Extensive scar modification for the treatment of intra-atrial re-entrant tachycardia in patients after congenital heart surgery

AbstractBackground:Catheter ablation is an important therapeutic option for atrial tachycardias in patients with CHD. As a result of extensive scarring and surgical repair, multiple intra-atrial re-entrant tachycardia circuits develop and serve as a substrate for arrhythmias. The best ablation approach for patients with multiple intra-atrial re-entrant tachycardias has not been investigated. Here, we compared substrate-based ablation using extensive scar modification to conventional ablation.Methods:The present study included patients with surgically corrected CHD that underwent intra-atrial re-entrant tachycardia ablation. Extensive scar modification was defined as substrate ablation based on a dense voltage map, aimed to eliminate all potentials in the scar region. The control group had activation mapping-based ablation. A clinical composite endpoint was assessed. Points were given for type, number, and treatment of intra-atrial re-entrant tachycardia recurrence.Results:In 40 patients, 63 (extensive scar modification 13) procedures were performed. Acute procedural success was achieved in 78%. Procedural duration was similar in both groups. Forty-nine percent had a recurrence within 1 year. During a 5-year follow-up (2.5–7.5 years), 46% required repeat catheter ablation. Compared to baseline, clinical composite endpoint significantly decreased by 46% after 12 months (p = 0.001). Acute procedural success, procedural parameters, recurrence and repeat ablation were similar between extensive scar modification and activation mapping-based ablation.Conclusion:Catheter ablation using extensive scar modification for intra-atrial re-entrant tachycardias occurring after surgically corrected CHD illustrated similar short- and long-term outcomes and procedural efficiency compared to catheter ablation using activation mapping-based ablation. The choice of ablation approach for multiple intra-atrial re-entrant tachycardia should remain at the discretion of the operator.

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The use of dornase alpha for post-operative pulmonary atelectasis after congenital heart surgery

Cardiology in the Young ◽

10.1017/s1047951113001078 ◽

2013 ◽

Vol 24 (5) ◽

pp. 807-812 ◽

Cited By ~ 4

Author(s):

Erkut Ozturk ◽

Ibrahim C. Tanidir ◽

Sertac Haydin ◽

Ismihan S. Onan ◽

Ender Odemis ◽

...

Keyword(s):

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Chest Physiotherapy ◽

Control Group ◽

Study Group ◽

Care Hospital ◽

Pulmonary Atelectasis ◽

Median Period ◽

Dornase Alpha

AbstractObjective: To investigate the efficacy of dornase alpha, a mucolytic agent, in children who developed pulmonary atelectasis after congenital heart surgery. Design: Retrospective case–control study. Setting: Paediatric cardiac intensive care unit at a tertiary care hospital. Patients: Between July, 2011 and July, 2012, 41 patients who underwent congenital cardiac operations and developed post-operative pulmonary atelectasis that was resistant to conventional treatment and chest physiotherapy. Interventions: In all, 26 patients received dornase alpha treatment. As a control group, 15 patients were treated with conventional medications and chest physiotherapy. Main results: The median age of patients was 25.5 (3–480) days in the study group and 50.0 (3–480) days in the control group. A total of 15 (57.6%) patients in the study group and 8 (53.3%) patients in the control group were male. The median weight was 4.2 (2.9–14.2) kg and 4.0 (3.5–13.6) kg in the study and control group, respectively. In the study group, pulmonary atelectasis was diagnosed at a median period of 5 (2–18) days after operations, whereas in the control group atelectasis was diagnosed at a median period of post-operative 6 (3–19) days. In the study group, the median atelectasis score decreased from 3.4 (1–6) to 0.8 (0–3) (p = 0.001). The median pO2 level increased from 69 (17–142) mmHg to 89 (30–168) mmHg (p = 0.04). In addition, heart rate and respiratory rate per minute were significantly decreased (p < 0.05). There were no significant changes in these parameters in the control group. Conclusions: The use of dornase alpha can be effective for the management of pulmonary atelectasis that develops following congenital heart surgery.

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Abstract P180: Hospital Readmission After Pediatric Congenital Heart Surgery: A Systematic Review And Meta-analysis Of Potential Risk Factors

Circulation ◽

10.1161/circ.143.suppl_1.p180 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Meagan E Stabler ◽

Devin M Parker ◽

Sarina Kothari ◽

Mahalia Dalmage ◽

Heather Johnson ◽

...

Keyword(s):

Hospital Readmission ◽

Congenital Heart ◽

Heart Surgery ◽

Meta Analysis ◽

Hospital Readmissions ◽

Congenital Heart Surgery ◽

Risk Of Bias ◽

Factors Associated ◽

Short And Long Term

Objective: Over 40,000 infants are born annually with a heart defect; 25% require surgery and of those 20% result in hospital readmissions. We sought to identify risk factors for short- and long-term readmission following pediatric congenital heart surgery (CHS) to reduce avoidable future admissions. Methods: A systematic approach was used to search four electronic databases and retrieve articles published through 05/2020. We included observational and experimental studies that observed factors associated with 30-day or 1-year readmission after CHS. Studies with a composite outcome of readmission and death were excluded. For each independent risk factor, we assessed the pooled effect size and heterogeneity using a random-effects model. Risk of bias was assessed via the Newcastle-Ottawa scale. Results: After removing 970 duplicates, we screened 5,084 studies; 17 were included in the systematic review and 15 (N= 82,794; 9,856 readmitted) in the meta-analysis. Hospital readmission was significantly and positively associated with gestational age, non-white race, Hispanic ethnicity, government insurance, genetic abnormality, renal dysfunction, failure to thrive, mechanical ventilation, intraoperative ventricular dysfunction, RACHS score, STAT mortality score, cross clamp time, gastroesophageal reflux disease, postoperative arrhythmia, valve regurgitation, feeding difficulties, and ICU and hospital length of stay (LOS). Readmission definition (i.e., 1-yr vs 30-day) and LOS dichotomization (i.e., ≥ 10 or ≥ 14) resulted in significant subgroup differences for age at surgery and LOS. Five studies had higher potential for risk of bias. Conclusions: This is the first meta-analysis to identify patient and clinical factors associated with short and long-term readmission after pediatric CHS. Findings may support clinical decisions before undergoing surgery and identify patients that may benefit from receiving more aggressive care transitions prior to discharge to reduce avoidable hospital readmissions.

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Complications and mortality after catheter ablation of ventricular arrhythmias: risk in VT ablation (RIVA) score

Clinical Research in Cardiology ◽

10.1007/s00392-021-01902-2 ◽

2021 ◽

Author(s):

Shibu Mathew ◽

Thomas Fink ◽

Sebastian Feickert ◽

Osamu Inaba ◽

Naotaka Hashiguchi ◽

...

Keyword(s):

Heart Disease ◽

Catheter Ablation ◽

Ventricular Arrhythmias ◽

Heart Surgery ◽

Therapeutic Option ◽

Major Complication ◽

Structural Heart Disease ◽

Large Patient ◽

Effective Therapeutic Option ◽

History Of

Abstract Aims Catheter ablation of ventricular arrhythmias (VA) has proven to be an effective therapeutic option for secondary arrhythmia prophylaxis. We sought to assess the procedural efficacy, safety and in-hospital mortality of a large patient cohort with and without structural heart disease undergoing VA ablation. Methods A total of 1417 patients (804 patients with structural heart disease) undergoing 1792 endo- and epicardial procedures were analyzed. Multivariable risk factor analysis for occurrence of major complications and intrahospital mortality was obtained and a score to allow preprocedural risk assessment for patients undergoing VA ablation procedures was established. Results Major complication occurred in 4.4% of all procedures and significantly more often in patients with structural heart disease than in structurally normal hearts (6.0 vs. 1.8%). The frequency of these periprocedural complications was significantly different between procedures with sole right ventricular and a combination of RV and LV access (0.5 vs. 3.1%). The most common complication was cardiac tamponade in 46 cases (3.0%). Intrahospital death was observed in 32 patients (1.8%). Logistic regression model revealed presence of ischemic heart disease, epicardial ablation, presence of oral anticoagulation or dual antiplatelet therapy as independent risk factors for the occurrence of complications or intrahospital death, while a history of previous heart surgery was an independent predictor with a decreased risk. Based on this analysis a risk score incorporating 5 standard variables was established to predict the occurrence of complications and intrahospital mortality. Conclusions Safety of VA catheter ablation mainly relies on patient baseline characteristics and the type of access into the ventricles or epicardial space.

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Effects of Remifentanil and Sufentanil Anesthesia on Cardiac Function and Serological Parameters in Congenital Heart Surgery

Journal of Healthcare Engineering ◽

10.1155/2021/4650291 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Zhigang Qin ◽

Younian Xu

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Treatment Group ◽

Cardiac Function ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Control Group ◽

Muscle Rigidity ◽

Significant Difference

In this study, we have investigated feasibility of remifentanil and sufentanil anesthesia in children with congenital heart disease surgery and its effects on cardiac function and serological parameters. For this purpose, a retrospective study was conducted on 120 children with congenital heart disease who underwent repair of ventricular septum or atrial septum in our hospital, specifically from January 2016 to January 2018, and 60 patients in each group were randomly divided into the control and treatment groups, respectively. The control group was anesthetized with sufentanil, and the treatment group was anesthetized with remifentanil. The heart function, serological indexes, and adverse reactions were observed and compared. We have observed that there was no significant difference in HR levels between these groups ( P > 0.05 ), but SDP and DBP values of the two groups were decreased after anesthetic induction ( P < 0.05 ). ACH, cortisol, and lactic acid in the treatment group were significantly lower than those in the control group, and the difference was statistically significant ( P < 0.05 ). The incidence of bradycardia, nausea and vomiting, hypotension, muscle rigidity, and respiratory depression in the treatment group was 16.67% lower than that in the control group ( P < 0.05 ). Remifentanil has less influence on hemodynamics and a better analgesic effect than fentanyl in inhibiting stress response in congenital heart surgery, which provides reference and basis for children congenital heart surgery.

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Abstract 4570: Association Between Intra-operative and Early Postoperative Glucose Levels and Adverse Outcomes Following Complex Congenital Heart Surgery

Circulation ◽

10.1161/circ.118.suppl_18.s_913-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Angelo Polito ◽

Ravi R Thigarajan ◽

Peter C Laussen ◽

Kimberlee Gauvreau ◽

Michael S Agus ◽

...

Keyword(s):

Length Of Stay ◽

Glucose Control ◽

Congenital Heart ◽

Heart Surgery ◽

Composite Endpoint ◽

Congenital Heart Surgery ◽

Adverse Outcomes ◽

Hospital Length Of Stay ◽

Glucose Levels ◽

Multiple Variables

Although hyperglycemia is associated with increased mortality in critically ill adults, studies in children undergoing cardiac surgery are limited and have reached conflicting conclusions. We sought to determine whether associations exist between perioperative glucose exposure, prolonged hospitalization and morbid events following complex congenital heart surgery. Metrics of glucose control including average, peak, minimum and standard deviation of glucose levels, and duration of hyperglycemia (hours >126 mg/dL and 200 mg/dL) were determined intraoperatively and for 72 hours following surgery for 378 consecutive children who had a Risk Adjustment in Congenital Heart Surgery-1 category ≥3. Regression analyses were used to determine relationships between glucose variables, hospital length of stay and a composite morbidity-mortality outcome (death, ECMO, infection, hepatic injury, renal failure, and/or brain injury) after controlling for multiple variables known to influence early outcomes. Intraoperatively, a minimum glucose ≤75 mg/dL was associated with greater adjusted odds of reaching the composite morbidity-mortality endpoint (odds ratio [OR], 3.10; 95% confidence interval [CI], 1.49 – 6.48), but other metrics of glucose control were not associated with the composite endpoint or length of stay. Greater duration of hyperglycemia (glucose >126 mg/dl) during the first 72 postoperative hours was associated with longer duration of hospitalization (p<0.001). In the 72 hours after surgery, average glucose <110 mg/dl (OR, 7.30; 95% CI, 1.95–27.25) or >143 mg/dl (OR, 5.21, 95% CI, 1.37–19.89), minimum glucose ≤75 mg/dL (OR, 2.85, 95% CI, 1.38 –5.88), and peak glucose level ≥250 mg/dl (OR, 2.55, 95% CI, 1.20 –5.43) were all associated with greater adjusted odds of reaching the composite morbidity-mortality endpoint. In children undergoing complex congenital heart surgery, intraoperative hyperglycemia was not associated with adverse outcomes. When considering analyses of several metrics of glucose control, the optimal postoperative glucose range may be 110 –126 mg/dl. A randomized trial of strict glycemic control achieved with insulin infusions in this patient population is needed.

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Role of terminal warm blood cardioplegia in complex congenital heart surgery

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318759105 ◽

2018 ◽

Vol 26 (3) ◽

pp. 196-202 ◽

Cited By ~ 1

Author(s):

Pribadi Wiranda Busro ◽

Harvey Romolo ◽

Sudigdo Sastroasmoro ◽

Jusuf Rachmat ◽

Mohammad Sadikin ◽

...

Keyword(s):

Treatment Group ◽

Myocardial Protection ◽

Caspase 3 ◽

Heart Surgery ◽

Troponin I ◽

Congenital Heart Surgery ◽

Control Group ◽

Blood Cardioplegia ◽

Warm Blood ◽

Warm Blood Cardioplegia

Introduction Myocardial protection is vital to ensure successful open heart surgery. Cardioplegic solution is one method to achieve good myocardial protection. Inevitably, ischemia-reperfusion injury occurs with aortic crossclamping. Histidine-tryptophan-ketoglutarate solution is a frequently used cardioplegia for complex congenital heart surgery. We postulated that addition of terminal warm blood cardioplegia before removal of the aortic crossclamp might improve myocardial protection. Method A randomized controlled trial was conducted on 109 cyanotic patients aged, 1 to 5 years who underwent complex biventricular repair. They were divided into a control group of 55 patients who had histidine-tryptophan-ketoglutarate only and a treatment group of 54 who had histidine-tryptophan-ketoglutarate with terminal warm blood cardioplegia. Endpoints were clinical parameters, troponin I levels, and caspase-3 as an apoptosis marker. Results The incidence of low cardiac output syndrome was 34%, with no significant difference between groups (35.2% vs. 33.3%, p = 0.84). The incidence of arrhythmias in our treatment group was lower compared to the control group (36% vs. 12%, p = 0.005). Troponin I and caspase-3 results did not show any significant differences between groups. For cases with Aristotle score ≥ 10, weak expression of caspase-3 in the treatment group post-cardiopulmonary bypass was lower compared to the control group. Conclusion For complex congenital cardiac surgery, the addition of terminal warm blood cardioplegia does not significantly improve postoperative clinical or metabolic markers.

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Endothelin-1 and nitric oxide in 3-year prognosis after acute myocardial infarction

Vojnosanitetski pregled ◽

10.2298/vsp151029278s ◽

2017 ◽

Vol 74 (9) ◽

pp. 862-870

Author(s):

Dragana Stanojevic ◽

Svetlana Apostolovic ◽

Sonja Salinger-Martinovic ◽

Ruzica Jankovic-Tomasevic ◽

Danijela Djordjevic-Radojkovic ◽

...

Keyword(s):

Nitric Oxide ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Composite Endpoint ◽

Control Group ◽

Endothelin 1 ◽

Short And Long Term ◽

St Elevation ◽

Experimental Group

Background/Aim. Acute myocardial infarction (AMI) is an important cause of mortality/morbidity worldwide. Biomarkers improve diagnostic and prognostic accuracy in AMI. The aim of this study was to investigate an increase of markers of endothelial dysfunction in AMI, measured on the 3rd day after the initial event and to investigate their association with short- and long-term (3-year) prognosis (outcome). Methods. The prospective study included 108 patients with AMI in the experimental group and 50 apparently healthy subjects in the control group. Endothelin-1 (ET-1) and nitric oxide degradation products (NOx) were determined. Results. The average age of the participants in the experimental group was 62 ? 10 years and 59 ? 9 years in the control group; 74.1% of the patients in experimental group were males and 68.8% in the control group. In 74.1% of the patients, ST-elevation myocardial infarction (STEMI) was diagnosed, and 25.9% of the patients presented with non-ST-elevation myocardial infarction (NSTEMI). Thirteen (5.6%) patients died during 3 years and they had significantly higher ET-1 levels compared to survivors [4.02 (2.72?5.93) vs 3.06 (2.23?3.58) pg/mL; p = 0.015]. Endothelin- 1 in 46 (42.6%) patients with composite endpoint (3- year mortality and rehospitalization) was significantly increased compared to other patients [3.14 (2.54?4.41) vs 3.05 (2.18?3.56) pg/mL; p = 0.035]. Intrahospital complications were found in 41 (48%) patients. Participants with echocardiographically detected complications (ventricular dyskinesia, left ventricular thrombus and papillary muscle rupture) had higher ET-1 levels compared to other patients [4.02 (2.78?5.57) vs 3.06 (2.29?3.66) pg/mL; p = 0.012]. Endothelin- 1 concentration above the 75th percentile (> 3.77 pg/mL) was associated with the increased risk for composite endpoint [Log Rank (?2 = 13.44; p < 0.001)]. Patients who were rehospitalized had significantly lower NOx concentration [125.5 (111.4?143.6) vs 139.3 (116.79?165.2) ?mol/L; p = 0.04]. Endothelin-1 positively correlated with high sensitivity troponin I (hsTnI), brain natriuretic peptide (BNP) and a number of leukocytes. Conclusion. Endothelin- 1 and NOx were increased on the 3rd day after AMI, and they were predictors of worse short- and long-term (3- year) prognosis (outcome). Endothelin-1 positively correlated with conventional prognostic markers in AMI.

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Leucocyte filtration of residual heart-lung machine blood in children undergoing congenital heart surgery

Perfusion ◽

10.1191/0267659104pf765oa ◽

2004 ◽

Vol 19 (6) ◽

pp. 345-349 ◽

Cited By ~ 2

Author(s):

A J de Vries ◽

Y J Gu ◽

W van Oeveren

Keyword(s):

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Blood Oxygenation ◽

Control Group ◽

Arterial Blood ◽

Heart Lung Machine ◽

Student’S T ◽

Lung Machine ◽

Student’S T Test

Cardiopulmonary bypass (CPB) leads to a generalized inflammatory reaction, resulting in increased postoperative leucocyte counts and decreased pulmonary function. In adults, removal of leucocytes from the residual heart - lung machine blood after CPB improved postoperative oxygenation. In children, however, the clinical effects of leucocyte filtration of the residual heart - lung machine blood are unknown. Therefore, we measured postoperative leucocyte counts and arterial blood oxygenation in children undergoing congenital cardiac surgery in a randomized prospective study. Anaesthesia and CPB were standardized. After CPB, the residual heart-lung machine blood was collected as usual. In a group of 25 children, this blood was filtered with a leucocyte depletion filter before transfusion. A control group of 25 children received this blood unfiltered. We found that the postoperative leucocyte counts were significantly lower in the filter group than in the control group ( p=0.02, repeated measurements ANOVA). This difference reached a maximum on the second postoperative day (12.9×109/L filter versus 15.9×109/L control, p=0.02, Student’s t-test). Values for the arterial blood oxygenation on the first postoperative day were not different between the two groups (15.5±1 kPa filter versus 14.6±1.3 kPa control, p=0.57, Student’s t-test). We conclude that leucocyte filtration of the residual heart-lung machine blood reduced systemic leucocyte counts, but did not improve arterial blood oxygenation in children after congenital heart surgery.

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Outcomes of Delayed Sternal Closure in Pediatric Heart Surgery: Single-Center Experience

BioMed Research International ◽

10.1155/2018/3742362 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Daniel Hurtado-Sierra ◽

Juan Calderón-Colmenero ◽

Pedro Curi-Curi ◽

Jorge Cervantes-Salazar ◽

Juan Pablo Sandoval ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Therapeutic Option ◽

Hemodynamic Instability ◽

Control Group ◽

Single Center ◽

Sternal Closure ◽

Pediatric Heart Surgery ◽

Single Center Experience ◽

Delayed Sternal Closure

Background. Delayed sternal closure (DSC) after cardiac surgery is a therapeutic option in the treatment of the severely impaired heart in pediatric cardiac surgery. Methods. A single-center retrospective review of all bypass surgeries performed over a 10-year period (2003–2012). Results. Of a total of 2325 patients registered in our database, the DSC group included 259 cases (11%), and the remaining 2066 cases (89%) constituted the control group (PSC). RACHS-1 risk was higher for the DSC group (74% had a score of 3 or 4) than for the PSC group (82% had a score of 2 or 3). The most frequent diagnosis for the DSC group was transposition of the great arteries (28%). We found out that hemodynamic instability was the main indication observed in patients aged ≤ 8 years (63%), while bleeding was the principal indication for patients aged ≥ 8 years (94%) (p≤0.001). The average time between surgery and sternal closure was 2.3±1.4 days. Overall mortality rates were higher for patients of the DSC group (22%) than for the PSC group (8.7%) (OR: 0.4 (95% CI: 0.4 to 0.5), p<0.05). There were six patients with DSC who developed mediastinitis (2.3%). The risk of mediastinitis was significantly higher when DSC was performed 4 days after the primary surgery. Conclusions. DSC is an important management strategy for congenital cardiac surgery in infants and children. The prolonged sternal closure time is associated with an increased rate of postoperative mediastinitis.

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Auricular vagal nerve stimulation in peripheral arterial disease patients

VASA ◽

10.1024/0301-1526/a000660 ◽

2017 ◽

Vol 46 (6) ◽

pp. 462-470 ◽

Cited By ~ 3

Author(s):

Gerald Hackl ◽

Andreas Prenner ◽

Philipp Jud ◽

Franz Hafner ◽

Peter Rief ◽

...

Keyword(s):

Primary Endpoint ◽

Nerve Stimulation ◽

Short Form ◽

Therapeutic Option ◽

Arterial Disease ◽

Walking Distance ◽

Control Group ◽

Sf 36 ◽

Peripheral Arterial ◽

Double Blinded

Abstract. Background: Auricular nerve stimulation has been proven effective in different diseases. We investigated if a conservative therapeutic alternative for claudication in peripheral arterial occlusive disease (PAD) via electroacupuncture of the outer ear can be established. Patients and methods: In this prospective, double-blinded trial an ear acupuncture using an electroacupuncture device was carried out in 40 PAD patients in Fontaine stage IIb. Twenty patients were randomized to the verum group using a fully functional electroacupuncture device, the other 20 patients received a sham device (control group). Per patient, eight cycles (1 cycle = 1 week) of electroacupuncture were performed. The primary endpoint was defined as a significantly more frequent doubling of the absolute walking distance after eight cycles in the verum group compared to controls in a standardized treadmill testing. Secondary endpoints were a significant improvement of the total score of the Walking Impairment Questionnaire (WIQ) as well as improvements in health related quality of life using the Short Form 36 Health Survey (SF-36). Results: There were no differences in baseline characteristics between the two groups. The initial walking distance significantly increased in both groups (verum group [means]: 182 [95 % CI 128–236] meters to 345 [95 % CI 227–463] meters [+ 90 %], p < 0.01; control group [means]: 159 [95 % CI 109–210] meters to 268 [95 % CI 182–366] meters [+ 69 %], p = 0.01). Twelve patients (60 %) in the verum group and five patients (25 %) in controls reached the primary endpoint of doubling walking distance (p = 0.05). The total score of WIQ significantly improved in the verum group (+ 22 %, p = 0.01) but not in controls (+ 8 %, p = 0.56). SF-36 showed significantly improvements in six out of eight categories in the verum group and only in one of eight in controls. Conclusions: Electroacupuncture of the outer ear seems to be an easy-to-use therapeutic option in an age of increasingly invasive and mechanically complex treatments for PAD patients.

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