Weight change in infants with a functionally univentricular heart: from surgical intervention to hospital discharge

2010 ◽  
Vol 21 (2) ◽  
pp. 136-144 ◽  
Author(s):  
Barbara Medoff-Cooper ◽  
Sharon Y. Irving ◽  
Bradley S. Marino ◽  
J. Felipe García-España ◽  
Chitra Ravishankar ◽  
...  
Keyword(s):  
Weight Gain ◽  
Hospital Discharge ◽  
Weight Change ◽  
Surgical Intervention ◽  
Atrioventricular Valve ◽  
Z Score ◽  
Valve Regurgitation ◽  
Atrioventricular Valve Regurgitation ◽  
Significant Difference ◽  
Weight For Age

AbstractObjectiveThe purpose of this study was to assess the pattern of weight change from surgical intervention to home discharge and to determine predictors of poor growth in this population of infants with congenital cardiac disease.MethodsNeonates with functionally univentricular physiology enrolled in a prospective cohort study examining growth between March, 2003 and May, 2007 were included. Weights were collected at birth, before surgical intervention, and at hospital discharge. In addition, retrospective echocardiographic data and data about post-operative complications were reviewed. Primary outcome variables were weight-for-age z-score at discharge and change in weight-for-age z-score between surgery and discharge.ResultsA total of 61 infants met the inclusion criteria. The mean change in weight-for-age z-score between surgery and hospital discharge was minus 1.5 plus or minus 0.8. Bivariate analysis revealed a significant difference in weight-for-age z-score between infants who were discharged on oral feeds, minus 1.1 plus or minus 0.8 compared to infants with feeding device support minus 1.7 plus or minus 0.7, p-value equal to 0.01. Lower weight-for-age z-score at birth, presence of moderate or greater atrioventricular valve regurgitation, post-operative ventilation time, and placement of an additional central venous line were associated with 60% of the variance in weight-for-age z-score change.ConclusionNeonates undergoing staged surgical repair for univentricular physiology are at significant risk for growth failure between surgery and hospital discharge. Haemodynamically significant atrioventricular valve regurgitation and a complex post-operative course were risk factors for poor post-operative weight gain. Feeding device support appears to be insufficient to ensure adequate weight gain during post-operative hospitalisation.

scholarly journals Site of interstage outpatient care and growth after the Norwood operation

2015 ◽  
Vol 25 (7) ◽  
pp. 1340-1347 ◽  
Author(s):  
Mehul D. Patel ◽  
Karen Uzark ◽  
Sunkyung Yu ◽  
Janet Donohue ◽  
Sara K. Pasquali ◽  
...  
Keyword(s):  
Weight Gain ◽  
Multivariable Analysis ◽  
Group Versus ◽  
Z Score ◽  
Norwood Operation ◽  
Surveillance Strategy ◽  
Site Group ◽  
Significant Difference ◽  
The Impact ◽  
Weight For Age

AbstractBackgroundRecent efforts have focused on optimising interstage outcomes, including growth, for infants following the Norwood operation. The impact of the site of interstage care remains unclear, and it has been hypothesised that care at the surgical site may be beneficial due to greater access to resources such as nutritional support. This study evaluated the relationship between site of interstage care and weight gain in a large multicentre cohort.MethodsInfants enrolled in the National Paediatric Cardiology Quality Improvement Collaborative (2008–2013) surviving up to Stage 2 were included. Change in weight-for-age z-score between Norwood discharge and Stage 2 admission was compared in those receiving care at the surgical versus non-surgical site.ResultsOf the 487 interstage survivors, 60% received all care at the surgical site, and 40% received care at a non-surgical site. There was no significant difference between groups in change in weight-for-age z-score: +0.36±0.96 for the surgical site group versus +0.46±1.02 for the non-surgical site group, p=0.3. Results were unchanged in multivariable analysis adjusting for differences in important baseline characteristics, duration of interstage, and home surveillance strategy. The proportion of all patients with weight-for-age z-score <−2 decreased from 40% at Norwood discharge to 29% at Stage 2, with no significant difference in change between the two groups (p=0.1).ConclusionsThe site of interstage care was not associated with weight gain during the interstage period. Nearly one-third of patients overall had a weight-for-age z-score <−2 at Stage 2. Further study is required to identify methods to optimise weight gain in these patients.

Bridging annuloplasty for common atrioventricular valve regurgitation

1995 ◽  
Vol 59 (4) ◽  
pp. 1003-1005 ◽  
Author(s):  
Tetsuro Takayama ◽  
Nobuhiro Nagata ◽  
Takeshi Miyairi ◽  
Masakazu Abe ◽  
Kenji Koseni ◽  
...  
Keyword(s):  
Atrioventricular Valve ◽  
Valve Regurgitation ◽  
Atrioventricular Valve Regurgitation ◽  
Common Atrioventricular Valve

Abstract 17543: The Chicken or the Eggs? Examining the Causal Relationship Between the Development of Atrioventricular Valve Regurgitation and Ventricular Dysfunction in Patients With Functionally Single-Ventricle Physiology

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yasuhiro Kotani ◽  
Devin Chetan ◽  
Selvi Senthilnathan ◽  
Arezou Saedi ◽  
Christopher A Caldarone ◽  
...  
Keyword(s):  
Causal Relationship ◽  
Single Ventricle ◽  
Ventricular Dysfunction ◽  
Stage I ◽  
Stage Ii ◽  
Atrioventricular Valve ◽  
Valve Regurgitation ◽  
Ventricular Dilation ◽  
Atrioventricular Valve Regurgitation ◽  
Annular Dilation

Introduction: Development of atrioventricular valve regurgitation (AVVR) with or without ventricular dysfunction (VD) often occurs during the first 6 months of life and has a significant impact on outcomes for single-ventricle patients. Yet, it is not well known whether AVVR causes VD or vice versa. Thus, we sought to identify the timing and causal relationship between AVVR and VD. Methods: Among 156 consecutive single-ventricle patients who had staged palliation (2005- 2012), 28 who had AVV repair at the time of stage II (n=24, 86%) or inter-stage (n=4, 14%) were reviewed. Diagnosis included HLHS in 17 (61%) patients, tricuspid atresia in 2 (7%), and others in 9 (32%). Ventricular morphology was left-dominant in 6 (21%) patients and right-dominant in 22 (79%). AVV morphology included mitral in 6 (21%) patients, tricuspid in 18 (64%), and common in 4 (14%). Serial echocardiograms were reviewed to identify the timing of development of AVVR and/or VD. Results: After stage I palliation, ventricular end-diastolic dimension (VEDD) z-score significantly increased from 4.01 to 5.69 (p<0.01) AVVR (Figure). By the time of stage II palliation, VEDD further increased and subsequent AVV annular dilation occurred, resulting in 23 patients with significant AVVR. None of the patients, however, had significant VD before stage II palliation/AVV repair, but 9 patients developed significant VD after AVV repair. Conclusions: Ventricular dilation occurred immediately after stage I palliation and continued until stage II palliation. Secondary annular dilation occurred inter-stage and this further triggered the development of AVVR. Tangible ventricular dysfunction was not seen before AVV repair, however, important ventricular dysfunction was unmasked after volume unloading surgery. Heart failure management and early intervention to significant AVVR may reduce the incidence of ventricular dysfunction following AVV repair.

Survival and predictors of mortality in patients after the Fontan operation

2020 ◽  
Vol 28 (9) ◽  
pp. 572-576
Author(s):  
Saviga Sethasathien ◽  
Suchaya Silvilairat ◽  
Hathaiporn Kraikruan ◽  
Rekwan Sittiwangkul ◽  
Krit Makonkawkeyoon ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Fontan Operation ◽  
Hazard Ratio ◽  
Early Mortality ◽  
Atrioventricular Valve ◽  
Valve Regurgitation ◽  
Artery Pressure ◽  
Mean Pulmonary Artery Pressure ◽  
Atrioventricular Valve Regurgitation

Background As a result of the surgical techniques now being employed, the survival rate in patients after undergoing the Fontan operation has improved. The aims of this study were focused on determining the survival rate and predictors of early mortality. Methods In a retrospective cohort study, 117 consecutive patients who underwent the Fontan operation were recruited. Multivariate Cox proportional regression analysis was used to assess the predictors of early mortality, defined as death within 30 days after the Fontan operation. Results The median follow-up time was 6.1 years. The median age at the time of the Fontan operation was 5.7 years. Survival rates in the patients at 5, 10, and 15 years postoperatively were 92%, 87% and 84%, respectively. Using univariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 26.0), renal failure (hazard ratio 9.5), heterotaxy syndrome (hazard ratio 5.3), and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 9.4). After adjusting for confounding factors using multivariate Cox regression analysis, the predictors of early mortality were found to be postoperative mean pulmonary artery pressure ≥23 mm Hg (hazard ratio 23.2) and uncorrected moderate or severe atrioventricular valve regurgitation (hazard ratio 8.2). Conclusions Uncorrected moderate or severe atrioventricular valve regurgitation and postoperative mean pulmonary artery pressure ≥23 mm Hg are independent predictors of early mortality after the Fontan operation. Patients with these factors should undergo aggressive management to minimize morbidity and mortality.

scholarly journals 193 * ATRIOVENTRICULAR VALVE REGURGITATION IN UNIVENTRICULAR HEARTS: OUTCOMES AFTER REPAIR

2014 ◽  
Vol 19 (suppl 1) ◽  
pp. S58-S58
Author(s):  
D. Laux ◽  
M. Vergnat ◽  
V. Lambert ◽  
B. Stos ◽  
M. Ly ◽  
...  
Keyword(s):  
Atrioventricular Valve ◽  
Valve Regurgitation ◽  
Atrioventricular Valve Regurgitation

The association between feeding protocol compliance and weight gain following high-risk neonatal cardiac surgery

2019 ◽  
Vol 29 (5) ◽  
pp. 594-601 ◽  
Author(s):  
Jamie M. Furlong-Dillard ◽  
Benjamin J. Miller ◽  
Kathy A. Sward ◽  
Alaina I. Neary ◽  
Trudy L. Hardin-Reynolds ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Weight Gain ◽  
High Risk ◽  
Congenital Heart ◽  
Clinical Severity ◽  
Z Score ◽  
Protocol Adherence ◽  
Feeding Protocol ◽  
Weight For Age

AbstractBackground:Children with congenital heart disease are at high risk for malnutrition. Standardisation of feeding protocols has shown promise in decreasing some of this risk. With little standardisation between institutions’ feeding protocols and no understanding of protocol adherence, it is important to analyse the efficacy of individual aspects of the protocols.Methods:Adherence to and deviation from a feeding protocol in high-risk congenital heart disease patients between December 2015 and March 2017 were analysed. Associations between adherence to and deviation from the protocol and clinical outcomes were also assessed. The primary outcome was change in weight-for-age z score between time intervals.Results:Increased adherence to and decreased deviation from individual instructions of a feeding protocol improves patients change in weight-for-age z score between birth and hospital discharge (p = 0.031). Secondary outcomes such as markers of clinical severity and nutritional delivery were not statistically different between groups with high or low adherence or deviation rates.Conclusions:High-risk feeding protocol adherence and fewer deviations are associated with weight gain independent of their influence on nutritional delivery and caloric intake. Future studies assessing the efficacy of feeding protocols should include the measures of adherence and deviations that are not merely limited to caloric delivery and illness severity.

scholarly journals 334. Weight Change Associated with Antiretroviral Therapy Switch to Integrase Strand Transfer Inhibitor-Based Regimens

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S177-S177 ◽  
Author(s):  
Saghar Saber ◽  
Andrew B Bernstein ◽  
Andrew D Sparks ◽  
Marc O Siegel
Keyword(s):  
Weight Gain ◽  
Antiretroviral Therapy ◽  
Weight Change ◽  
Statistical Significance ◽  
Inverse Correlation ◽  
Cd4 Count ◽  
Strand Transfer ◽  
Significant Difference ◽  
Transfer Inhibitor ◽  
Integrase Strand Transfer Inhibitor

Abstract Background An association between switching antiretroviral therapy (ART) to integrase strand transfer inhibitor (INSTI)-based ART and weight gain has been previously reported. However, insufficient data exists on risk factors associated with such weight gain. Methods We reviewed charts of 119 virally-suppressed HIV-positive patients switched from nonnucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI)-based ART to INSTI-based ART and compared their weight change over 17 months to 56 virally-suppressed patients who were maintained on NNRTI-based regimens over the same period.We looked at variables associated with weight gain including age, weight, body mass index (BMI), gender, CD4 count, starting ART, and final INSTI-based ART. Results The 119 patients switched to INSTI-based ART gained an average of 6.9 lbs compared with an average 1 lbs weight gain in the 56 patients who were maintained on NNRTI-based ART (P = 0.002). There was also a statistically significant difference in the percentage % weight change between the two groups (4.2% vs. 0.7%, P < 0.001).There was an average 1.2 lbs weight loss in 92 of the 119 patients with weights recorded 17 months before switching ART, compared with an average 6.7 lbs weight gain after the switch (P < 0.001).There was no association between gender, CD4 count at the time of switch, starting ART, or final INSTI-based ART with weight gain. However, patients weighing < 150 lbs at the time of switch had a greater % weight gain than patients weighing >200 lbs (6.9% vs. 2.7%, P = 0.02) and a trend to greater % weight gain than those weighing ≥150 to ≤ 200 lbs (6.9% vs. 3.8%, P = 0.06). There was marginal statistical significance when comparing those with BMIs < 25 to those with BMIs ≥25 to ≤ 30 (8.2 vs. 6.5 lbs, P = 0.069) and those with BMIs >30 (8.2 vs. 5.0 lbs, P = 0.057). There was an inverse correlation between age and weight gain, indicating that less weight was gained when switching to INSTI-based ART as the age of the patient increased (ρ = -0.211, P = 0.021). Conclusion Our study showed a statistically significant weight gain in patients switched from NNRTI- or PI- to INSTI-based ART compared with patients maintained on NNRTI-based ART.Baseline variables associated with greater weight gain included weight <150 lbs, BMI <25 and younger age. Disclosures All authors: No reported disclosures.

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