Marino, BS; Tabbutt, S; MacLaren, G; Hazinski, MF; Adatia, I; Atkins, DL; Checchia, PA; DeCaen, A; Fink, EL; Hoffman, GM; Jefferies, JL; Kleinman, M; Krawczeski, CD; Licht, DJ; Macrae, D; Ravishankar, C; Samson, RA; Thiagarajan, RR; Toms, R; Tweddell, J; Laussen, PC; American Heart Association Congenital Cardiac Defe. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease: A Scientific Statement From the American Heart Association. Circulation. 2018; 137(22):e691-e782.
This statement is for caregivers of children with heart disease in the prehospital and in-hospital settings. Understanding the anatomy and physiology of the high-risk pediatric cardiac population will promote early recognition and treatment of decompensation to prevent cardiac arrest, increase survival from cardiac arrest by providing high-quality resuscitations, and improve outcomes with post-resuscitation care.
Martinez, HR; Wittekind, S; Bryant, R 3rd; Tweddell, JS; Chin, C. Identifiable Risk Factors and Miscalculations During Listing for Pediatric Heart Transplantation. Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual. 2018; 21:2-8.
Mistakes from health-care providers negatively impact and compound the high-risk status of the patient in transplant survival. The identification of multiple risk factors and undesirable miscalculations may help transplant teams make decisions before allocating organs, intervene or minimize morbidity, and provide the best quality of life to recipients.
Moore, R; D'Souza, G; Villa, C; Taylor, M; Morales, DLS; Lorts, A. Optimizing surgical placement of the HeartWare ventricular assist device in children and adolescents by virtual implantation. Progress in Pediatric Cardiology. 2017; 47:11-13.
The HeartWare HVAD and other continuous flow ventricular assist devices (VADs) advanced the care of children with medically resistant heart failure tremendously. No longer is VAD support just a bridge to transplant (used for ~40% of all children awaiting transplant), but a stand-alone therapy for children used instead of transplant. The use of measurements such as weight or body surface area to determine if children and adolescents can benefit from this technology compared to advanced radiological imaging is an antiquated mindset. This study demonstrates how virtual implantation can determine whether devices such as the HVAD will fit by creating an individual assessment based on a patient’s body habitus and internal anatomy. The benefits of this technology are many: it’s also used to help the development of smaller devices, and is a key component in virtual surgery, allowing us to plan for patient-specific complex congenital heart operations.
Sachdeva, S; Jacobsen, RM; Woods, RK; Mitchell, ME; Cava, JR; Ghanayem, NS; Frommelt, PC; Bartz, PJ; Tweddell, JS. Anatomic Repair of Congenitally Corrected Transposition of the Great Arteries: Single-Center Intermediate-Term Experience. Pediatric Cardiology. 2017; 38(8):1696-1702.
Congenitally corrected transposition of the great arteries is a rare cardiac malformation characterized by atrioventricular and ventriculoarterial discordance resulting from abnormal looping of the embryonic cardiac tube. The majority of these patients have associated cardiac defects, commonly ventricular septal defects, pulmonary stenosis, pulmonary atresia, tricuspid regurgitation, and/or double outlet right ventricle. Physiological repair results in a high rate of late morphologic right ventricular dysfunction and tricuspid regurgitation. In contrast, anatomic repair consists of redirection of blood flow at both the atrial and arterial levels in order to place the morphologic left ventricle in the systemic position. This paper summarizes a single surgeon experience with anatomic repair showing that excellent early and midterm results.
Zafar, F; Jaquiss, RD; Almond, CS; Lorts, A; Chin, C; Rizwan, R; Bryant, R 3rd; Tweddell, JS; Morales, DLS. Pediatric Heart Donor Assessment Tool (PH-DAT): A novel donor risk scoring system to predict 1-year mortality in pediatric heart transplantation. Journal of Heart and Lung Transplantation. 2018; 37(3):332-339.
Heart transplantation remains the best treatment option for children with end-stage heart failure; however, a persistent national organ donor shortage limits the availability of pediatric heart transplant, resulting in longer waiting list times and increased death on waiting list. Unfortunately, individual institutions discard around 60% of currently available donor hearts because of criteria mostly not data-driven. An increase in utilization of donors that are otherwise considered high-risk as shown in the European experience does not to affect post-transplantation outcomes, however, in the U.S., there has been no policy change in utilization of high-risk donors since the year 2000. The Pediatric Heart Donor Assessment Tool (PH-DAT) is a novel, pediatric-specific, donor risk scoring system that appears capable of predicting post-transplant mortality and defines high-risk donors. This tool could allow collective stratification of donor risk and will likely lead to better utilization of currently available donor hearts. With further validation, age-specific PH-DATs may result in a national standardized donor selection guide similar to that in kidney transplantation.