Hayanga, Michael S. Firstenberg, Alfred H. Stammers, and Linda B. Mongero
- Subjects
Pulmonary and Respiratory Medicine ,Complete data ,Convalescent plasma ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Critically ill ,medicine.medical_treatment ,Hydroxychloroquine ,Continuous variable ,surgical procedures, operative ,Anesthesia ,Extracorporeal membrane oxygenation ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Intravenous steroids ,medicine.drug - Abstract
BACKGROUND: The role of ECMO in the management of patients with COVID-19 continues to evolve. The purpose of this manuscript is to review a multi-institutional clinical experience in 200 consecutive patients at 29 hospitals with confirmed COVID-19 supported with ECMO. METHODS: This analysis includes our first 200 COVID-19 patients with complete data who were supported with and separated from ECMO. These patients were cannulated between March 17 and December 9, 2020. Differences by mortality group were assessed using chi-square tests for categorical variables and Kruskal-Wallis rank sum tests and Welch's ANOVA for continuous variables. RESULTS: Median ECMO time was 15 days (IQR=9-28). All 200 patients have separated from ECMO: 90 patients (45%) survived and 110 patients (55%) died. Survival with veno-venous ECMO was 87 of 188 patients (46.3%), while survival with veno-arterial ECMO was 3 of 12 patients (25%). Of 90 survivors, 77 have been discharged from the hospital and 13 remain hospitalized at the ECMO-providing hospital. Survivors had lower median age (47 versus 56 years, p
- Published
- 2022
8. Report of the 2022 Society of Thoracic Surgeons Congenital Heart Surgery Practice Survey
- Author
-
Elizabeth H. Stephens, James D. St. Louis, Robert D.B. Jaquiss, Eric N. Feins, Lauren C. Kane, Kristine J. Guleserian, Ming-Sing M. Si, Robert J. Dabal, Mahesh S. Sharma, James J. Gangemi, Minoo N. Kavarana, S. Ram Kumar, Damien J. LaPar, and Stephanie Fuller
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
9. The World Society for Pediatric and Congenital Heart Surgery: 2021 Update of the World Database for Pediatric and Congenital Heart Surgery
- Author
-
James D, St Louis, Luqin, Deng, Claire, Covington, Nicholas A, Timkovich, Danielle, Crethers, Craig S, Collum, John K, Pennington, Taylor, Broser, Robert J, Dabal, Jeffrey P, Jacobs, James E, O'Brien, Erle H, Austin, Christo I, Tchervenkov, and James K, Kirklin
- Subjects
Heart Defects, Congenital ,Databases, Factual ,Pediatrics, Perinatology and Child Health ,Humans ,Thoracic Surgery ,Surgery ,General Medicine ,Cardiac Surgical Procedures ,Child ,Cardiology and Cardiovascular Medicine ,Societies, Medical - Abstract
Background The World Database for Pediatric and Congenital Heart Surgery (WDPCHS), sponsored by the World Society for Pediatric and Congenital Heart Surgery (WSPCHS), provides complex programmatic outcomes analyses for all members of the WSPCHS. Methods The Data center, currently at Kirklin Institute for Research in Surgical Outcomes (KIRSO), University of Alabama, Birmingham (USA), provides biannual reports to all active members of the database. This report presents a descriptive analysis of these procedures submitted from January 1, 2017 to December 31, 2020. Results A total of 37,386 procedures were submitted with an overall mortality of 4.3%. The majority of submissions were from Asian countries. The majority of cases submitted from these countries were of Society of Thoracic Surgeons (STS)-European Association for Cardio-Thoracic Surgery (STAT) Mortality Categories I and II. Conclusions The WSPCHS accomplished one of its missions in 2017 when the WDPCHS began accepting data from pediatric and congenital heart surgery programs across the globe. In doing so, it became one of the first organizations to create a platform for the exchange of knowledge and experience, regardless of the socioeconomic status of the particular program or country.
- Published
- 2022
10. Interventricular Septal Hematoma after Congenital Cardiac Defects Repair at a Single Institution
- Author
-
Yuan Hu, Xiaohui Yang, Jie Dong, Peng Huang, Jinwen Luo, Guangxian Yang, James D. St. Louis, and Xicheng Deng
- Subjects
Pediatrics, Perinatology and Child Health ,Radiology, Nuclear Medicine and imaging ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Published
- 2022
11. The debate goes on…
- Author
-
Brian P. Bateson and James D. St Louis
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
12. Time Is Not on Our Side
- Author
-
James D, St Louis
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2023
13. Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature – The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11)
- Author
-
Stephen P. Sanders, Rodney C. G. Franklin, James D. St. Louis, Jeffrey P. Jacobs, Andrew C. Cook, Lindsay S. Rogers, Amy L. Juraszek, Kristine J. Guleserian, Shubhika Srivastava, Martin J. Elliott, Henry L. Walters, Hiromi Kurosawa, Jeffrey R. Boris, Charles W. Shepard, Lianyi Wang, Elif Seda Selamet Tierney, Rohit Loomba, Christo I. Tchervenkov, Marina L. Hughes, Diane E. Spicer, Bohdan Maruszewski, Marshall L. Jacobs, Jill J. Savla, Constantine Mavroudis, Steven D. Colan, Jorge M. Giroud, Meryl S. Cohen, Marie J. Béland, Vera Demarchi Aiello, Adrian Crucean, Stephen P. Seslar, Allen D. Everett, Lazaro E. Hernandez, Justin T. Tretter, O. N. Krogmann, Giovanni Stellin, Leo Lopez, J. William Gaynor, Frédérique Bailliard, Paul M. Weinberg, and Lucile Houyel
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Standardization ,Unification ,030204 cardiovascular system & hematology ,World Health Organization ,Eleventh ,World health ,Code (semiotics) ,Terminology ,03 medical and health sciences ,0302 clinical medicine ,International Classification of Diseases ,medicine ,Humans ,Medical physics ,Registries ,Intensive care medicine ,Child ,Nomenclature ,Societies, Medical ,Global system ,business.industry ,General Medicine ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC.The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
- Published
- 2021
14. Current Status of Training and Certification for Congenital Heart Surgery Around the World: Proceedings of the Meetings of the Global Council on Education for Congenital Heart Surgery of the World Society for Pediatric and Congenital Heart Surgery
- Author
-
Morten Helvind, Bohdan Maruszewski, Emile A. Bacha, Kisaburo Sakamoto, Christo I. Tchervenkov, Susan Vosloo, Cheul Lee, James S. Tweddell, Christian Kreutzer, Attilio A. Lotto, Hani K. Najm, Giovanni Stellin, Nguyen Ly Thinh Truong, Piya Samankatiwat, Jeffrey P. Jacobs, Joseph A. Dearani, Drissi Boumzebra, Miguel Arboleda, Krishna S Iyer, Pedro Becker, Tae-Gook Jun, James D St Louis, Valdano Manuel, Claudia Herbst, Bistra Zheleva, George E. Sarris, Richard A. Jonas, Frank Edwin, Kirsten Finucane, Sivakumar Sivalingam, Hafil B Abdulgani, Hao Zhang, David M. Overman, Marcelo B. Jatene, Vladimiro L. Vida, David J. Barron, Zohair Al-Halees, José Fragata, Adel Elgamal, Budi Rahmat, Elizabeth H. Stephens, Jorge Cervantes, Nestor Sandoval, Darshan Reddy, James K. Kirklin, and Justin T. Tretter
- Subjects
Heart Defects, Congenital ,Nonprofit organization ,medicine.medical_specialty ,Certification ,Heart disease ,education ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Cardiac Surgical Procedures ,Quality of care ,Child ,Societies, Medical ,business.industry ,Thoracic Surgery ,General Medicine ,medicine.disease ,Surgery ,Cardiac surgery ,030228 respiratory system ,Cardiothoracic surgery ,Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine ,business - Abstract
The optimal training of the highly specialized congenital heart surgeon is a long and complex process, which is a significant challenge in most parts of the world. The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has established the Global Council on Education for Congenital Heart Surgery as a nonprofit organization with the goal of assessing current training and certification and ultimately establishing standardized criteria for the training, evaluation, and certification of congenital heart surgeons around the world. The Global Council and the WSPCHS have reviewed the present status of training and certification for congenital cardiac surgery around the world. There is currently lack of consensus and standardized criteria for training in congenital heart surgery, with significant disparity between continents and countries. This represents significant obstacles to international job mobility of competent congenital heart surgeons and to the efforts to improve the quality of care for patients with Congenital Heart Disease worldwide. The purpose of this article is to summarize and document the present state of training and certification in congenital heart surgery around the world.
- Published
- 2021
15. Multi-institutional Analysis of 100 Consecutive Patients with COVID-19 and Severe Pulmonary Compromise Treated with Extracorporeal Membrane Oxygenation: Outcomes and Trends Over Time
- Author
-
Kirti Patel, Keshava Rajagopal, Eric A. Tesdahl, Alfred H. Stammers, Anthony K. Sestokas, Faisal H. Cheema, Vinay Badhwar, Michael S. Firstenberg, Marvin J. Slepian, J.W. Awori Hayanga, Feriel Esseghir, Jeffrey P. Jacobs, James D. St. Louis, Linda B. Mongero, and Tom Coley
- Subjects
Adult ,Male ,pulmonary failure ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,Critical Illness ,Biomedical Engineering ,Biophysics ,coronavirus ,heart failure ,Bioengineering ,030204 cardiovascular system & hematology ,outcomes ,Biomaterials ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Extracorporeal membrane oxygenation ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Aged ,business.industry ,Management of COVID-19 Patients ,SARS-CoV-2 ,COVID-19 ,Hydroxychloroquine ,General Medicine ,extracorporeal membrane oxygenation ,acute respiratory distress syndrome ,Middle Aged ,medicine.disease ,surgical procedures, operative ,030228 respiratory system ,quality ,Anesthesia ,Heart failure ,Cohort ,Female ,Intravenous steroids ,business ,medicine.drug ,Cohort study - Abstract
The role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with coronavirus disease 2019 (COVID-19) continues to evolve. The purpose of this study is to review a multi-institutional clinical experience in 100 consecutive patients, at 20 hospitals, with confirmed COVID-19 supported with ECMO. This analysis includes our first 100 patients with complete data who had confirmed COVID-19 and were supported with ECMO. The first patient in the cohort was placed on ECMO on March 17, 2020. Differences by the mortality group were assessed using χ2 tests for categorical variables and Kruskal-Wallis rank-sum tests and Welch's analysis of variance for continuous variables. The median time on ECMO was 12.0 days (IQR = 8-22 days). All 100 patients have since been separated from ECMO: 50 patients survived and 50 patients died. The rate of survival with veno-venous ECMO was 49 of 96 patients (51%), whereas that with veno-arterial ECMO was 1 of 4 patients (25%). Of 50 survivors, 49 have been discharged from the hospital and 1 remains hospitalized at the ECMO-providing hospital. Survivors were generally younger, with a lower median age (47 versus 56.5 years, p = 0.014). In the 50 surviving patients, adjunctive therapies while on ECMO included intravenous steroids (26), anti-interleukin-6 receptor blockers (26), convalescent plasma (22), remdesivir (21), hydroxychloroquine (20), and prostaglandin (15). Extracorporeal membrane oxygenation may facilitate salvage and survival of selected critically ill patients with COVID-19. Survivors tend to be younger. Substantial variation exists in the drug treatment of COVID-19, but ECMO offers a reasonable rescue strategy.
- Published
- 2021
16. Self‐reported quality of life in children with ventricular assist devices
- Author
-
David M. Peng, Sunkyung Yu, Ray Lowery, Courtney Ventresco, Melissa K. Cousino, James D. St. Louis, Elizabeth D. Blume, and Karen Uzark
- Subjects
Heart Failure ,Male ,Transplantation ,Treatment Outcome ,Pediatrics, Perinatology and Child Health ,Quality of Life ,Humans ,Female ,Heart-Assist Devices ,Self Report ,Child - Abstract
We sought to describe QOL in children with VAD and to identify factors associated with impaired QOL.There were 82 children (6-19 years) in the Pediatric Interagency Registry for Mechanical Circulatory Support who completed the PedsQL +/- a VAD-specific QOL assessment pre-VAD implant (n = 18), 3 months post-VAD (n = 63), and/or 6 months post-VAD (n = 38). Significantly impaired QOL is a score1 SD below norms.Study patients were 59% male, 67% Caucasian, with cardiomyopathy diagnosis in 82%, and median age at implant of 14 y (IQR 11-17). PedsQL scores were lower than norms for physical (p .0001) and psychosocial (p .01) QOL in pre- and post-VAD groups. Compared to chronic health condition and complex or severe heart disease groups, PedsQL scores were lower for physical and psychosocial QOL in the pre-VAD group (p .0001); however, psychosocial QOL was not significantly different in post-VAD groups. Psychosocial QOL was impaired in 67%, 40%, and 24% in pre-VAD, 3-month, and 6-month post-VAD groups, respectively. Total and psychosocial QOL scores were significantly higher in the 3-month and 6-month post-VAD group than pre-VAD (all p ≤ .02). VAD patients were most bothered by their inability to participate in usual play activities. Impaired QOL 3 months post-VAD was associated with inotropic support2 weeks/ongoing post-VAD (p = .04).Physical QOL is significantly impaired in most children pre- and post-VAD. However, psychosocial QOL is not significantly impaired in most children post-VAD suggesting VAD implantation may improve psychosocial QOL in children.
- Published
- 2022
17. Early Impact of the COVID-19 Pandemic on Congenital Heart Surgery Programs Across the World: Assessment by a Global Multi-Societal Consortium
- Author
-
Emile A. Bacha, Erle H. Austin, James K. Kirklin, Mauro Lo Rito, Eleftherios M Protopapas, Jeffery P. Jacobs, Zdzislaw Tobota, Sachin Talwar, Zohair Al Halees, Yasutaka Hirata, George E. Sarris, Bistra Zheleva, Krishna S Iyer, Elizabeth H. Stephens, Hao Zhang, Marcello B Jatene, James S. Tweddell, Cheul Lee, Bohdan Maruszewski, Hiromi Kurosawa, Jorge Cervantes, Rajesh Sharma, Vladimiro L. Vida, James D. St. Louis, Nestor Sandoval, Christo I. Tchervenkov, Joseph A. Dearani, Frank Edwin, Kisaburo Sakamoto, and James E. O'Brien
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Heart disease ,morbidity) ,congenital heart surgery ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,congenital heart disease (CHD) ,outcomes (includes mortality ,pediatric ,030204 cardiovascular system & hematology ,Global Health ,Article ,03 medical and health sciences ,Extracorporeal Membrane Oxygenation ,0302 clinical medicine ,Hospital Administration ,Health care ,Pandemic ,medicine ,Humans ,030212 general & internal medicine ,Cardiac Surgical Procedures ,Child ,Pandemics ,SARS-CoV-2 ,business.industry ,International survey ,COVID-19 ,General Medicine ,medicine.disease ,Organizational Policy ,Patient Care Management ,Surgery ,Elective Surgical Procedures ,Health Care Surveys ,Pediatrics, Perinatology and Child Health ,Infectious risk ,Cardiology and Cardiovascular Medicine ,business ,Pediatric population - Abstract
The coronavirus disease 2019 (COVID-19) pandemic currently gripping the globe is impacting the entire health care system with rapidly escalating morbidities and mortality. Although the infectious risk to the pediatric population appears low, the effects on children with congenital heart disease (CHD) remain poorly understood. The closure of congenital heart surgery programs worldwide to address the growing number of infected individuals could have an unintended impact on future health for COVID-19-negative patients with CHD. Pediatric and congenital heart surgeons, given their small numbers and close relationships, are uniquely positioned to collectively assess the impact of the pandemic on surgical practice and care of children with CHD. We present the results of an international survey sent to pediatric and congenital heart surgeons characterizing the early impact of COVID-19 on the care of patients with CHD.
- Published
- 2020
18. Valve Replacement in Children with Single Ventricle Physiology
- Author
-
Noor Alshami, Amanda S. Thomas, James D. St. Louis, Geetha Raghuveer, Amber Leila Sarvestani, and Lazaros Kochilas
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Adolescent ,medicine.medical_treatment ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Univentricular Heart ,National Death Index ,Article ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Internal medicine ,Hospital discharge ,medicine ,Humans ,Child ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Atrioventricular valve ,business.industry ,Vascular surgery ,Cardiac surgery ,Treatment Outcome ,030228 respiratory system ,Single ventricle physiology ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Severe atrioventricular valve (AVV) or semilunar valve (SLV) regurgitation in the setting of a single ventricle physiology may proceed to valve replacement if repair strategies fail. Outcome data for these children are limited. We present transplant-free survival of a case series of children with single ventricle physiology undergoing either atrioventricular replacement (AVVR) or semilunar valve replacement (SLVR) from a multi-institutional, US-based registry (Pediatric Cardiac Care Consortium—PCCC). Outcomes were derived from PCCC and by linkage with the National Death Index (NDI) and Organ Procurement Transplant Network (OPTN). Fifty children with single ventricle physiology were identified to have received either AVVR (n = 38) or SLVR (n = 12). There were 17 in-hospital deaths including 8 intraoperative deaths (all intraoperative deaths were among children requiring AVVR). The in-hospital mortality was 42% and 8% for AVVR and SLVR, respectively. Among the 33 children surviving to hospital discharge, follow-up was available in 15 (46%). Death or cardiac transplant after hospital discharge occurred in 10—death in 4 (all among those requiring AVVR), cardiac transplant in 6 (2 following AVVR, 4 following SLVR). Valve replacement in children with single ventricle physiology, especially AVVR, is associated with poor outcomes. Alternative palliation strategies should be considered in children with single ventricle physiology with significant AVV or SLV regurgitations.
- Published
- 2019
19. Age at surgery and outcomes following neonatal cardiac surgery: An analysis from the Pediatric Cardiac Critical Care Consortium
- Author
-
Andrew H. Smith, Andrew Y. Shin, Sarah Tabbutt, Mousumi Banerjee, Wenying Zhang, Santiago Borasino, Justin J. Elhoff, J. William Gaynor, Nancy S. Ghanayem, Sara K. Pasquali, James D. St Louis, Subhadra Shashidharan, Michael Ruppe, Kurt R. Schumacher, Michael Gaies, and John M. Costello
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
The optimal timing for neonatal cardiac surgery is a potentially modifiable factor that may affect outcomes. We studied the relationship between age at surgery (AAS) and outcomes across multiple hospitals, focusing on neonatal operations where timing appears is not emergency.We studied neonates ≥37 weeks' gestation and ≥2.5 kg admitted to a treating hospital on or before day of life 2 undergoing selected index cardiac operations. The impact of AAS on outcomes was evaluated across the entire cohort and a standard risk subgroup (ie, free of preoperative mechanical ventilation, mechanical circulatory support, or other organ failure). Outcomes included mortality, major morbidity (ie, cardiac arrest, mechanical circulatory support, unplanned cardiac reintervention, or neurologic complication), and postoperative cardiac intensive care unit and hospital length of stay. Post hoc analyses focused on operations undertaken between day of life 2 and 7.We studied 2536 neonates from 47 hospitals. AAS from day of life 2 through 7 was not associated with risk adjusted mortality or major morbidity among the entire cohort and the standard risk subgroup. Older AAS, although associated with modest increases in postoperative cardiac intensive care unit and hospital length of stay in the entire cohort, was not associated with hospital length of stay in the standard risk subgroup.Among select nonemergency neonatal cardiac operations, AAS between day of life 2 and 7 was not found to be associated with risk adjusted mortality or major morbidity. Although delays in surgical timing may modestly increase preoperative resource use, studies of AAS and outcomes not evident at the time of discharge are needed.
- Published
- 2021
20. Mechanical support of superior cavopulmonary (Glenn) physiology to heart transplantation
- Author
-
Aliessa P. Barnes, Edo K.S. Bedzra, James D. St. Louis, and Brian F. Birnbaum
- Subjects
Pulmonary and Respiratory Medicine ,Heart transplantation ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,medicine ,Cardiology ,Surgery ,business ,Congenital: Mechanical Circulatory Support: Case Reports - Published
- 2020
21. Variation in outcomes with extracorporeal membrane oxygenation in the era of coronavirus: A multicenter cohort evaluation
- Author
-
Alfred H Stammers, Eric A Tesdahl, Anthony K Sestokas, Linda B Mongero, Kirti Patel, Shannon Barletti, Michael S Firstenberg, James D St. Louis, Ankit Jain, Caryl Bailey, Jeffrey P Jacobs, and Samuel Weinstein
- Subjects
Advanced and Specialized Nursing ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,Safety Research - Abstract
Extracorporeal membrane oxygenation (ECMO) is used in critically ill patients with coronavirus disease 2019 (COVID-19) with acute respiratory distress syndrome unresponsive to other interventions. However, a COVID-19 infection may result in a differential tolerance to both medical treatment and ECMO management. The aim of this study was to compare outcomes (mortality, organ failure, circuit complications) in patients on ECMO with and without COVID-19 infection, either by venovenous (VV) or venoarterial (VA) cannulation. This is a multicenter, retrospective analysis of a national database of patients placed on ECMO between May 2020 and January 2022 within the United States. Nine-hundred thirty patients were classified as either Pulmonary (PULM, n = 206), Cardiac (CARD, n = 279) or COVID-19 (COVID, n = 445). Patients were younger in COVID groups: PULM = 48.4 ± 15.8 years versus COVID = 44.9 ± 12.3 years, p = 0.006, and CARD = 57.9 ± 15.4 versus COVID = 46.5 ± 11.8 years, p < 0.001. Total hours on ECMO were greatest for COVID patients with a median support time two-times higher for VV support (365 [101, 657] hours vs 183 [63, 361], p < 0.001), and three times longer for VA support (212 [99, 566] hours vs 70 [17, 159], p < 0.001). Mortality was highest for COVID patients for both cannulation types (VA-70% vs 51% in CARD, p = 0.041, and VV-59% vs PULM-42%, p < 0.001). For VA supported patients hepatic failure was more often seen with COVID patients, while for VV support renal failure was higher. Circuit complications were more frequent in the COVID group as compared to both CARD and PULM with significantly higher circuit change-outs, circuit thromboses and oxygenator failures. Anticoagulation with direct thrombin inhibitors was used more often in COVID compared to both CARD (31% vs 10%, p = 0.002) and PULM (43% vs 15%, p < 0.001) groups. This multicenter observational study has shown that COVID patients on ECMO had higher support times, greater hospital mortality and higher circuit complications, when compared to patients managed for either cardiac or pulmonary lesions.
- Published
- 2022
22. Multicentre comparative analysis of long-term outcomes after aortic valve replacement in children
- Author
-
James H. Moller, Chizitam F Ibezim, Elizabeth Turk, Geetha Raghuveer, James D. St. Louis, Bahaaldin Alsoufi, Courtney McCracken, Jessica H. Knight, Amber Leila Sarvestani, and Lazaros Kochilas
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,National Death Index ,Article ,Young Adult ,Valve replacement ,Aortic valve replacement ,Cardiac interventions ,medicine ,Long term outcomes ,Humans ,Child ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,business.industry ,Hazard ratio ,Infant, Newborn ,Infant ,Retrospective cohort study ,medicine.disease ,Aortic Valve Disease ,Surgery ,surgical procedures, operative ,Treatment Outcome ,Aortic Valve ,Child, Preschool ,Heart Valve Prosthesis ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cardiac transplants - Abstract
ObjectiveThe ideal valve substitute for surgical intervention of congenital aortic valve disease in children remains unclear. Data on outcomes beyond 10–15 years after valve replacement are limited but important for evaluating substitute longevity. We aimed to describe up to 25-year death/cardiac transplant by type of valve substitute and assess the potential impact of treatment centre. Our hypothesis was that patients with pulmonic valve autograft would have better survival than mechanical prosthetic.MethodsThis is a retrospective cohort study from the Pediatric Cardiac Care Consortium, a multi-institutional US-based registry of paediatric cardiac interventions, linked with the National Death Index and United Network for Organ Sharing through 2019. Children (0–20 years old) receiving aortic valve replacement (AVR) from 1982 to 2003 were identified. Kaplan-Meier transplant-free survival was calculated, and Cox proportional hazard models estimated hazard ratios for mechanical AVR (M-AVR) versus pulmonic valve autograft.ResultsAmong 911 children, the median age at AVR was 13.4 years (IQR=8.4–16.5) and 73% were male. There were 10 cardiac transplants and 153 deaths, 5 after transplant. The 25-year transplant-free survival post AVR was 87.1% for autograft vs 76.2% for M-AVR and 72.0% for tissue (bioprosthetic or homograft). After adjustment, M-AVR remained related to increased mortality/transplant versus autograft (HR=1.9, 95% CI=1.1 to 3.4). Surprisingly, survival for patients with M-AVR, but not autograft, was lower for those treated in centres with higher in-hospital mortality.ConclusionPulmonic valve autograft provides the best long-term outcomes for children with aortic valve disease, but AVR results may depend on a centre’s experience or patient selection.
- Published
- 2021
23. Refining The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model With Enhanced Risk Adjustment for Chromosomal Abnormalities, Syndromes, and Noncardiac Congenital Anatomic Abnormalities
- Author
-
Peter J. Gruber, Christian Pizarro, Sean M. O'Brien, Richard A. Jonas, James M. Meza, James D. St. Louis, Kevin D. Hill, Sara K. Pasquali, Jeffrey P. Jacobs, Erle H. Austin, S. Ram Kumar, David M. Shahian, J. William Gaynor, Dylan Thibault, John E. Mayer, and Marshall L. Jacobs
- Subjects
Adult ,Heart Defects, Congenital ,Male ,Pulmonary and Respiratory Medicine ,Canada ,medicine.medical_specialty ,Down syndrome ,Time Factors ,Adolescent ,Databases, Factual ,Chromosome Disorders ,030204 cardiovascular system & hematology ,Logistic regression ,computer.software_genre ,Risk Assessment ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Risk of mortality ,medicine ,Humans ,Hospital Mortality ,Cardiac Surgical Procedures ,Young adult ,Child ,Societies, Medical ,Retrospective Studies ,Models, Statistical ,Database ,business.industry ,Infant, Newborn ,Infant ,Thoracic Surgery ,Retrospective cohort study ,Odds ratio ,medicine.disease ,United States ,Surgery ,030228 respiratory system ,Cardiothoracic surgery ,Child, Preschool ,Atrioventricular canal ,Female ,Cardiology and Cardiovascular Medicine ,business ,computer ,Follow-Up Studies - Abstract
Background The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model adjusts not only for procedure and age group pairings but also for additional patient factors, including the binary presence or absence of a chromosomal abnormality (CA), syndrome (S), and/or a noncardiac congenital anatomic abnormality (NCAA). This analysis refines case-mix adjustment by adding more granular adjustment for individual conditions (CA, S, and NCAA), consistent with a hypothesis that associated risk of mortality differs between individual conditions. Methods CA/S corresponding to the same condition were merged to a single condition code. Odds ratios were estimated for all CA/S. For CA/S associated with at least 10 deaths in neonates and infants and at least 10 deaths in children and adults, odds ratios were estimated for the effect of the CA/S separately in neonates/infants and in children/adults. In addition to these condition/age interactions, condition/age/procedure interactions were explored (eg, effect of Down syndrome was estimated based on age and procedure subgroups, including atrioventricular canal repair and single-ventricle palliation). Bayesian modeling was used to create 5 maximally homogeneous groups of CA/S from 81 candidate CA/S variables. A standard logistic regression model then incorporated indicator variables for the 5 categories of CAs/Ss, 7 unique NCAAs, and all other covariates in the previously published Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Model. Results Analysis included 107,062 operations in 100 centers (2010 to 2015). Operative Mortality was 3,629 (3.4%). In the development sample, the C statistics of the original nonaugmented model and the augmented model were 0.872 and 0.875, respectively. Conclusions The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model has been augmented by addition of covariates representing individual CAs, Ss, and NCAAs.
- Published
- 2019
24. Proceedings From the 3rd Symposium of the World Database for Pediatric and Congenital Heart Surgery
- Author
-
Zohair Al Halees, Kirsten Finucane, Jeffrey P. Jacobs, Nestor Sandoval, James D. St. Louis, Christo I. Tchervenkov, James K. Kirklin, Hao Zhang, Richard A. Jonas, and Sachin Talwar
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Databases, Factual ,Outcome analysis ,Heart defect ,030204 cardiovascular system & hematology ,computer.software_genre ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Cardiac Surgical Procedures ,Child ,Societies, Medical ,Database ,business.industry ,Thoracic Surgery ,General Medicine ,Congresses as Topic ,Surgery ,030228 respiratory system ,Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
The World Database for Pediatric and Congenital Heart Surgery was created to provide a resource for centers to be able to perform complex outcomes analyses of children undergoing repair of a congenital heart defect. In just under two years, the World Society for Pediatric and Congenital Heart Surgery (WSPCHS) has amassed over 13,000 procedures from 55 centers into the database. This Proceedings of the 3rd World Database Symposium held at the 6th Scientific Meeting of the WSPCHS summarizes the presentations of international experts in the fields of outcomes analysis and care of children with congenital heart surgery.
- Published
- 2019
25. Third Annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report: Preimplant Characteristics and Outcomes
- Author
-
Angela Lorts, Pedimacs Investigators, Ryan S. Cantor, James D. St. Louis, Devin Koeh, Iki Adachi, David L.S. Morales, Christina VanderPluym, David N. Rosenthal, James K. Kirklin, David L Sutcliffe, Joseph W. Rossano, and Elizabeth D. Blume
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Population ,Cardiomyopathy ,030204 cardiovascular system & hematology ,Pediatrics ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Preoperative Care ,medicine ,Humans ,Registries ,Child ,education ,Survival rate ,Societies, Medical ,Heart Failure ,education.field_of_study ,business.industry ,Thoracic Surgery ,Hospitals, Pediatric ,medicine.disease ,United States ,Survival Rate ,Treatment Outcome ,030228 respiratory system ,Cardiothoracic surgery ,Child, Preschool ,Heart failure ,Ventricular assist device ,Emergency medicine ,Cohort ,Heart Transplantation ,Female ,Surgery ,Heart-Assist Devices ,Implant ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The influence of ventricular assist device (VAD) use in the care of children with end-stage heart failure is growing rapidly through increasing numbers, new devices, expanding indications, and improving outcomes. Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), a National Institutes of Health–sponsored United States database, provides a platform to understand this emerging population. Methods Between September 19, 2012, and December 31, 2017, 30 hospitals implanted 508 devices in 423 patients aged younger than 19 years. This past year was one of evolution for the database as its management was transitioned to The Society of Thoracic Surgery; therefore, this report does not include data from institutions not under contract by August 1, 2018. Results Of the 423 patients, the diagnosis was cardiomyopathy in 261 (62%), myocarditis in 48 (11%), other in 28 (7%), and congenital heart disease (CHD) in 86 (20%), with 52 of these patients having single-ventricle physiology. The two most common support strategies included left VAD in 342 (81%) and biventricular assist device in 64 (15%). Positive outcome (alive on device or bridge to transplantation/recovery) was 80% at 6 months (overall mortality of 20%). The patient cohort for implantable continuous-flow (IC) pumps (n = 197; age at implant, 13.4 ± 3.8 years; 19% Interagency Registry for Mechanically Assisted Circulatory Support [Intermacs] profile 1, 21% intubated at implant, and 12% with CHD) was significantly different from the paracorporeal continuous-flow (PC) pump cohort (n = 79; age, 3.9 ± 5.2 years; 49% Intermacs profile 1, 86% intubated at implant, and 38% with CHD) and the paracorporeal pulsatile (PP) pump cohort (n = 121; age, 3.3 ± 3.9 years; 41% Intermacs profile 1, 77% intubated at implant, and 21% with CHD). Consistent with their cohort composition, device type positive outcomes at 6 months were PC, 63%; PP, 77%; and IC, 92%. Parametric hazard modeling showed an early hazard for death was associated with Intermacs profile 1, biventricular assist device, percutaneous devices, PC devices, small-volume institutions, low age, and low weight, whereas a constant hazard was associated with intubation and liver dysfunction at time of implant. Conclusions IC VADs are the most common VAD type placed in children. The positive outcomes for the IC VADs exceed 90% at 6 months, which may represent our field’s maturation in both patient selection and timing of implantation. The PP/PC devices are currently limited to supporting our most challenging patients, those weighing less than 20 kg and those with CHD. The introduction of new devices and our communities’ commitment to shared learning and improvement will lead to more pediatric lives saved by VAD support and will also focus on improving the quality of life of children supported with VADs.
- Published
- 2019
26. Extracorporeal Cardiopulmonary Resuscitation (ECPR): Initiation and Surgical Technique in the Pediatric Population
- Author
-
James D. St. Louis and Mark D. Plunkett
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Corrective surgery ,030204 cardiovascular system & hematology ,Postoperative survival ,Complex congenital heart defect ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,medicine ,Extracorporeal membrane oxygenation ,Surgery ,Extracorporeal cardiopulmonary resuscitation ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Pediatric population - Abstract
Surgical outcomes in the field of congenital heart surgery have dramatically improved over the last several decades. This success has led to sicker and more complex children presenting for major corrective surgery. Extracorporeal cardiopulmonary resuscitation (ECPR) in form of mechanical circulatory support that has become an integral service of most congenital heart programs; the concept of ECPR is essentially the rapid and effective initiation of extracorporeal membrane oxygenation (ECMO), usually at the bedside and often on an infant who has just undergone repair of a complex congenital heart defect. The financial resources and personnel that must be dedicated to an ECPR program exceed those of routine ECMO programs and must be justified relative to the surgical complexity that a particular institution chooses to offer its patients. With the appropriate dedication of resources and personnel, ECPR has been shown to improve postoperative survival as compared to outcomes when this service is not available.
- Published
- 2019
27. Outcomes of Mechanical Mitral Valve Replacement in Children
- Author
-
Lazaros Kochilas, James H. Moller, Omar Qayum, Jessica H. Knight, Amber Leila Sarvestani, Courtney McCracken, Geetha Raghuveer, Noor Alshami, James D. St. Louis, Elizabeth M. Turk, and Chizitam F Ibezim
- Subjects
Male ,Reoperation ,Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Heart disease ,medicine.medical_treatment ,Heart Valve Diseases ,030204 cardiovascular system & hematology ,Prosthesis Design ,National Death Index ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Mechanical Mitral Valve ,Mitral valve ,medicine ,Humans ,Child ,Survival rate ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,business.industry ,Age Factors ,Mitral valve replacement ,Infant ,Retrospective cohort study ,medicine.disease ,United States ,Survival Rate ,Transplantation ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Child, Preschool ,Heart Valve Prosthesis ,Mitral Valve ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Mitral valve anomalies in children are rare but frequently severe, recalcitrant, and not often amenable to primary repair, necessitating mechanical mitral valve replacement (M-MVR). This study examined outcomes of a cohort undergoing a first M-MVR at age younger than 21 years.We queried the Pediatric Cardiac Care Consortium, a multi-institutional United States-based cardiac intervention registry, for patients undergoing first M-MVR for 2-ventricle congenital heart disease. Survival and transplant status through 2014 were obtained from Pediatric Cardiac Care Consortium and linkage with the National Death Index and the Organ Procurement and Transplantation Network.We identified 441 patients (median age, 4.3 years; interquartile range, 1.3 to 10.1 years) meeting study criteria. The commonest disease necessitating M-MVR was atrioventricular canal (44.3%). Early mortality (death90 days after M-MVR) was 11.1%; there was increased risk of early death if age at M-MVR was younger than 2 years (odds ratio, 7.8; 95% confidence interval [CI], 1.1 to 56.6) and with concurrent other mechanical valve placement (odds ratio, 8.5; 95% CI, 2.0 to 35.6). In those surviving more than 90 days after M-MVR, transplant-free survival was 76% at 20 years of follow-up (median follow-up, 16.6 years; interquartile range, 11.9 to 21.3 years). Adjusted analysis in those who survived more than 90 days showed elevated risk of death/transplant for boys (hazard ratio, 1.5; 95% CI, 1.0 to 2.3), age at M-MVR younger than 2 years (10-year survival: hazard ratio, 4.3; 95% CI, 1.2 to 15.1), and nonbileaflet prosthesis placement (hazard ratio, 2.4; 95% CI, 1.3 to 4.3).M-MVR is a viable strategy in children with unrepairable mitral valve disease. Age younger than 2 years at the first M-MVR is associated with significant early risk of death and poorer long-term survival.
- Published
- 2019
28. The World Database for Pediatric and Congenital Heart Surgery 'A Call to Service for North American Congenital Heart Surgery Programs'
- Author
-
Viktor Hraska, James D. St. Louis, Erle H. Austin, Christo I. Tchervenkov, Pranava Sinha, Kristine J. Guleserian, Mark D. Plunkett, Nick Timkovich, Jeffery P. Jacobs, Marshall L. Jacobs, James E. O'Brien, John L. Myers, James K. Kirklin, Susanna Lenderman, and Richard A. Jonas
- Subjects
Pulmonary and Respiratory Medicine ,Service (business) ,medicine.medical_specialty ,Quality management ,Database ,business.industry ,Heart defect ,General Medicine ,030204 cardiovascular system & hematology ,computer.software_genre ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,medicine ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
The World Society for Pediatric and Congenital Heart Surgery has endorsed the establishment of an international platform for the exchange of knowledge and experience for those that treat patients with a congenital heart defect. On January 1, 2017, the release of the World Database for Pediatric and Congenital Heart Surgery opened a new era in evaluation of treatment with congenital heart defects. The contribution of data from countries with established congenital surgical databases will greatly enhance the efforts to provide the most accurate measure of overall surgical outcomes across the globe.
- Published
- 2019
29. Development of an international standard set of clinical and patient-reported outcomes for children and adults with congenital heart disease: a report from the International Consortium for Health Outcomes Measurement Congenital Heart Disease Working Group
- Author
-
Amy Basken, Luis Antonio Garcia, Gerard R. Martin, Tomás Chalela, Lisa A. Hom, Bistra Zheleva, Amy Verstappen, Steven M. Schwartz, Ingrid M. van Beynum, Laila Akbar Ladak, Kathy J. Jenkins, Nick Sillett, Kevin Hummel, Almudena March, Nicolas L. Madsen, Babar Hasan, Sarah Whittaker, Roberta G. Williams, James D. St. Louis, Disty Pearson, Julie Chauhan, Malin Berghammer, and Pediatrics
- Subjects
Adult ,Heart Defects, Congenital ,medicine.medical_specialty ,MEDLINE ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,SDG 3 - Good Health and Well-being ,Surveys and Questionnaires ,Outcome Assessment, Health Care ,Health care ,medicine ,Humans ,Patient Reported Outcome Measures ,030212 general & internal medicine ,Medical diagnosis ,Child ,Set (psychology) ,business.industry ,Health Policy ,International standard ,Benchmarking ,Family medicine ,Cardiology and Cardiovascular Medicine ,business ,International development - Abstract
Aims Congenital heart disease (CHD) is the most common congenital malformation. Despite the worldwide burden to patient wellbeing and health system resource utilization, tracking of long-term outcomes is lacking, limiting the delivery and measurement of high-value care. To begin transitioning to value-based healthcare in CHD, the International Consortium for Health Outcomes Measurement aligned an international collaborative of CHD experts, patient representatives, and other stakeholders to construct a standard set of outcomes and risk-adjustment variables that are meaningful to patients. Methods and results The primary aim was to identify a minimum standard set of outcomes to be used by health systems worldwide. The methodological process included four key steps: (i) develop a working group representative of all CHD stakeholders; (ii) conduct extensive literature reviews to identify scope, outcomes of interest, tools used to measure outcomes, and case-mix adjustment variables; (iii) create the outcome set using a series of multi-round Delphi processes; and (iv) disseminate set worldwide. The Working Group established a 15-item outcome set, incorporating physical, mental, social, and overall health outcomes accompanied by tools for measurement and case-mix adjustment variables. Patients with any CHD diagnoses of all ages are included. Following an open review process, over 80% of patients and providers surveyed agreed with the set in its final form. Conclusion This is the first international development of a stakeholder-informed standard set of outcomes for CHD. It can serve as a first step for a lifespan outcomes measurement approach to guide benchmarking and improvement among health systems.
- Published
- 2021
30. Time-Related Risk of Pulmonary Conduit Re-replacement: A Congenital Heart Surgeons' Society Study
- Author
-
Nabi Aghaei, Aaron W. Eckhauser, Brian W. McCrindle, Eugene H. Blackstone, Tara Karamlou, Jeremy L. Herrmann, James K. Kirklin, John W. Brown, Christopher W. Baird, James D St Louis, Linda M. Lambert, Connor P Callahan, Anusha Jegatheeswaran, Karthik Ramakrishnan, William M. DeCampli, Anastasios C. Polimenakos, and Jennifer S. Nelson
- Subjects
Pulmonary and Respiratory Medicine ,Heart Defects, Congenital ,Male ,endocrine system ,medicine.medical_specialty ,Cardiac Catheterization ,Time Factors ,Heart Ventricles ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Competing risks ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,Electrical conduit ,medicine.artery ,Medicine ,Humans ,Cardiac Surgical Procedures ,Child ,Societies, Medical ,Retrospective Studies ,business.industry ,Hazard ratio ,Anastomosis, Surgical ,Infant, Newborn ,Infant ,Thoracic Surgery ,Surgery ,medicine.anatomical_structure ,030228 respiratory system ,Pulmonary valve ,Child, Preschool ,Pulmonary artery ,Female ,Cardiology and Cardiovascular Medicine ,business ,Artery ,Follow-Up Studies - Abstract
Patients receiving a right ventricle to pulmonary artery conduit (PC) in infancy will require successive procedures or replacements, each with variable longevity. We sought to identify factors associated with time-related risk of a subsequent surgical replacement (PC3) or transcatheter pulmonary valve insertion (TPVI) after a second surgically placed PC (PC2).From 2002 to 2016, 630 patients from 29 Congenital Heart Surgeons' Society member institutions survived to discharge after initial valved PC insertion (PC1) at age ≤ 2 years. Of those, 355 underwent surgical replacement (PC2) of that initial conduit. Competing risk methodology and multiphase parametric hazard analyses were used to identify factors associated with time-related risk of PC3 or TPVI.Of 355 PC2 patients (median follow-up, 5.3 years), 65 underwent PC3 and 41 TPVI. Factors at PC2 associated with increased time-related risk of PC3 were smaller PC2 Z score (hazard ratio [HR] 1.6, P.001), concomitant aortic valve intervention (HR 7.6, P = .009), aortic allograft (HR 2.2, P = .008), younger age (HR 1.4, P.001), and larger Z score of PC1 (HR 1.2, P = .04). Factors at PC2 associated with increased time-related risk of TPVI were aortic allograft (HR: 3.3, P = .006), porcine unstented conduit (HR 4.7, P.001), and older age (HR 2.3, P = .01).Aortic allograft as PC2 was associated with increased time-related risk of both PC3 and TPVI. Surgeons may reduce risk of these subsequent procedures by not selecting an aortic homograft at PC2, and by oversizing the conduit when anatomically feasible.
- Published
- 2021
31. Are Mechanical Prostheses Valid Alternatives To Ross Procedure In Young Children Under 6 Years Old?
- Author
-
Lazaros Kochilas, Jessica H. Knight, James D. St. Louis, Geetha Raghuveer, and Bahaaldin Alsoufi
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Ross procedure ,medicine.medical_treatment ,Operative mortality ,Hazard ratio ,medicine.disease ,Confidence interval ,Article ,Surgery ,Aortic valve replacement ,Aortic valve surgery ,Medicine ,Cumulative incidence ,Congenital disease ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Aortic valve replacement in young children is associated with technical difficulties and potential morbidity. In contrast to the versatile Ross operation, mechanical prostheses (MP) are uncommonly used. Methods We examined transplant-free survival and cardiac reoperation among 124 young children (aged 1-6 years) who underwent the Ross operation (n = 84) or MP (n = 40) for congenital disease (1982-2003) using the Pediatric Cardiac Care Consortium database. We explored variables influencing outcomes. Results Children who received MP were operated in an earlier era and were more likely to have aortic regurgitation, conotruncal abnormalities, prior aortic valve surgery, and to need Konno annular enlargement. Although no significant differences were found in hospital mortality (1.2% vs 5.0%, P = .24) or 15-year transplant-free survival (94.1% vs 87.5%, P = .16) between Ross and MP recipients, survival diverged with later follow-up (91.3% vs 68.9%, respectively, at 25 years; P = .01). On multivariable regression analysis the association of MP use and transplant-free survival changed over time (hazard ratios, 0.8 [95% confidence interval, 0.1-4.4; P = .78] vs 6.0 [95% confidence interval, 0.6-63.1; P = .13], respectively) before and after 17 years. Cumulative incidence of cardiac reoperation at 10 years was 37.7% and 53.6% after the Ross procedure and MP, respectively (P = .05). The most common reoperation after the Ross procedure was conduit replacement and pacemaker ± automated internal cardiac defibrillator and after MP was pacemaker ± automated internal cardiac defibrillator and redo aortic valve replacement. Conclusions Over the study period there was a trend for increased Ross utilization. Interestingly MP use was associated with comparable operative mortality and survival up to 17 years, albeit with higher need for redo aortic valve replacement. On longer follow-up survival diverged with increased attrition in the MP group, likely because of late valve– and reoperation-related complications.
- Published
- 2020
32. A LARGE SINGLE TRANSMURAL CARDIAC RHABDOMYOMA IN A FETUS
- Author
-
Bridget Curley, James D. St. Louis, Joseph White, and Liezl T. Domingo
- Subjects
Cardiology and Cardiovascular Medicine - Published
- 2022
33. Factors associated with mortality or transplantation versus Fontan completion after cavopulmonary shunt for patients with tricuspid atresia
- Author
-
Connor P. Callahan, Anusha Jegatheeswaran, David J. Barron, S. Adil Husain, Pirooz Eghtesady, Karl F. Welke, Christopher A. Caldarone, David M. Overman, James K. Kirklin, Marshall L. Jacobs, Linda M. Lambert, William M. DeCampli, Brian W. McCrindle, Aaron M. Abarbanell, Peter J. Gruber, Tara Karamlou, Linda Lambert, David B. Meyer, Christian Pizarro, Karthik Ramakrishnan, James D. St Louis, and Varsha Zadokar
- Subjects
Male ,Pulmonary and Respiratory Medicine ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Fontan Procedure ,Risk Assessment ,Tricuspid Atresia ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Mitral valve ,medicine.artery ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,Tricuspid atresia ,Mitral valve repair ,business.industry ,Heart Bypass, Right ,Hazard ratio ,Infant ,medicine.disease ,Transplantation ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,030228 respiratory system ,Great vessels ,Pulmonary artery ,cardiovascular system ,Cardiology ,Heart Transplantation ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,Mitral valve regurgitation ,business - Abstract
OBJECTIVE Tricuspid atresia with normally related great vessels (TA) is considered the optimal substrate for the Fontan pathway. The factors associated with death or transplantation after cavopulmonary shunt (CPS) are underappreciated. We aimed to determine factors associated with CPS-Fontan interstage death/transplantation versus transition to Fontan in TA. METHODS A total of 417 infants younger than 3 months of age with TA were enrolled (January 1999 to February 2020) from 40 institutions into the Congenital Heart Surgeons' Society TA cohort. Parametric competing risk methodology was used to determine factors associated with the competing end points of death/transplantation without Fontan completion, and transition to Fontan. RESULTS CPS was performed in 382 patients with TA; of those, 5% died or underwent transplantation without transition to Fontan and 91% transitioned to Fontan by 5 years after CPS. Prenatal diagnosis (hazard ratio [HR], 0.74; P
- Published
- 2022
34. Heart Valves : From Design to Clinical Implantation
- Author
-
Paul A. Iaizzo, Tinen L. Iles, Massimo Griselli, James D. St. Louis, Paul A. Iaizzo, Tinen L. Iles, Massimo Griselli, and James D. St. Louis
- Subjects
- Heart valve prosthesis, Heart valves--Diseases, Heart valves
- Abstract
This state-of-the-art handbook is dedicated to cardiac valve anatomy, models for testing and research methods, clinical trials; and clinical needs and applications. In this new edition, chapters are updated with the latest research in addition to new chapters on complex repair of CHD requiring conduits, new trends for valve replacement like the Ozaki procedure, as well as complex procedures in TAV, SAV, HARPOON, and BASILICA, with case studies for each type of procedure. This volume serves as a helpful reference for patients, educators, students, device designers and developers, clinical study specialists, clinicians, and other associated healthcare providers.
- Published
- 2023
35. Fourth Annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report
- Author
-
Devin Koehl, Katrina Fields, Pedimacs Investigators, Joseph W. Rossano, James D. St. Louis, Angela Lorts, David M. Peng, James K. Kirklin, Iki Adachi, Ryan S. Cantor, Jeffrey P. Jacobs, Jennifer Conway, David L.S. Morales, Elizabeth D. Blume, and Pranava Sinha
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Myocarditis ,Heart disease ,Adolescent ,Heart Diseases ,Population ,Cardiomyopathy ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,Outcome Assessment, Health Care ,medicine ,Humans ,Registries ,Young adult ,education ,Child ,Survival rate ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,Infant, Newborn ,Infant ,medicine.disease ,United States ,Survival Rate ,Treatment Outcome ,030228 respiratory system ,Child, Preschool ,Cohort ,Cardiology ,Surgery ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background The Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), originally a National Institutes of Health–sponsored U.S. database, provides a platform to understand the population of children supported with ventricular assist devices (VADs) during this time of increasing numbers, new devices, expanding indications, and improved outcomes. Methods Between September 19, 2012, and December 31, 2019, 44 hospitals implanted 1031 devices in 856 patients under 19 years of age. Results Overall, diagnosis was cardiomyopathy in 497 (58%) patients, congenital heart disease (CHD) in 216 (25%), myocarditis in 85 (10%), and other in 58 (7%). Positive outcome (alive on device or bridge to transplantation and recovery) occurred in 82% at 6 months. The patient cohort for implantable continuous (IC) pumps (n = 365) (age 13.2 ± 3.9 years, 18% Interagency Registry for Mechanically Assisted Circulatory Support [Intermacs] profile 1, 23% intubated at implantation, 16% with CHD) was significantly different from the paracorporeal continuous (PC) pump cohort (n = 212) (age 3.6 ± 4.9 years, 46% Intermacs profile 1, 81% intubated, 42% CHD) and the paracorporeal pulsatile (PP) pump cohort (n = 230) (age 2.7 ± 3.5 years, 31% Intermacs profile 1, 76% intubated, 26% CHD). Consistent with their cohort composition, positive outcomes at 6 months based on device type were the following: IC, 92%; PC, 68%; and PP, 81%. The incidence of cerebrovascular accidents in the IC, PC, and PP cohorts was 7%, 14%, and 15%, respectively. Conclusions IC VADs, the most common VAD type placed in children, are associated with improved outcomes compared with PP and PC devices, though PP and PC devices are limited to supporting our most challenging patients. Noteworthy, the incidence of cerebrovascular accidents for pediatric VADs has significantly decreased and is now 11% overall. This report demonstrates again that although often attributed to age, size, or device type, much of the burden in mortality and adverse events is correlated to the patient’s overall state at VAD implantation.
- Published
- 2020
36. COVID-19: FAQs-Congenital Heart Surgery Recovery and Defining a 'New Normal'
- Author
-
George E. Sarris, Kristine J. Guleserian, James D. St. Louis, Emile A. Bacha, Elizabeth H. Stephens, Jennifer C. Romano, Joseph A. Dearani, James S. Tweddell, Carl L. Backer, and David M. Overman
- Subjects
Prioritization ,Heart Defects, Congenital ,Telemedicine ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,education ,Pneumonia, Viral ,Specialty ,030204 cardiovascular system & hematology ,Patient care ,Article ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,Health care ,Pandemic ,medicine ,Humans ,030212 general & internal medicine ,congenital cardiac surgery ,crisis management ,Pandemics ,business.industry ,SARS-CoV-2 ,COVID-19 ,General Medicine ,Recovery of Function ,Surgery ,New normal ,Pediatrics, Perinatology and Child Health ,Cardiology and Cardiovascular Medicine ,business ,Coronavirus Infections - Abstract
As recovery of congenital heart surgery programs begins during this COVID-19 pandemic, we review key considerations such as screening, protection of patients and health care workers (HCWs), case prioritization, barriers to reactivation, redesign of patient care teams, contribution of telemedicine, modification of trainees’ experiences, preparation for potential resurgence, and strategies to maintain HCW wellness. COVID-19 has tested the resolve and grit of our specialty and we have an opportunity to emerge more refined.
- Published
- 2020
37. Extracorporeal Membrane Oxygenation in the Treatment of Severe Pulmonary and Cardiac Compromise in Coronavirus Disease 2019: Experience with 32 Patients
- Author
-
Keshava Rajagopal, Tom Coley, Jeffrey P. Jacobs, Eric A. Tesdahl, Vinay Badhwar, James D. St. Louis, Alfred H. Stammers, J.W. Awori Hayanga, Marvin J. Slepian, Anthony K. Sestokas, Faisal H. Cheema, Michael S. Firstenberg, and Linda B. Mongero
- Subjects
pulmonary failure ,medicine.medical_specialty ,ARDS ,Coronavirus disease 2019 (COVID-19) ,medicine.medical_treatment ,coronavirus ,Biomedical Engineering ,Biophysics ,heart failure ,Bioengineering ,030204 cardiovascular system & hematology ,outcomes ,Biomaterials ,coronavirus disease 2019 ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Tocilizumab ,Patient experience ,medicine ,Extracorporeal membrane oxygenation ,Management of COVID-19 Patients ,business.industry ,Hydroxychloroquine ,General Medicine ,extracorporeal membrane oxygenation ,acute respiratory distress syndrome ,medicine.disease ,Sarilumab ,surgical procedures, operative ,030228 respiratory system ,chemistry ,quality ,Adult Circulatory Support ,Heart failure ,Emergency medicine ,business ,medicine.drug - Abstract
As coronavirus disease 2019 (COVID-19) cases surge worldwide, an urgent need exists to enhance our understanding of the role of extracorporeal membrane oxygenation (ECMO) in the management of severely ill patients with COVID-19 who develop acute respiratory and cardiac compromise refractory to conventional therapy. The purpose of this manuscript is to review our initial clinical experience in 32 patients with confirmed COVID-19 treated with ECMO. A multi-institutional registry and database was created and utilized to assess all patients who were supported with ECMO provided by SpecialtyCare. Data captured included patient characteristics, pre-COVID-19 risk factors and comorbidities, confirmation of COVID-19 diagnosis, features of ECMO support, specific medications utilized to treat COVID-19, and short-term outcomes through hospital discharge. This analysis includes all of our patients with COVID-19 supported with ECMO, with an analytic window starting March 17, 2020, when our first COVID-19 patient was placed on ECMO, and ending April 9, 2020. During the 24 days of this study, 32 consecutive patients with COVID-19 were placed on ECMO at nine different hospitals. As of the time of analysis, 17 remain on ECMO, 10 died before or shortly after decannulation, and five are alive and extubated after removal from ECMO, with one of these five discharged from the hospital. Adjunctive medication in the surviving patients while on ECMO was as follows: four of five survivors received intravenous steroids, three of five survivors received antiviral medications (Remdesivir), two of five survivors were treated with anti-interleukin-6-receptor monoclonal antibodies (Tocilizumab or Sarilumab), and one of five survivors received hydroxychloroquine. Analysis of these 32 COVID-19 patients with severe pulmonary compromise supported with ECMO suggests that ECMO may play a useful role in salvaging select critically ill patients with COVID-19. Additional patient experience and associated clinical and laboratory data must be obtained to further define the optimal role of ECMO in patients with COVID-19 and acute respiratory distress syndrome (ARDS). These initial data may provide useful information to help define the best strategies to care for these challenging patients and may also provide a framework for much-needed future research about the use of ECMO to treat patients with COVID-19.
- Published
- 2020
- Full Text
- View/download PDF
38. Commentary: Running the Bypass Route: What Does Neonatal ECMO Have to Offer?
- Author
-
Edo K.S. Bedzra and James D. St. Louis
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Extracorporeal Membrane Oxygenation ,business.industry ,medicine.medical_treatment ,medicine ,MEDLINE ,Extracorporeal membrane oxygenation ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2020
39. La base de datos mundial de cirugía cardíaca pediátrica y congénita: una colaboración con el Registro Nacional de Cirugía Cardíaca Pediátrica (RENACCAPE)
- Author
-
James E. O’BrienJr., Nestor Sandoval, Jeffery P. Jacobs, Alejandro Bolio-Cerdán, Jorge Cervantes-Salazar, Hiromi Kurosawa, James D. St. Louis, Christo I. Tchervenkov, Alexis Palacios-Macedo, James K. Kirklin, and Richard A. Jonas
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2019
40. The world database for pediatric and congenital heart surgery: A collaboration with the Registro Nacional de Cirugía Cardiaca Pediátrica
- Author
-
Jeffery P. Jacobs, James E. O'Brien, Hiromi Kurosawa, Christo I. Tchervenkov, Nestor Sandoval, Alejandro Bolio-Cerdán, Alexis Palacios-Macedo, Richard A. Jonas, Jorge Cervantes-Salazar, James D St-Louis, and James K. Kirklin
- Subjects
Heart Defects, Congenital ,medicine.medical_specialty ,Internationality ,Heart disease ,Databases, Factual ,Heart Diseases ,computer.software_genre ,03 medical and health sciences ,0302 clinical medicine ,Cardiopatia congenita ,medicine ,Humans ,030212 general & internal medicine ,Registries ,Cardiac Surgical Procedures ,Child ,Mexico ,Database ,business.industry ,General Medicine ,medicine.disease ,Cardiac surgery ,Surgery ,030228 respiratory system ,National registry ,business ,computer - Abstract
Following the notable work accomplished by the Mexican Association of Specialists in Congenital Heart Disease (Asociación Mexicana de Especialistas en Cardiopatías Congénitas) with the development of a national registry for congenital cardiac surgery, the World Society for Pediatric and Congenital Heart Surgery has implemented an international platform to collect data and analyze outcomes of children with congenital heart disease.This manuscript proposes a possible collaboration between Mexico's national congenital cardiac database (Registro Nacional de Cirugía Cardíaca Pediátrica) and the World Database for Pediatric and Congenital Heart Surgery.Such a partnership would advance the countries' desire for the ongoing development of quality improvement processes and improve the overall treatment of children with congenital heart disease.Siguiendo el notable trabajo realizado por la Asociación Mexicana de Especialistas en Cardiopatías Congénitas (Asociación Mexicana de Especialistas en Cardiopatías Congénitas: AMECC) con el desarrollo de un registro nacional para la cirugía cardíaca congénita, la Sociedad Mundial de Pediatría y Cirugía Cardíaca Congénita ha implementado una plataforma internacional para recopilar datos y analizar los resultados de los niños con cardiopatía congénita.Este manuscrito propone una posible colaboración entre la base nacional de datos cardiacos congénitos de México (RENACCAPE) y la Base de Datos Mundial para la Cirugía Cardíaca Pediátrica y Congénita (WDPCHS).Esta asociación promovería el deseo de los países de seguir desarrollando procesos de mejora de la calidad y mejorar el tratamiento general de los niños con cardiopatía congénita.
- Published
- 2019
41. Outcomes after surgical coronary artery revascularisation in children with congenital heart disease
- Author
-
Kalpana Thammineni, Michael Kelleman, James H. Moller, Jeremiah S Menk, Jeffrey M. Vinocur, James D. St. Louis, Lazaros Kochilas, Brian A. Harvey, Amanda S. Thomas, and Anna-Maria Korakiti
- Subjects
Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Adolescent ,Heart disease ,Bypass grafting ,Psychological intervention ,Long Term Adverse Effects ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Myocardial Revascularization ,medicine ,Hospital discharge ,Humans ,Hospital Mortality ,Registries ,Coronary revascularisation ,Survival analysis ,Retrospective Studies ,business.industry ,Infant, Newborn ,Retrospective cohort study ,medicine.disease ,Survival Analysis ,United States ,Surgery ,Outcome and Process Assessment, Health Care ,medicine.anatomical_structure ,030228 respiratory system ,Child, Preschool ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Artery - Abstract
ObjectiveSurgical coronary revascularisation in children with congenital heart disease (CHD) is a rare event for which limited information is available. In this study, we review the indications and outcomes of surgical coronary revascularisation from the Pediatric Cardiac Care Consortium, a large US-based multicentre registry of interventions for CHD.MethodsThis is a retrospective cohort study of children (ResultsCoronary revascularisation was accomplished by bypass grafting (n=72, median age 6.8 years, range 3 days–17.4 years) or other operations (n=65, median age 2.6 years, range 5 days–16.7 years) in 137 patients. Most revascularisations were related to the aortic root (61.3%) or coronary anomalies (27.7%), but 10.9% of them were unrelated to either of them. Twenty in-hospital deaths occurred, 70% of them after urgent ‘rescue’ revascularisation in association with another operation. Long-term outcomes were available by external linkage for 54 patients surviving to hospital discharge (median follow-up time 15.0 years, max follow-up 29.8 years) with a 15-year transplant-free survival of 91% (95% CI 83% to 99%).ConclusionsSurgical coronary revascularisation can be performed in children with CHD with acceptable immediate and long-term survival. Outcomes are dependent on indication, with the highest mortality in rescue procedures.
- Published
- 2018
42. The World Database for Pediatric and Congenital Heart Surgery: Use of an International Congenital Database in South Korea
- Author
-
Sakamoto Kisaburo, Hiromi Kurosawa, James K. Kirklin, James D. St. Louis, Christo I. Tchervenkov, Richard A. Jonas, Jeffery P. Jacobs, and Cheul Lee
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,lcsh:Surgery ,MEDLINE ,lcsh:RD1-811 ,030204 cardiovascular system & hematology ,Brief Communication ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Published
- 2018
43. Second annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) report: Pre-implant characteristics and outcomes
- Author
-
Pedimacs Investigators, Christina VanderPluym, David N. Rosenthal, Joseph W. Rossano, Elizabeth D. Blume, J. Timothy Baldwin, Marissa A. Miller, James K. Kirklin, David L.S. Morales, Ryan S. Cantor, James D. St. Louis, Pirooz Eghtesady, Angela Lorts, Devin Koehl, and David L Sutcliffe
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,Heart disease ,medicine.medical_treatment ,Population ,Cardiomyopathy ,Annual Reports as Topic ,030204 cardiovascular system & hematology ,law.invention ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,law ,Interquartile range ,Artificial heart ,medicine ,Humans ,Registries ,Child ,education ,Heart Failure ,Heart transplantation ,Transplantation ,education.field_of_study ,business.industry ,Infant ,medicine.disease ,United States ,Treatment Outcome ,030228 respiratory system ,Child, Preschool ,Ventricular assist device ,Preoperative Period ,Female ,Surgery ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Expanded use of pediatric ventricular assist devices (VADs) has decreased mortality in children awaiting heart transplantation. Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs), a National Heart, Lung, and Blood Institute–sponsored North American database, provides a platform to understand this emerging population. Methods Between September 2012 and September 2016, patients aged younger than 19 years who underwent VAD implantation were enrolled in Pedimacs. FDA approved durable devices as well as temporary support devices were included. The second annual report updates the current Pedimacs data. Patients implanted with temporary devices are included in Pedimacs and this analysis includes this group of paracorporeal continuous flow VADs. Results Over the 4 years, 42 hospitals implanted 432 devices in 364 patients less than 19 yrs of age. Diagnoses included cardiomyopathy in 223 (61%), myocarditis in 41 (11%), and congenital heart disease in 77 (21%), of which 48 had single-ventricle physiology. At implant, 87% were at Intermacs patient profile 1 or 2. The age distribution of children (59% male) supported on VAD included 69 (19%) aged younger than 1 year, 66 (18%) aged 1 to 6 years, 56 (15%) aged 6 to 10 years, and 173 (48%) aged 11 to 19 years. Median follow-up was 2.2 months (range, 1 day to 41.5 months). Median (interquartile) age at implant was 1.7 (0.3–10.0) years for paracorporeal continuous-flow pumps ( n = 60), 1.7 (0.4–5.3) years for paracorporeal pulsatile pumps ( n = 105), and 15.0 (11.3–16.9) years for implantable continuous-flow pumps ( n = 174). Support strategies included LVAD in 293 (80%), biventricular device in 55 (15%), and total artificial heart in 8 (2%). Nearly 50% of patients underwent transplantation within 6 months, with overall mortality of 19%. Adverse event burden continues to be high. Conclusions Pedimacs constitutes the largest longitudinal pediatric VAD registry. Preimplant data across centers will be helpful at creating shared protocols with which to improve outcomes. Adverse events continue to be the major challenge, especially among the young critically ill children with complex congenital disease.
- Published
- 2018
44. History of the World Society for Pediatric and Congenital Heart Surgery: The First Decade
- Author
-
Carl L. Backer, Sertac Cicek, Jorge Cervantes, Hiromi Kurosawa, Nestor Sandoval, José Fragata, Jinfen Liu, Bohdan Maruszewski, Tjark Ebels, Richard A. Jonas, Constantine Mavroudis, Joseph A. Dearani, James K. Kirklin, Giovanni Stellin, Zohair Al-Halees, Jeffrey P. Jacobs, James D. St. Louis, Christian Kreutzer, George E. Sarris, Christo I. Tchervenkov, Robin H. Kinsley, Krishna S Iyer, Marcelo B. Jatene, Frank Edwin, Kirsten Finucane, and Cardiothoracic Surgery
- Subjects
Heart Defects, Congenital ,Quality of life ,medicine.medical_specialty ,Canada ,History ,Heart disease ,media_common.quotation_subject ,Thorax surgery ,education ,Heart defect ,Community service ,QUALIDADE DE VIDA ,030204 cardiovascular system & hematology ,Pediatrics ,History, 21st Century ,Professional affairs ,03 medical and health sciences ,Congenital ,0302 clinical medicine ,Quality of life (healthcare) ,Excellence ,Medical ,Medicine ,Humans ,Cardiac Surgical Procedures ,Societies, Medical ,media_common ,Heart Defects ,business.industry ,Surgical care ,Thoracic Surgery ,General Medicine ,medicine.disease ,Congenital heart malformation ,Surgery ,Heart surgery ,Medical society ,030228 respiratory system ,Cardiothoracic surgery ,Pediatrics, Perinatology and Child Health ,Professional association ,Cardiology and Cardiovascular Medicine ,business ,Societies ,Database (all types) ,Human - Abstract
The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) is the largest professional organization in the world dedicated to pediatric and congenital heart surgery. The purpose of this article is to document the first decade of the history of WSPCHS from its formation in 2006, to summarize the current status of WSPCHS, and to consider the future of WSPCHS. The WSPCHS was incorporated in Canada on April 7, 2011, with a head office in Montreal, Canada. The vision of the WSPCHS is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The mission of the WSPCHS is to promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient’s economic means, with an emphasis on excellence in teaching, research, and community service.
- Published
- 2018
45. Long-Term Transplant-Free Survival After Repair of Total Anomalous Pulmonary Venous Connection
- Author
-
Jeffrey M. Vinocur, Logan G. Spector, Hayley S. Hancock, Matthew E. Oster, James H. Moller, Jeremiah S Menk, Brian A. Harvey, Courtney McCracken, Lazaros Kochilas, Elizabeth M. Turk, and James D. St. Louis
- Subjects
Pulmonary and Respiratory Medicine ,Heart transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Hazard ratio ,030204 cardiovascular system & hematology ,National Death Index ,Article ,Surgery ,Transplantation ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Interquartile range ,Risk of mortality ,Medicine ,Risk factor ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Background Long-term survival, risk of transplantation, and causes of death after repair of total anomalous pulmonary venous connection (TAPVC) remain unknown. By linking the Pediatric Cardiac Care Consortium with the National Death Index and the United Network for Organ Sharing, we evaluated long-term transplant-free survival in children undergoing repair of TAPVC. Methods We identified 777 infants within the Pediatric Cardiac Care Consortium who underwent TAPVC repair (median 21 days; interquartile range, 5 to 80) and had sufficient personal identifiers for linkage with the National Death Index and United Network for Organ Sharing. Sixty-six deaths, ten cardiac transplantations, and one bilateral lung transplantation had occurred by the end of 2014. Data collected included age and weight at time of procedure, TAPVC type, associated cardiac lesions, and postoperative length of stay. The study cohort was divided into simple and complex TAPVC based on the presence of an associated cardiac lesion. Parametric survival plots were constructed, and risk factor analyses were performed to identify demographic and clinical characteristics associated with long-term outcomes. Results Mortality or need for transplantation was 9.7% with a median follow-up of 18.4 years and a median age of death or transplant of 0.74 years. The risk of mortality and transplant after TAPVC repair was highest during the first 18 months after hospital discharge. Cardiac causes accounted for the majority of deaths. Multivariate regression models for transplant-free survival demonstrated that complex TAPVC, mixed TAPVC, and postoperative length of stay were associated with increased risk of death/transplant. Conclusions Transplant-free survival after TAPVC repair is excellent, with most deaths or transplant events occurring early. Factors associated with the worst long-term outcomes included complex TAPVC, mixed TAPVC, and prolonged postoperative length of stay.
- Published
- 2018
46. International quality improvement initiatives
- Author
-
Nestor Sandoval, Jean A. Connor, George E. Sarris, Jeffery P. Jacobs, Giovanni Stellin, Michael G. Gaies, David F. Vener, Kaitlin Doherty, Sara K. Pasquali, Sarah Tabbutt, Hiromi Kurosawa, James D. St. Louis, James K. Kirklin, Kathy J. Jenkins, Kotturathu Mammen Cherian, Christo I. Tchervenkov, Richard A. Jonas, Haibo Zhang, Rajnish Garg, and Patricia A. Hickey
- Subjects
Heart Defects, Congenital ,Patient Care Team ,Quality management ,Primary Health Care ,business.industry ,Globe ,Collaborative learning ,Cardiovascular care ,General Medicine ,030204 cardiovascular system & hematology ,Public relations ,Quality Improvement ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Data transparency ,Pediatrics, Perinatology and Child Health ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Cooperative Behavior ,Cardiology and Cardiovascular Medicine ,business - Abstract
Across the globe, the implementation of quality improvement science and collaborative learning has positively affected the care and outcomes for children born with CHD. These efforts have advanced the collective expertise and performance of inter-professional healthcare teams. In this review, we highlight selected quality improvement initiatives and strategies impacting the field of cardiovascular care and describe implications for future practice and research. The continued leveraging of technology, commitment to data transparency, focus on team-based practice, and recognition of cultural norms and preferences ensure the success of sustainable models of global collaboration.
- Published
- 2017
47. LONG-TERM TRANSPLANT-FREE SURVIVAL AFTER CONGENITAL HEART SURGERY
- Author
-
Chao Zhang, Alvaro Alonso, Amanda S. Thomas, J'Neka S. Claxton, James H. Moller, James D. St. Louis, Courtney McCracken, Fawwaz R Shaw, Yijian Huang, Lazaros Kochilas, and Logan G. Spector
- Subjects
Transplant free survival ,medicine.medical_specialty ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Term (time) ,Surgery - Published
- 2021
48. Type IV Total Anomalous Pulmonary Venous Connection
- Author
-
James D. St. Louis, Elizabeth M. Turk, Jeffrey P. Jacobs, and James E. O'Brien
- Subjects
medicine.medical_specialty ,business.industry ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Cardiology ,Total anomalous pulmonary venous connection ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Mortality associated with correction of type IV total anomalous pulmonary venous connection (TAPVC) is generally reported in combination with other anatomic types. The objective of this study is to review surgical outcomes associated with the repair of type IV TAPVC by analyzing a multi-institutional cohort specific for this group. We also analyze patient-specific variables that may contribute to poor operative outcomes. Methods: A retrospective review of the Pediatric Cardiac Care Consortium (PCCC) registry identified patients who underwent repair of type IV TAPVC between 1982 and 2007. Variables reviewed included gender, prematurity, age at repair, anatomic pattern, presence of obstruction, associated anomalies, and operative mortality. Subclassifications were defined as type IV A (2+2 pattern), type IV B (3+1 pattern), and type IV C (bizarre). Results: Of the 2,248 patients with the diagnosis of TAPVC, 215 belonged to type IV. For type IV, the overall unadjusted mortality was 26%. There was no difference in mortality based on the particular anatomic drainage pattern. Twenty-eight percent had partial obstruction of the pulmonary venous return, with no patient having complete obstruction. Patients with obstruction had a significantly greater mortality than those without obstruction (39% vs 20%, P = .005). Approximately 16% of patients who present with obstruction of some pulmonary vein(s) underwent an emergency repair. Conclusion: Type IV TAPVC is a rare disease with a diverse anatomic presentation. Even though a small number of the patients with obstruction underwent emergent repair, mortality remained significant. This likely represents the intrinsic lung pathology that must be considered in the postoperative period.
- Published
- 2017
49. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2017 Update on Outcomes and Quality
- Author
-
Sean M. O'Brien, James S. Tweddell, Hal Walters, Jane M. Han, David M. Overman, Sara K. Pasquali, Christian Pizarro, Richard L. Prager, Jeffrey P. Jacobs, Martin J. Elliott, James D. St. Louis, Christo I. Tchervenkov, John E. Mayer, Erle H. Austin, Susan Becker, Carl L. Backer, Charles D. Fraser, Richard A. Jonas, Constantine Mavroudis, Donna McDonald, Marshall L. Jacobs, David M. Shahian, François Lacour-Gayet, Tara Karamlou, Kevin D. Hill, and Jennifer C. Hirsch-Romano
- Subjects
Heart Defects, Congenital ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Databases, Factual ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,computer.software_genre ,Subspecialty ,Truncus arteriosus ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,medicine ,Humans ,Cardiac Surgical Procedures ,Quality of Health Care ,Tetralogy of Fallot ,Database ,business.industry ,Operative mortality ,medicine.disease ,United States ,Surgery ,Cardiac surgery ,Treatment Outcome ,030228 respiratory system ,Atrioventricular canal ,Norwood procedure ,Cardiology and Cardiovascular Medicine ,business ,computer - Abstract
The Society of Thoracic Surgeons Congenital Heart Surgery Database is the largest congenital and pediatric cardiac surgical clinical data registry in the world. It is the platform for all activities of The Society of Thoracic Surgeons related to the analysis of outcomes and the improvement of quality in this subspecialty. This report summarizes current aggregate national outcomes in congenital and pediatric cardiac surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency. The reported data about aggregate national outcomes are exemplified by an analysis of 10 benchmark operations performed from January 2012 to December 2015. This analysis documents the overall aggregate operative mortality (interquartile range among all participating programs) for the following procedural groups: off-bypass coarctation repair, 1.3% (0.0% to 1.8%); ventricular septal defect repair, 0.6% (0.0% to 0.9%); tetralogy of Fallot repair, 1.1% (0.0% to 1.4%); complete atrioventricular canal repair, 3.0% (0.0% to 4.7%); arterial switch operation, 2.7% (0.0% to 4.1%); arterial switch operation and ventricular septal defect repair, 5.3% (0.0% to 6.7%); Glenn/hemi-Fontan, 2.5% (0.0% to 4.5%); Fontan operation, 1.2% (0.0% to 1.2%); truncus arteriosus repair, 9.4% (0.0% to 16.7%); and Norwood procedure, 15.7% (8.9% to 25.0%).
- Published
- 2017
50. Commentary: Humanitarian outreach—Providing resources and measuring quality
- Author
-
Jeffrey P. Jacobs, Frank G. Scholl, and James D. St. Louis
- Subjects
Pulmonary and Respiratory Medicine ,Outreach ,Medical education ,business.industry ,media_common.quotation_subject ,MEDLINE ,Medicine ,Surgery ,Quality (business) ,Cardiology and Cardiovascular Medicine ,business ,Altruism ,media_common - Published
- 2020
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.