Congenital cardiac surgery

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Recombinant Factor VIIa Is Associated With Increased Thrombotic Complications in Pediatric Cardiac Surgery Patients.

Jue, 03/23/2017 - 00:54
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Recombinant Factor VIIa Is Associated With Increased Thrombotic Complications in Pediatric Cardiac Surgery Patients.

Anesth Analg. 2017 Mar 17;:

Authors: Downey L, Brown ML, Faraoni D, Zurakowski D, DiNardo JA

Abstract
BACKGROUND: Recombinant factor VIIa (rFVIIa) is routinely used as an off-label hemostatic agent in children undergoing cardiac surgery. Despite evidence that rFVIIa use is associated with an increased incidence of thrombotic complications in adult cardiac surgery, the safety of rFVIIa as a rescue hemostatic agent in the pediatric cardiac surgical population is less definitively delineated. In this retrospective study, we used propensity score matching to compare the incidence of thrombotic complications between children treated with rFVIIa and their matched controls.
METHODS: We retrospectively reviewed medical records and pharmacy data from all neonates and children who underwent congenital cardiac surgery between May 1, 2011, and October 31, 2013, at Boston Children's Hospital, and identified those who received rFVIIa during the perioperative period. Using existing knowledge, we chose 10 factors associated with bleeding after cardiac surgery to be used in our propensity score: age, sex, body weight, neonates, prematurity, previous sternotomy, cardiopulmonary bypass time, deep hypothermic circulatory arrest time, aortic cross-clamp time, and the operative surgeon. We then used propensity-matched analysis to match children treated with rFVIIa with 2 controls. The primary outcome was thrombotic complications. Secondary outcomes included reexploration for bleeding, length of cardiac intensive care unit stay, length of hospital stay, and 30-day mortality.
RESULTS: One hundred forty-nine patients received perioperative rFVIIa during the study period. Propensity matching yielded 143 rFVIIa patients matched to 2 control patients each (n = 286). Three control patients were found to have received rFVIIa during the perioperative course and were removed from the analysis, for a total of 283 control patients. The administration of rFVIIa was associated with an increased incidence of thrombotic complications (20% vs 8%; odds ratio [OR]: 3.9 [95% confidence interval {CI}: 2.6-5.9], P < .001). Administration of rFVIIa was associated with a prolonged median length of cardiac intensive care unit stay (8 days [interquartile range {IQR}: 4-24] vs 5 days [IQR: 2-10], P < .001) and prolonged length of hospital stay (20 [IQR: 9-44] vs 11 days [IQR: 7-23], P < .001). No difference in reexploration for bleeding (rFVII = 14% vs controls = 9%; OR: 1.7 [95% CI, 0.92-3.1], P = .12) or 30-day mortality was observed (8% vs 6%; OR 1.3 [95% CI, 0.60-2.89], P = .51).
CONCLUSIONS: This retrospective analysis confirmed that perioperative administration of rFVIIa is associated with an increased incidence of postoperative thrombotic complications in neonates and children undergoing cardiac surgery, without increase in 30-day mortality. In conclusion, rFVIIa should be used with extreme caution in pediatric patients undergoing cardiac surgery.

PMID: 28319507 [PubMed - as supplied by publisher]

Categorías: Cirugía congénitos

The H3K27 demethylase, Utx, regulates adipogenesis in a differentiation stage-dependent manner.

Jue, 03/23/2017 - 00:54
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The H3K27 demethylase, Utx, regulates adipogenesis in a differentiation stage-dependent manner.

PLoS One. 2017;12(3):e0173713

Authors: Ota K, Tong KI, Goto K, Tomida S, Komuro A, Wang Z, Nishio K, Okada H

Abstract
Understanding the molecular mechanisms that drive adipogenesis is important in developing new treatments for obesity and diabetes. Epigenetic regulations determine the capacity of adipogenesis. In this study, we examined the role of a histone H3 lysine 27 demethylase, the ubiquitously transcribed tetratricopeptide repeat protein on the X chromosome (Utx), in the differentiation of mouse embryonic stem cells (mESCs) to adipocytes. Using gene trapping, we examined Utx-deficient male mESCs to determine whether loss of Utx would enhance or inhibit the differentiation of mESCs to adipocytes. Utx-deficient mESCs showed diminished potential to differentiate to adipocytes compared to that of controls. In contrast, Utx-deficient preadipocytes showed enhanced differentiation to adipocytes. Microarray analyses indicated that the β-catenin/c-Myc signaling pathway was differentially regulated in Utx-deficient cells during adipocyte differentiation. Therefore, our data suggest that Utx governs adipogenesis by regulating c-Myc in a differentiation stage-specific manner and that targeting the Utx signaling pathway could be beneficial for the treatment of obesity, diabetes, and congenital utx-deficiency disorders.

PMID: 28319137 [PubMed - in process]

Categorías: Cirugía congénitos

Incorporating Comorbidity Within Risk Adjustment for UK Pediatric Cardiac Surgery.

Jue, 03/23/2017 - 00:54
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Incorporating Comorbidity Within Risk Adjustment for UK Pediatric Cardiac Surgery.

Ann Thorac Surg. 2017 Mar 15;:

Authors: Brown KL, Rogers L, Barron DJ, Tsang V, Anderson D, Tibby S, Witter T, Stickley J, Crowe S, English K, Franklin RC, Pagel C

Abstract
BACKGROUND: When considering early survival rates after pediatric cardiac surgery it is essential to adjust for risk linked to case complexity. An important but previously less well understood component of case mix complexity is comorbidity.
METHODS: The National Congenital Heart Disease Audit data representing all pediatric cardiac surgery procedures undertaken in the United Kingdom and Ireland between 2009 and 2014 was used to develop and test groupings for comorbidity and additional non-procedure-based risk factors within a risk adjustment model for 30-day mortality. A mixture of expert consensus based opinion and empiric statistical analyses were used to define and test the new comorbidity groups.
RESULTS: The study dataset consisted of 21,838 pediatric cardiac surgical procedure episodes in 18,834 patients with 539 deaths (raw 30-day mortality rate, 2.5%). In addition to surgical procedure type, primary cardiac diagnosis, univentricular status, age, weight, procedure type (bypass, nonbypass, or hybrid), and era, the new risk factor groups of non-Down congenital anomalies, acquired comorbidities, increased severity of illness indicators (eg, preoperative mechanical ventilation or circulatory support) and additional cardiac risk factors (eg, heart muscle conditions and raised pulmonary arterial pressure) all independently increased the risk of operative mortality.
CONCLUSIONS: In an era of low mortality rates across a wide range of operations, non-procedure-based risk factors form a vital element of risk adjustment and their presence leads to wide variations in the predicted risk of a given operation.

PMID: 28318514 [PubMed - as supplied by publisher]

Categorías: Cirugía congénitos

Improving Risk Adjustment for Mortality After Pediatric Cardiac Surgery: The UK PRAiS2 Model.

Jue, 03/23/2017 - 00:54
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Improving Risk Adjustment for Mortality After Pediatric Cardiac Surgery: The UK PRAiS2 Model.

Ann Thorac Surg. 2017 Mar 15;:

Authors: Rogers L, Brown KL, Franklin RC, Ambler G, Anderson D, Barron DJ, Crowe S, English K, Stickley J, Tibby S, Tsang V, Utley M, Witter T, Pagel C

Abstract
BACKGROUND: Partial Risk Adjustment in Surgery (PRAiS), a risk model for 30-day mortality after children's heart surgery, has been used by the UK National Congenital Heart Disease Audit to report expected risk-adjusted survival since 2013. This study aimed to improve the model by incorporating additional comorbidity and diagnostic information.
METHODS: The model development dataset was all procedures performed between 2009 and 2014 in all UK and Ireland congenital cardiac centers. The outcome measure was death within each 30-day surgical episode. Model development followed an iterative process of clinical discussion and development and assessment of models using logistic regression under 25 × 5 cross-validation. Performance was measured using Akaike information criterion, the area under the receiver-operating characteristic curve (AUC), and calibration. The final model was assessed in an external 2014 to 2015 validation dataset.
RESULTS: The development dataset comprised 21,838 30-day surgical episodes, with 539 deaths (mortality, 2.5%). The validation dataset comprised 4,207 episodes, with 97 deaths (mortality, 2.3%). The updated risk model included 15 procedural, 11 diagnostic, and 4 comorbidity groupings, and nonlinear functions of age and weight. Performance under cross-validation was: median AUC of 0.83 (range, 0.82 to 0.83), median calibration slope and intercept of 0.92 (range, 0.64 to 1.25) and -0.23 (range, -1.08 to 0.85) respectively. In the validation dataset, the AUC was 0.86 (95% confidence interval [CI], 0.82 to 0.89), and the calibration slope and intercept were 1.01 (95% CI, 0.83 to 1.18) and 0.11 (95% CI, -0.45 to 0.67), respectively, showing excellent performance.
CONCLUSIONS: A more sophisticated PRAiS2 risk model for UK use was developed with additional comorbidity and diagnostic information, alongside age and weight as nonlinear variables.

PMID: 28318513 [PubMed - as supplied by publisher]

Categorías: Cirugía congénitos

School-related adjustment in children and adolescents with CHD.

Jue, 03/23/2017 - 00:54
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School-related adjustment in children and adolescents with CHD.

Cardiol Young. 2017 Mar 20;:1-7

Authors: Im YM, Lee S, Yun TJ, Choi JY

Abstract
Advancements in medical and surgical treatment have increased the life expectancy of patients with CHD. Many patients with CHD, however, struggle with the medical, psychosocial, and behavioural challenges as they transition from childhood to adulthood. Specifically, the environmental and lifestyle challenges in school are very important factors that affect children and adolescents with CHD. This study aimed to evaluate school-related adjustments depending on school level and disclosure of disease in children and adolescents with CHD. This was a descriptive and exploratory study with 205 children and adolescents, aged 7-18 years, who were recruited from two congenital heart clinics from 5 January to 27 February, 2015. Data were analysed using the Student's t-test, analysis of variance, and a univariate general linear model. School-related adjustment scores were significantly different according to school level and disclosure of disease (p<0.001) when age, religion, experience being bullied, and parents' educational levels were assigned as covariates. The school-related adjustment score of patients who did not disclose their disease dropped significantly in high school. This indicated that it is important for healthcare providers to plan developmentally appropriate educational transition programmes for middle-school students with CHD in order for students to prepare themselves before entering high school.

PMID: 28318457 [PubMed - as supplied by publisher]

Categorías: Cirugía congénitos

Simultaneous repair of Morgagni hernia and ventricular septal defect.

Jue, 03/23/2017 - 00:54
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Simultaneous repair of Morgagni hernia and ventricular septal defect.

Pediatr Int. 2017 Mar;59(3):367-368

Authors: Shimada M, Hoashi T, Tazuke Y, Kagisaki K, Ichikawa H

PMID: 28317299 [PubMed - in process]

Categorías: Cirugía congénitos

Surgical planning for a complex double-outlet right ventricle using 3D printing.

Jue, 03/23/2017 - 00:54
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Surgical planning for a complex double-outlet right ventricle using 3D printing.

Echocardiography. 2017 Mar 19;:

Authors: Bhatla P, Tretter JT, Chikkabyrappa S, Chakravarti S, Mosca RS

Abstract
Rapid prototyping may be beneficial in properly selected cases of complex congenital heart disease, providing detailed anatomical understanding that helps to guide potential surgical and cardiac catheterization interventions. We present a case of double-outlet right ventricle, where the decision to obtain a three-dimensional printed model helped for better understanding of the anatomy, with the additional advantage of surgical simulation in planning the surgical approach and type of surgical repair.

PMID: 28317159 [PubMed - as supplied by publisher]

Categorías: Cirugía congénitos

Total cavopulmonary connection with a new bioabsorbable vascular graft: First clinical experience.

Jue, 03/23/2017 - 00:54
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Total cavopulmonary connection with a new bioabsorbable vascular graft: First clinical experience.

J Thorac Cardiovasc Surg. 2017 Feb 07;:

Authors: Bockeria LA, Svanidze O, Kim A, Shatalov K, Makarenko V, Cox M, Carrel T

Abstract
OBJECTIVES: To assess safety and clinical performance of a novel bioabsorbable vascular graft in pediatric patients with univentricular cardiac malformation who received surgical correction via an extracardiac cavopulmonary conduit.
METHODS: The implanted graft material is designed to attract patient's own cells and proteins, which trigger a cascade of physiological events leading to endogenous tissue restoration. As the graft resorbs progressively after implantation, components of native tissue including collagen, endothelial lining, and capillary blood vessels develop and organize into a natural tissue. Five patients (aged 4-12 years) received this new vascular graft as interposition between the inferior vena cava and the pulmonary artery. They were followed up to 12 months after surgery. The conduit was assessed by echocardiography, computed tomography and magnetic resonance imaging, including 4-dimensional flow.
RESULTS: All patients recovered from the procedure without complications. No device-related adverse events were reported. Two patients required interventional occlusion of aortopulmonary collaterals. At 12 months, there was a significant improvement in the patients' general condition. Imaging studies demonstrated anatomical (conduit diameter, length and wall thickness) and functional (blood flow pattern) stability of the bioabsorbable grafts in all patients with no significant changes at 12 months compared with early postoperative data.
CONCLUSIONS: Initial clinical experience with a novel absorbable graft underlines the potential of this new material to improve cardiac and vascular surgical procedures. In addition, better biocompatibility may reduce permanent implant-related complications. A longer follow-up is needed to assess the long-term effectiveness of biodegradable vascular grafts, including their ability to grow.

PMID: 28314534 [PubMed - as supplied by publisher]

Categorías: Cirugía congénitos

Postprocedural Outcomes and Risk Factors for Arrhythmias Following Transcatheter Closure of Congenital Perimembranous Ventricular Septal Defect: A Single-center Retrospective Study.

Jue, 03/23/2017 - 00:54
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Postprocedural Outcomes and Risk Factors for Arrhythmias Following Transcatheter Closure of Congenital Perimembranous Ventricular Septal Defect: A Single-center Retrospective Study.

Chin Med J (Engl). 2017 5th Mar;130(5):516-521

Authors: Zhao LJ, Han B, Zhang JJ, Yi YC, Jiang DD, Lyu JL

Abstract
BACKGROUND: Currently, transcatheter closure of perimembranous ventricular septal defect (pmVSD) is a widely accepted therapeutic modality. However, arrhythmias, especially postprocedural heart blocks, are a concern and outcomes are not very clear. This study explored the outcomes and risk factors of arrhythmias associated with transcatheter device closure of pmVSD.
METHODS: A total of 395 patients diagnosed with pmVSD who successfully underwent transcatheter intervention between January 2010 and December 2015 in our center were retrospectively reviewed. Electrocardiographic data before and after the procedure were collected and analyzed. We first evaluated the potential risk factors including gender, age, weight, inlet and outlet diameters of defect, subaortic rim length, occluder size, corrected occluder size into body surface area, fluoroscopy time, presence of aneurysm, and deployment position. We compared the potential risk factors between arrhythmia and nonarrhythmia groups using univariate analysis, followed by logistic analysis for independent risk factors.
RESULTS: Various arrhythmias were detected in 95 cases (24.1%) following transcatheter closure procedure. Logistic regression analysis revealed that eccentric (odds ratio [OR] 2.9, 95% confidence interval [CI]: 1.2-7.2) and large occluders (OR 2.0, 95% CI: 1.6-2.5), as well as long fluoroscopy time (OR 1.1, 95% CI: 1.1-1.2), were correlated with postprocedural arrhythmia. During 35.5 months (range: 9-80 months) of follow-up, most of the patients (74 out of 95) reverted to normal heart rhythm.
CONCLUSIONS: The mid-term outcome of patients with arrhythmias after transcatheter closure of pmVSD was satisfactory as most of the patients recovered normal rhythm. Eccentric, large device and long fluoroscopy time increase the risk of arrhythmias after transcatheter closure of pmVSD.

PMID: 28229981 [PubMed - indexed for MEDLINE]

Categorías: Cirugía congénitos

Effects of platelet-rich plasma on cartilage regeneration after costal cartilage resection: a stereological and histopathological study.

Jue, 03/23/2017 - 00:54
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Effects of platelet-rich plasma on cartilage regeneration after costal cartilage resection: a stereological and histopathological study.

Acta Chir Belg. 2017 Feb;117(1):21-28

Authors: Sengul AT, Buyukkkarabacak YB, Altunkaynak BZ, Yetim TD, Altun GY, Sengul B, Basoglu A

Abstract
BACKGROUND: In cases of congenital chest wall deformities, it is important to maintain the flexibility of the chest wall after rib cartilage resection. In this study, we aimed to determine the regeneration capability of cartilage and the effects of platelet-rich plasma (PRP) on the regeneration process.
METHODS: A total of 16 four-week-old New Zealand rabbits were used in this study. In the 4th-5th right costal cartilages, the perichondrial sheaths were dissected and costal cartilages were excised. Then, the perichondrial sheaths were closed with absorbable material in the sham group (n = 8), and this was done after replacing PRP in the PRP group (n = 8). The left costal cartilages of the animals were used as controls. The volumes of the costal cartilages and their perichondrial sheaths were estimated using Cavalieri's principle. In addition, the mean numerical densities of the chondroblasts and chondrocytes per square millimetre were estimated using unbiased counting frames.
RESULTS: In the PRP and sham groups, the volumes of the cartilages and perichondrial sheaths were higher than those of the control group (p < 0.05). The numerical densities of the chondroblasts and chondrocytes increased more in the PRP group than in the sham group (p < 0.05).
CONCLUSIONS: Applying PRP after resection may provide better healing and faster regeneration of cartilage.

PMID: 27487267 [PubMed - indexed for MEDLINE]

Categorías: Cirugía congénitos

Transcatheter native pulmonary valve and tricuspid valve replacement with the sapien XT: Initial experience and development of a new delivery platform.

Jue, 03/23/2017 - 00:54
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Transcatheter native pulmonary valve and tricuspid valve replacement with the sapien XT: Initial experience and development of a new delivery platform.

Catheter Cardiovasc Interv. 2016 Sep;88(3):434-43

Authors: Levi DS, Sinha S, Salem MM, Aboulhosn JA

Abstract
BACKGROUND: While the Melody valve is unable to be used for replacement of large pulmonary outflow tracts, the 29 mm Sapien XT transcatheter valve, designed specifically for aortic valve replacement, can potentially be used in these large native outflow tracts. Techniques to enable off-label use of the Sapien XT valve for large-diameter pulmonary and tricuspid valve replacement are described.
METHODS: Use of the Sapien valve for transcatheter pulmonary and tricuspid valve replacement using both the commercially available Novaflex+ system and using a novel flexible delivery system was reviewed. This customized flexible delivery platform was constructed using the Ensemble sheath and a 30 mm Nucleus balloon. This system was bench tested prior to its clinical use.
RESULTS: Ten patients had successful implantation of Sapien valves into native right ventricular outflow tracts (RVOTs) (n = 7) or tricuspid valves (n = 3). There was no stenosis or regurgitation after Sapien valve implantation. Several of the pulmonary valve replacement cases were extremely challenging due to the limited flexibility of the Novaflex system. The Sapien valve was crimped onto a 30 mm Nucleus balloon preloaded through an Ensemble sheath. This system was able to consistently deliver the Sapien valve safely in a bench model as well as in native RVOTs in two patients.
CONCLUSION: The 29 mm Sapien XT valve allows for large-diameter transcatheter valve replacement in both the pulmonary and tricuspid positions. Initial results of new techniques to utilize a more flexible delivery platform are described that could obviate the need for the Novaflex system. © 2016 Wiley Periodicals, Inc.

PMID: 27142960 [PubMed - indexed for MEDLINE]

Categorías: Cirugía congénitos

Congenital cardiac surgery; +1622 new citations

Mar, 03/21/2017 - 00:00

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Categorías: Cirugía congénitos