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Pubblicazioni recenti - pediatric cardiac
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Mechanical Ventilation during ECMO: Lessons from Clinical Trials and Future Prospects.
Semin Respir Crit Care Med2022 Jun;():. doi: 10.1055/s-0042-1749450.
Fior Gabriele, Colon Zasha F Vazquez, Peek Giles J, Fraser John F,
Abstract
Acute Respiratory Distress Syndrome (ARDS) accounts for 10% of ICU admissions and affects 3 million patients each year. Despite decades of research, it is still associated with one of the highest mortality rates in the critically ill. Advances in supportive care, innovations in technologies and insights from recent clinical trials have contributed to improved outcomes and a renewed interest in the scope and use of Extracorporeal life support (ECLS) as a treatment for severe ARDS, including high flow veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO) and low flow Extracorporeal Carbon Dioxide Removal (ECCO2R). The rationale being that extracorporeal gas exchange allows the use of lung protective ventilator settings, thereby minimizing ventilator-induced lung injury (VILI). Ventilation strategies are adapted to the patient's condition during the different stages of ECMO support. Several areas in the management of mechanical ventilation in patients on ECMO, such as the best ventilator mode, extubation-decannulation sequence and tracheostomy timing, are tailored to the patients' recovery. Reduction in sedation allowing mobilization, nutrition and early rehabilitation are subsequent therapeutic goals after lung rest has been achieved.
Thieme. All rights reserved.
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The effect of gentle human touch on pain, comfort and physiological parameters in preterm infants during heel lancing.
Complement Ther Clin Pract2022 Jun;48():101622. doi: S1744-3881(22)00090-1.
Sezer Efe Ya?mur, Erdem Emine, Caner Nuray, Güne? Tamer,
Abstract
OBJECTIVE:
This research was conducted to evaluate the effects of gentle human touch (GHT) on pain, comfort, and physiologic parameters in preterm infants during heel lancing.
METHOD:
This prospective, assessor-blind, randomized controlled study was performed between August 10, 2021 and September 10, 2021 in the Neonatal Intensive Care Units (NICU) of a tertiary hospital in the Central Anatolia Region of Turkey. Fifty preterm infants were randomly appointed to GHT and control groups. The researcher applied GHT to the infants in the GHT group by placing one hand on the infant's head and the other hand on the lower abdomen covering the waist and hips for 15 min. Data were collected with a Questionnaire, Physiological Parameters Observation Form, Newborn Infant Pain Scale (NIPS), The Comfort Scale (COMFORT), and Pulse Oximeter.
RESULTS:
The NIPS and COMFORT mean scores of preterm infants in the GHT group were lower during (p 0.05). The study found that preterm infants in the GHT group had less crying time during the heel lancing (p
CONCLUSION:
It could recommend using in painful procedures because GHT may positively affect preterm infants' pain, comfort, and physiologic parameters. The results of this study will contribute to NICU nurses should include non-pharmacological methods such as GHT to decrease pain of preterm infants in procedural pain.
TRIAL REGISTRATION:
ClinicalTrials.gov (NCT05001191).
Copyright © 2022 Elsevier Ltd. All rights reserved.
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Effect of Nitric Oxide via Cardiopulmonary Bypass on Ventilator-Free Days in Young Children Undergoing Congenital Heart Disease Surgery: The NITRIC Randomized Clinical Trial.
JAMA2022 Jun;():. doi: 10.1001/jama.2022.9376.
Schlapbach Luregn J, Gibbons Kristen S, Horton Stephen B, Johnson Kerry, Long Debbie A, Buckley David H F, Erickson Simon, Festa Marino, d'Udekem Yves, Alphonso Nelson, Winlaw David S, Delzoppo Carmel, van Loon Kim, Jones Mark, Young Paul J, Butt Warwick, Schibler Andreas, ,
Abstract
Importance:
In children undergoing heart surgery, nitric oxide administered into the gas flow of the cardiopulmonary bypass oxygenator may reduce postoperative low cardiac output syndrome, leading to improved recovery and shorter duration of respiratory support. It remains uncertain whether nitric oxide administered into the cardiopulmonary bypass oxygenator improves ventilator-free days (days alive and free from mechanical ventilation).
Objective:
To determine the effect of nitric oxide applied into the cardiopulmonary bypass oxygenator vs standard care on ventilator-free days in children undergoing surgery for congenital heart disease.
Design, Setting, and Participants:
Double-blind, multicenter, randomized clinical trial in 6 pediatric cardiac surgical centers in Australia, New Zealand, and the Netherlands. A total of 1371 children younger than 2 years undergoing congenital heart surgery were randomized between July 2017 and April 2021, with 28-day follow-up of the last participant completed on May 24, 2021.
Interventions:
Patients were assigned to receive nitric oxide at 20 ppm delivered into the cardiopulmonary bypass oxygenator (n?=?679) or standard care cardiopulmonary bypass without nitric oxide (n?=?685).
Main Outcomes and Measures:
The primary end point was the number of ventilator-free days from commencement of bypass until day 28. There were 4 secondary end points including a composite of low cardiac output syndrome, extracorporeal life support, or death; length of stay in the intensive care unit; length of stay in the hospital; and postoperative troponin levels.
Results:
Among 1371 patients who were randomized (mean [SD] age, 21.2 [23.5] weeks; 587 girls [42.8%]), 1364 (99.5%) completed the trial. The number of ventilator-free days did not differ significantly between the nitric oxide and standard care groups, with a median of 26.6 days (IQR, 24.4 to 27.4) vs 26.4 days (IQR, 24.0 to 27.2), respectively, for an absolute difference of -0.01 days (95% CI, -0.25 to 0.22; P?=?.92). A total of 22.5% of the nitric oxide group and 20.9% of the standard care group developed low cardiac output syndrome within 48 hours, needed extracorporeal support within 48 hours, or died by day 28, for an adjusted odds ratio of 1.12 (95% CI, 0.85 to 1.47). Other secondary outcomes were not significantly different between the groups.
Conclusions and Relevance:
In children younger than 2 years undergoing cardiopulmonary bypass surgery for congenital heart disease, the use of nitric oxide via cardiopulmonary bypass did not significantly affect the number of ventilator-free days. These findings do not support the use of nitric oxide delivered into the cardiopulmonary bypass oxygenator during heart surgery.
Trial Registration:
anzctr.org.au Identifier: ACTRN12617000821392.
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LINC01013 Is a Determinant of Fibroblast Activation and Encodes a Novel Fibroblast-Activating Micropeptide.
J Cardiovasc Transl Res2022 Jun;():. doi: 10.1007/s12265-022-10288-z.
Quaife N M, Chothani S, Schulz J F, Lindberg E L, Vanezis K, Adami E, O'Fee K, Greiner J, Litvi?uková M, van Heesch S, Whiffin N, Hubner N, Schafer S, Rackham O, Cook S A, Barton P J R,
Abstract
Myocardial fibrosis confers an almost threefold mortality risk in heart disease. There are no prognostic therapies and novel therapeutic targets are needed. Many thousands of unannotated small open reading frames (smORFs) have been identified across the genome with potential to produce micropeptides (100 amino acids). We sought to investigate the role of smORFs in myocardial fibroblast activation.Analysis of human cardiac atrial fibroblasts (HCFs) stimulated with profibrotic TGF?1 using RNA sequencing (RNA-Seq) and ribosome profiling (Ribo-Seq) identified long intergenic non-coding RNA LINC01013 as TGF?1 responsive and containing an actively translated smORF. Knockdown of LINC01013 using siRNA reduced expression of profibrotic markers at baseline and blunted their response to TGF?1. In contrast, overexpression of a codon-optimised smORF invoked a profibrotic response comparable to that seen with TGF?1 treatment, whilst FLAG-tagged peptide associated with the mitochondria.Together, these data support a novel LINC01013 smORF micropeptide-mediated mechanism of fibroblast activation.
© 2022. The Author(s).
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Emergence of heartbeat frailty in advanced age I: perspectives from life-long EKG recordings in adult mice.
Geroscience2022 Jun;():. doi: 10.1007/s11357-022-00605-4.
Moen Jack M, Morrell Christopher H, Matt Michael G, Ahmet Ismayil, Tagirova Syevda, Davoodi Moran, Petr Michael, Charles Shaquille, de Cabo Rafael, Yaniv Yael, Lakatta Edward G,
Abstract
The combined influences of sinoatrial nodal (SAN) pacemaker cell automaticity and its response to autonomic input determine the heart's beating interval variability and mean beating rate. To determine the intrinsic SAN and autonomic signatures buried within EKG RR interval time series change in advanced age, we measured RR interval variability before and during double autonomic blockade at 3-month intervals from 6 months of age until the end of life in long-lived (those that achieved the total cohort median life span of 24 months and beyond) C57/BL6 mice. Prior to 21 months of age, time-dependent changes in intrinsic RR interval variability and mean RR interval were relatively minor. Between 21 and 30 months of age, however, marked changes emerged in intrinsic SAN RR interval variability signatures, pointing to a reduction in the kinetics of pacemaker clock mechanisms, leading to reduced synchronization of molecular functions within and among SAN cells. This loss of high-frequency signal processing within intrinsic SAN signatures resulted in a marked increase in the mean intrinsic RR interval. The impact of autonomic signatures on RR interval variability were net sympathetic and partially compensated for the reduced kinetics of the intrinsic SAN RR interval variability signatures, and partially, but not completely, shifted the EKG RR time series intervals to a more youthful pattern. Cross-sectional analyses of other subsets of C57/BL6 ages indicated that at or beyond the median life span of our longitudinal cohort, noncardiac, constitutional, whole-body frailty was increased, energetic efficiency was reduced, and the respiratory exchange ratio increased. We interpret the progressive reduction in kinetics in intrinsic SAN RR interval variability signatures in this context of whole-body frailty beyond 21 months of age to be a manifestation of "heartbeat frailty."
© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
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Benefits of BNP/NT-proBNP serum level evaluation for dry weight adjustment in pediatric hemodialysis patients.
Pediatr Nephrol2022 Jun;():. doi: 10.1007/s00467-022-05658-3.
Mouche Antoine, Parmentier Cyrielle, Fendri Fatma, Herbez-Rea Claire, Couderc Anne, Dehoux Laurène, Avramescu Marina, Kwon Theresa, Hogan Julien, Delbet Jean-Daniel, Ulinski Tim,
Abstract
BACKGROUND:
Dry weight (DW) adjustment in children on hemodialysis (HD) can be challenging. It relies on clinical evaluation and additional supports. Our aim was to study the benefits of cardiac biomarker assessment, in addition to the more commonly used technique, bioimpedance spectroscopy (BIS), and clinical signs for DW prescription in pediatric HD patients.
METHOD:
Observational study including 41 children on HD in three pediatric HD centers in the Paris region. During one session, BIS was performed before the session and serum levels of BNP and NT-proBNP were analyzed before and after the session.
RESULTS:
Median pre-dialysis level of BNP was 87 ng/L [24-192] and NT-proBNP 968 ng/L [442-4828]. Cardiac biomarker levels showed positive correlation with the BIS hydration status evaluation (p?=?0.004). The most appropriate cutoff for pre-dialysis BNP to detect significant overhydration (OH) was 165 ng/L (sensitivity 0.67, specificity 0.84). Based on the BIS evaluation, only 32% of patients with high blood pressure (BP) had OH, whereas in the normal BP group, 33% had significant OH.
CONCLUSIONS:
DW prescription for children on HD should not only rely on clinical evaluation, particularly BP, but should also include additional helpful parameters. BIS is well-validated in children, but it has limitations in non-cooperative patients, and its cost can limit its use in some settings. Cardiac biomarkers, especially BNP, were well-correlated to hydration status evaluated by BIS, and thus could add valuable information for individual patient management and DW assessment. A higher resolution version of the Graphical abstract is available as Supplementary information.
© 2022. The Author(s), under exclusive licence to International Pediatric Nephrology Association.
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Comparison between the difficulty of laparoscopic limited liver resections of tumors located in Segment 7 vs. Segment 8: an international multicenter propensity-score matched study.
J Hepatobiliary Pancreat Sci2022 Jun;():. doi: 10.1002/jhbp.1210.
Efanov Mikhail, Salimgereeva Diana, Alikhanov Ruslan, Wu Andrew G R, Geller David, Cipriani Federica, Aghayan Davit L, Fretland Asmund Avdem, Sijberden Jasper, Belli Andrea, Marino Marco V, Mazzaferro Vincenzo, Chiow Adrian K H, Sucandy Iswanto, Ivanecz Arpad, Choi Sung-Hoon, Lee Jae Hoon, Prieto Mikel, Vivarelli Marco, Giuliante Felice, Ruzzenente Andrea, Yong Chee-Chine, Fondevila Constantino, Rotellar Fernando, Choi Gi-Hong, Robless Campos Ricardo, Wang Xiaoying, Sutcliffe Robert P, Pratschke Johann, Lai Eric, Chong Charing C, D'Hondt Mathieu, Monden Kazuteru, Lopez-Ben Santiago, Herman Paulo, Di Benedetto Fabrizio, Kingham T Peter, Liu Rong, Long Tran Cong Duy, Ferrero Alessandro, Levi Sandri Giovanni Battista, Cherqui Daniel, Scatton Olivier, Wakabayashi Go, Troisi Roberto I, Cheung Tan-To, Sugioka Atsushi, Han Ho-Seong, Abu Hilal Mohamed, Soubrane Olivier, Fuks David, Aldrighetti Luca, Edwin Bjorn, Goh Brian K P, ,
Abstract
BACKGROUND:
Presently, according to different difficulty scoring systems, there is no difference in complexity estimation of laparoscopic liver resection (LLR) of segments 7 and 8. However, there is no published data supporting this assumption. To date, no studies are comparing the outcomes of laparoscopic parenchyma-sparing resection of the liver segments 7 and 8.
METHODS:
A posthoc analysis of patients undergoing LLR of segments 7 and 8 in 46 centers between 2004 and 2020 was performed. 1:1 Propensity score matching (PSM) was used to compare isolated LLR of segments 7 and 8. Subset analyses were also performed to compare atypical resections and segmentectomies of 7 and 8.
RESULTS:
2411 patients were identified, and 1691 patients met the inclusion criteria. Comparison after PSM between the entire cohort of segment 7 and segment 8 resections revealed inferior results for segment 7 resection in terms of increased blood loss, blood transfusions, and conversions to open surgery. Subset analyses of only atypical resections similarly demonstrated poorer outcomes for segment 7 in terms of increased blood loss, operation time, blood transfusions, and conversions to open surgery. Conversely, a subgroup analysis of segmentectomies after PSM found better outcomes for segment 7 in terms of a shorter operation time and hospital stay.
CONCLUSION:
Differences in the outcomes of segments 7 and 8 resections suggest a greater difficulty of laparoscopic atypical resection of segment 7 compared to segment 8, and greater difficulty of segmentectomy 8 compared to segmentectomy 7.
This article is protected by copyright. All rights reserved.
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Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model.
J Vis Exp2022 Jun;(184):. doi: 10.3791/63661.
Hao Yimeng, Sun Xiaolin, Kiekenap Jonathan Frederik Sebastian, Emeis Jasper, Steitz Marvin, Breitenstein-Attach Alexander, Berger Felix, Schmitt Boris,
Abstract
Transcatheter pulmonary valve replacement has been established as a viable alternative approach for patients suffering from right ventricular outflow tract or bioprosthetic valve dysfunction, with excellent early and late clinical outcomes. However, clinical challenges such as stented heart valve deterioration, coronary occlusion, endocarditis, and other complications must be addressed for lifetime application, particularly in pediatric patients. To facilitate the development of a lifelong solution for patients, transcatheter autologous pulmonary valve replacement was performed in an adult sheep model. The autologous pericardium was harvested from the sheep via left anterolateral minithoracotomy under general anesthesia with ventilation. The pericardium was placed on a 3D shaping heart valve model for non-toxic cross-linking for 2 days and 21 h. Intracardiac echocardiography (ICE) and angiography were performed to assess the position, morphology, function, and dimensions of the native pulmonary valve (NPV). After trimming, the crosslinked pericardium was sewn onto a self-expandable Nitinol stent and crimped into a self-designed delivery system. The autologous pulmonary valve (APV) was implanted at the NPV position via left jugular vein catheterization. ICE and angiography were repeated to evaluate the position, morphology, function, and dimensions of the APV. An APV was successfully implanted in sheep J. In this paper, sheep J was selected to obtain representative results. A 30 mm APV with a Nitinol stent was accurately implanted at the NPV position without any significant hemodynamic change. There was no paravalvular leak, no new pulmonary valve insufficiency, or stented pulmonary valve migration. This study demonstrated the feasibility and safety, in a long-time follow-up, of developing an APV for implantation at the NPV position with a self-expandable Nitinol stent via jugular vein catheterization in an adult sheep model.
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Single-stage off-pump repair of coarctation of the aorta and ventricular septal defects in children.
Interact Cardiovasc Thorac Surg2022 Jun;():. doi: ivac186.
Kulyabin Yuriy Y, Voitov Alexey V, Nichay Nataliya R, Soynov Ilya A, Zubritskiy Alexey V, Bogachev-Prokophiev Alexander V,
Abstract
OBJECTIVES:
The appropriate approach for surgical repair of coarctation of the aorta with ventricular septal defect remains controversial. This study evaluated the outcomes of primary repair of ventricular septal defects with perventricular device closure without cardiopulmonary bypass through left thoracotomy in patients without arch hypoplasia.
METHODS:
We selected 21 patients aged
RESULTS:
The median occluder size was 6 (range, 5-8) mm. The median mechanical ventilation time was 14 (range, 2-68) h, and the median duration of hospital stay was 11 (range, 7-16) days. No reoperations were required to correct ventricular septal defect shunting, and the median residual shunt size was 1 (range, 1-2) mm. The median follow-up period was 13 (range, 4-31) months. No late mortality was reported, and no haemodynamically significant pressure gradient at the anastomotic site was observed. The median distal aortic arch z-score was 0.39 (range, -0.1 to 0.9). Only one patient underwent permanent pacemaker implantation towards the end of the follow-up.
CONCLUSIONS:
PVDC can be used safely for closure of VSD in children with CoAo without a hypoplastic aortic arch even in neonates to reduce the risk of prolonged CPB. This hybrid approach can be performed with low incidence of rhythm disturbances and residual shunting. However, a meticulous assessment of the VSD anatomy is essential to avoid any unfavorable events.
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): third Paediatric (Paedi-EUROMACS) report.
Eur J Cardiothorac Surg2022 Jun;():. doi: ezac355.
de By Theo M M H, Schweiger Martin, Hussain Hina, Amodeo Antonio, Martens Thomas, Bogers Ad J J C, Damman Kevin, Gollmnan-Tepeköylü Can, Hulman Michael, Iacovoni Attilio, Krämer Ulrike, Loforte Antonio, Napoleone Carlo Pace, N?mec Petr, Netuka Ivan, Özbaran Mustafa, Polo Luz, Pya Yuri, Ramjankhan Faiz, Sandica Eugen, Sliwka Joanna, Stiller Brigitte, Kadner Alexander, Franceschini Alessio, Thiruchelvam Timothy, Zimpfer Daniel, Meyns Bart, Berger Felix, Miera Oliver,
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Mesenchymal Stem Cell-derived Extracellular Vesicles Prevent Experimental Bronchopulmonary Dysplasia Complicated By Pulmonary Hypertension.
Stem Cells Transl Med2022 Jun;():. doi: szac041.
Sharma Mayank, Bellio Michael A, Benny Merline, Kulandavelu Shathiyah, Chen Pingping, Janjindamai Chawisa, Han Chenxu, Chang Liming, Sterling Shanique, Williams Kevin, Damianos Andreas, Batlahally Sunil, Kelly Kaitlyn, Aguilar-Caballero Daniela, Zambrano Ronald, Chen Shaoyi, Huang Jian, Wu Shu, Hare Joshua M, Schmidt Augusto, Khan Aisha, Young Karen,
Abstract
Mesenchymal stem cell (MSC) extracellular vesicles (EVs) have beneficial effects in preclinical bronchopulmonary dysplasia and pulmonary hypertension (BPD-PH) models. The optimal source, dosing, route, and duration of effects are however unknown. The objectives of this study were to (a) compare the efficacy of GMP-grade EVs obtained from Wharton's Jelly MSCs (WJ-MSCs) and bone marrow (BM-MSCs), (b) determine the optimal dosing and route of administration, (c) evaluate its long-term effects, and (d) determine how MSC EVs alter the lung transcriptome. Newborn rats exposed to normoxia or hyperoxia (85% O2) from postnatal day (P)1-P14 were given (a) intra-tracheal (IT) BM or WJ-MSC EVs or placebo, (b) varying doses of IT WJ-MSC EVs, or (c) IT or intravenous (IV) WJ-MSC EVs on P3. Rats were evaluated at P14 or 3 months. Early administration of IT BM-MSC or WJ-MSC EVs had similar beneficial effects on lung structure and PH in hyperoxia-exposed rats. WJ-MSC EVs however had superior effects on cardiac remodeling. Low, medium, and high dose WJ-MSC EVs had similar cardiopulmonary regenerative effects. IT and IV WJ-MSC EVs similarly improved vascular density and reduced PH in hyperoxic rats. Gene-set enrichment analysis of transcripts differentially expressed in WJ-MSC EV-treated rats showed that induced transcripts were associated with angiogenesis. Long-term studies demonstrated that a single early MSC EV dose has pulmonary vascular protective effects 3 months after administration. Together, our findings have significant translational implications as it provides critical insight into the optimal source, dosing, route, mechanisms of action, and duration of effects of MSC-EVs for BPD-PH.
© The Author(s) 2022. Published by Oxford University Press.
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Fish and human health: an umbrella review of observational studies.
Int J Food Sci Nutr2022 Jun;():1-10. doi: 10.1080/09637486.2022.2090520.
Jurek Joanna, Owczarek Marcin, Godos Justyna, La Vignera Sandro, Condorelli Rosita A, Marventano Stefano, Tieri Maria, Ghelfi Francesca, Titta Lucilla, Lafranconi Alessandra, Gambera Angelo, Alonzo Elena, Sciacca Salvatore, Buscemi Silvio, Ray Sumantra, Del Rio Daniele, Galvano Fabio, Grosso Giuseppe,
Abstract
Fish represents one of the most important dietary sources of omega-3 polyunsaturated fatty acids, which are known to be associated with various health benefits. This study aimed to systematically review existing meta-analyses of observational studies exploring the association between fish intake and various health outcomes. A systematic search of electronic databases was conducted to retrieve a total of 63 studies. Evidence was deemed as possible for the association between higher fish intake and decreased risk of the acute coronary syndrome, liver cancer, and depression, and limited for other outcomes (including age-related macular degeneration, Alzheimer's disease, heart failure, all-cause and coronary heart disease mortality, total and ischaemic stroke) due to heterogeneity between results and potential otherwise inexplicable confounding factors. In conclusion, results from epidemiological studies support the mechanistic effects associated with omega-3 fatty acids from high fish consumption, but evidence needs to be further corroborated with more reliable results.
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Neo-cusp Reconstruction Procedure for Aortic Regurgitation Induced by Transcatheter Occluder Device for Ventricular Septal Defect Closure.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):495-498. doi: 10.1177/21501351221104419.
Garekar Swati, Sheth Ronak, Mali Shivaji, Dhake Shyam, Mhatre Amit, Bind Dilip, Kandavel Dinesh, Soni Bharat, Malankar Dhananjay,
Abstract
Aortic regurgitation after transcatheter device closure of a perimembranous ventricular septal defect is a known complication. We present the case of an 11-year-old boy with severe aortic valve regurgitation due to cusp perforation complicating previous device closure of a ventricular septal defect. The patient underwent successful aortic valve repair (neo-cusp reconstruction technique) by replacement of a cusp and shaving off of a rim of the device 5 years after device closure.
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Ten Years of Data Verification: The European Congenital Heart Surgeons Association Congenital Database Audits.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):466-474. doi: 10.1177/21501351221103794.
Herbst Claudia, Tobota Zdzislaw, Urganci Erhan, Sarris George, Jacobs Jeffrey P, Kansy Andrzej, Maruszewski Bohdan,
Abstract
BACKGROUND:
Congenital heart surgery databases are tools for internal programmatic evaluation, benchmarking institutional results to multi-institutional aggregate data, and research. Therefore, it is essential to ensure the completeness and accuracy of data. This study analyzes the results of ten years of on-site source data verification of the European Congenital Heart Surgeons Association Congenital Heart Surgery Database (ECHSA CHSD).
METHODS:
All data forms verified between 2009 and 2018 were analyzed. The data form consists of 12 data elements: dates of birth, admission, surgery, discharge, and death; weight; case category; cardiopulmonary bypass time; aortic cross-clamp time; validation rules; diagnoses; and procedures. Descriptive data calculation and rates of completeness and accuracy were determined. The trend of error rate of seven centers with ?5 visits was analyzed.
RESULTS:
Sixty-nine on-site verification visits took place at 17 centers. A total of 26,245 cases were verified; 2,841 of these 26,245 cases (10.8%) showed an error. The total mean error rate of centers for all years was 12.3?±?2.1%. Rates of completeness and accuracy were 99% and 89.2%, respectively. Coded diagnoses and procedure analysis revealed that 716 (2.7%) and 456 (1.7%) datasets were incorrect, respectively. Rates of completeness and accuracy of dates were 100%, and 97.1%, respectively. Validation fields showed no errors.
CONCLUSION:
Source data verification is an appropriate tool to determine completeness and accuracy of data. The ECHSA CHSD verification analysis of a ten-year period showed a high level of completeness and accuracy. The verified data of the ECHSA CHSD are well-suited for benchmarking and research.
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Total Anomalous Pulmonary Venous Connection Repair: Single-Center Outcomes in a Lower-Middle Income Region.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):458-465. doi: 10.1177/21501351221103492.
Bayya Praveen Reddy, Varghese Shruti, Jayashankar Jessin Puliparambil, Sudhakar Abish, Balachandran Rakhi, Kottayil Brijesh Parayaru, Srimurugan Balaji, Varma Praveen Kerala, Neema Praveen Kumar, Krishna Kumar R,
Abstract
BACKGROUND:
The management of total anomalous pulmonary venous connection (TAPVC) in neonates and infants is resource-intensive. We describe early and follow-up outcomes after surgical repair of isolated TAPVC at a single institution in a resource-limited setting.
METHODS:
The data of 316 consecutive patients with isolated TAPVC undergoing repair (January 2010-September 2020) were reviewed. The study setting was a tertiary hospital in southern India that provides subsidized or charitable care. Standard surgical technique was used for repair, circulatory arrest was avoided, and suture-less anastomosis was reserved for small or stenotic pulmonary veins. Surgical and postoperative strategies were directed toward minimizing intensive care unit (ICU) stay.
RESULTS:
302 (95.6%) patients were infants and 128 patients (40.5%) were neonates; median weight was 3.3?kg (IQR 2.8-4.0?kg). Obstruction of the TAPVC was seen in 176 patients (56%) and pulmonary hypertension in 278 patients (88%). Seventeen (5.4%) underwent delayed sternal closure. The median postoperative ICU stay was 120?h (IQR 96-192?h), mechanical ventilation was 45?h (IQR 24-82?h), and hospital stay was 13 days (IQR 9-17 days). There were three in-hospital deaths (0.9%). Over a median follow-up period of 53.3 months (IQR 22.9-90.4), pulmonary vein restenosis was seen in 32 patients (10.1%) after a mean of 2.2 months (1-6 months). No perioperative risk factors for restenosis were identified.
CONCLUSIONS:
Using specific perioperative strategies, it is possible to correct TAPVC with excellent surgical outcomes in low-resource environments. Late pulmonary vein restenosis remains an important complication.
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Surgery for Anomalous Aortic Origin of a Coronary Artery (AAOCA) in Children and Adolescents: A Meta-Analysis.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):485-494. doi: 10.1177/21501351221095424.
Ponzoni Matteo, Frigo Anna C, Padalino Massimo A,
Abstract
We conducted a systematic review and meta-analysis of the literature to assess the outcomes of surgery for the anomalous aortic origin of a coronary artery in children and young adults (
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Fontan Palliation in Patients with Heterotaxy Syndrome: A Five Decade Experience.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):436-442. doi: 10.1177/21501351221099944.
Stephens Elizabeth H, Graham Gabriel, Dearani Joseph A, Niaz Talha, Cetta Frank,
Abstract
BACKGROUND:
Patients with heterotaxy syndromes (right and left atrial isomerism) are at high risk of poor outcomes after single-ventricle palliation. However, the long-term outcomes and specific parameters associated with poor outcomes are incompletely understood.
METHODS:
A retrospective review was performed of all patients with atrial isomerism who had a Fontan at our institution from 1973 to 2020. Standard demographic, as well as pre-, peri-, and postoperative parameters were collected. Features and outcomes of patients with polysplenia were compared to asplenia. Outcomes were analyzed for effect during 4 eras: (1: 1973-1984; n?=?27), (2: 1985-1994; n?=?93), (3: 1995-2004; n?=?28), and (4: 2005-2020; n?=?10).
RESULTS:
Of the 1176 patients who had a Fontan operation, 158 (14%) had a heterotaxy syndrome. The median age at the time of Fontan was 8 (9) years. Early mortality was 20% and was greater in patients with asplenia compared to polysplenia (27% vs. 12%, ?=?.019). But it substantially improved over time (61% in era 1 vs. 7%-10% in the more recent eras (?.001)), as did transplant-free survival (22% at 10 years in era 1 vs. 88% in era 4, ?.001). Transplant-free survival was significantly lower in patients with asplenia versus those with polysplenia (?=?.014), and patients with heterotaxy had lower survival than nonheterotaxy (?=?.01). This was largely due to the asplenia group (?.001) (hazard ratio?=?3.05, ?=?.007).
CONCLUSIONS:
After Fontan operation, patients with heterotaxy, particularly asplenia, continue to demonstrate worse transplant-free survival than nonheterotaxy patients. Early mortality and long-term transplant-free survival have improved in more recent eras.
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Invited Commentary: An Ounce of Prevention Is Worth a Pound of Cure: Advancing the Search for Modifiable Factors Associated With Cardiac Arrest.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):482-484. doi: 10.1177/21501351221102069.
Dhillon Gurpreet S, Lasa Javier J,
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Cardiac Arrest in Children Following Cardiac Surgery: A Scoping Review of Contributing Factors.
World J Pediatr Congenit Heart Surg2022 Jul;13(4):475-481. doi: 10.1177/21501351221100791.
Riley Christine M, Murphy Lee D, Mastropietro Christopher W,
Abstract
Nearly half of children experiencing cardiac arrest following cardiac surgery do not survive hospital discharge and patients who survive often experience significant neurological impairment. Additionally, increased resource utilization following cardiac arrest translates into adverse logistical and financial consequences. Although some studies have identified patient characteristics that increase the risk of cardiac arrest after pediatric cardiac surgery, modifiable risk factors, which could provide a foundation for effective prevention strategies, have been elusive. This scoping review explores the current knowledge surrounding risk factors associated with cardiac arrest in children following cardiac surgery and provides recommendations for future research.
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An Editor's Perspective and an Opportunity to Say "Thank You".
World J Pediatr Congenit Heart Surg
