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https://www.readbyqxmd.com/read/28148334/training-fellows-and-residents-in-paediatric-cardiac-critical-care
#1
Sarah Tabbutt, Nancy Ghanayem, Melvin C Almodovar, John Charpie, Stephen J Roth, James Fortenberry, Ron Bronicki
As pediatric cardiac critical care becomes more sub-specialized it is reasonable to assume that dedicated units may provide a better infrastructure for improved multidisciplinary care, cardiac-specific patient safety initiatives, and dedicated training of fellows and residents. The knowledge base required to optimally manage pediatric patients with critical cardiac disease has evolved sufficiently to consider a standardized training curriculum and board certification for pediatric cardiac critical care. This strategy would potentially provide consistency of training and healthcare and improve quality of care and patient safety...
December 2016: Cardiology in the Young
https://www.readbyqxmd.com/read/28065432/turnstyle-gridlock-passenger-corpuscular-overload-or-slow-moving-train
#2
EDITORIAL
Nancy S Ghanayem, Ronald K Woods
No abstract text is available yet for this article.
November 19, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28012642/postoperative-cerebral-and-somatic-near-infrared-spectroscopy-saturations-and-outcome-in-hypoplastic-left-heart-syndrome
#3
George M Hoffman, Nancy S Ghanayem, John P Scott, James S Tweddell, Michael E Mitchell, Kathleen A Mussato
BACKGROUND: Circulatory vulnerability reflected by low systemic venous oxygen saturation after surgical palliation of hypoplastic left heart syndrome predicts adverse neurologic outcome and reduced survival, and targeting venous saturation may improve outcome. We herein test the hypothesis that near-infrared spectroscopy (NIRS)-derived cerebral and somatic/renal regional saturations can predict survival. METHODS: Patient data, from a prospective Institutional Review Board-approved registry of hemodynamic measures after initial palliation of hypoplastic left heart syndrome, were analyzed with logistic and multivariable mixed regression methods to determine relationships between standard hemodynamic measures, direct and NIRS measures of saturation, and outcome...
December 21, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28007060/mechanical-circulatory-support-of-the-fontan-patient
#4
REVIEW
Ronald K Woods, Nancy S Ghanayem, Michael E Mitchell, Steven Kindel, Robert A Niebler
Because of the inadequacies inherent to a circulation supported by a single ventricle, many Fontan patients will experience failure of their circulation. To date, there is no medical regimen that reliably and consistently restores circulatory function in these patients. Because of the shortage of donor organs and the fact that many of these patients present with features that either preclude or render heart transplantation a high risk, there is an intense need to better understand how mechanical circulatory support (MCS) may benefit these patients...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/27558553/center-variability-in-timing-of-stage-2-palliation-and-association-with-interstage-mortality-a-report-from-the-national-pediatric-cardiology-quality-improvement-collaborative
#5
Garick D Hill, Nancy A Rudd, Nancy S Ghanayem, David A Hehir, Peter J Bartz
For infants with single-ventricle lesions with aortic arch hypoplasia, the interstage period from discharge following stage 1 palliation (S1P) until stage 2 palliation (S2P) remains high risk. Significant variability among institutions exists around the timing of S2P. We sought to describe institutional variation in timing of S2P, determine the association between timing of S2P and interstage mortality, and determine the impact of earlier S2P on hospital morbidity and mortality. The National Pediatric Cardiology Quality Improvement Collaborative registry was queried...
December 2016: Pediatric Cardiology
https://www.readbyqxmd.com/read/27490617/hypoplastic-left-heart-syndrome-and-other-shunt-dependent-single-ventricles
#6
Sarah Tabbutt, James S Tweddell, Nancy Ghanayem
OBJECTIVES: In this review, we discuss the pathophysiology, treatment, and outcomes of patients with the hypoplastic left heart syndrome and other single ventricle variants prior to and following surgery. DATA SOURCE: MEDLINE and PubMed. CONCLUSIONS: Patients with shunted single ventricle physiology are at increased risk for acute hemodynamic decompensation owing to the increased myocardial workload, the dynamic balance between systemic and pulmonary circulations, and the potential for shunt obstruction...
August 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27490600/near-infrared-spectroscopy-as-a-hemodynamic-monitor-in-critical-illness
#7
Nancy S Ghanayem, George M Hoffman
OBJECTIVES: The objectives of this review are to discuss the technology and clinical interpretation of near infrared spectroscopy oximetry and its clinical application in patients with congenital heart disease. DATA SOURCE: MEDLINE and PubMed. CONCLUSION: Near infrared spectroscopy provides a continuous noninvasive assessment of tissue oxygenation. Over 20 years ago, near infrared spectroscopy was introduced into clinical practice for monitoring cerebral oxygenation during cardiopulmonary bypass in adults...
August 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/27425254/bacteremia-in-patients-with-heterotaxy-a-review-and-implications-for-management
#8
REVIEW
Rohit S Loomba, Gabrielle C Geddes, Donald Basel, Dudley W Benson, Steven R Leuthner, David A Hehir, Nancy Ghanayem, Amanda J Shillingford
Heterotaxy (HTX) is a laterality defect resulting in abnormal arrangement of the thoracic and abdominal organs across the right-left axis, and is associated with multiple anatomic and physiologic disruptions. HTX often occurs in association with complex congenital heart disease. Splenic abnormalities are also common and convey an increased risk of bacteremia (bacteremia) with a high associated mortality. We performed a systematic review of the literature studying the risk of infection in HTX patients and strategies that can be utilized to prevent such infections...
December 2016: Congenital Heart Disease
https://www.readbyqxmd.com/read/27197775/adverse-events-in-children-implanted-with-ventricular-assist-devices-in-the-united-states-%C3%A2-data-from-the-pediatric-interagency-registry-for-mechanical-circulatory-support-pedimacs
#9
David N Rosenthal, Christopher S Almond, Robert D Jaquiss, Christine E Peyton, Scott R Auerbach, David R Morales, Deirdre J Epstein, Ryan S Cantor, Robert L Kormos, David C Naftel, Ryan J Butts, Nancy S Ghanayem, James K Kirklin, Elizabeth D Blume
BACKGROUND: Ventricular assist devices (VADs) have been used in children on an increasing basis in recent years. One-year survival rates are now >80% in multiple reports. In this report we describe adverse events experienced by children with durable ventricular assist devices, using a national-level registry (PediMACS, a component of INTERMACS) METHODS: PediMACS is a national registry that contains clinical data on patients who are <19 years of age at the time of VAD implantation...
May 2016: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/27185218/risk-factors-and-outcomes-of-in-hospital-cardiac-arrest-following-pediatric-heart-operations-of-varying-complexity
#10
Punkaj Gupta, Mallikarjuna Rettiganti, Howard E Jeffries, Matthew C Scanlon, Nancy S Ghanayem, Jennifer Daufeldt, Tom B Rice, Randall C Wetzel
BACKGROUND: Multi center data regarding cardiac arrest in children undergoing heart operations of varying complexity are limited. METHODS: Children <18 years undergoing heart surgery (with or without cardiopulmonary bypass) in the Virtual Pediatric Systems (VPS, LLC) Database (2009-2014) were included. Multivariable mixed logistic regression models were adjusted for patient's characteristics, surgical risk category (STS-EACTS Categories 1, 2, and 3 classified as "low" complexity and Categories 4 and 5 classified as "high" complexity), and hospital characteristics...
August 2016: Resuscitation
https://www.readbyqxmd.com/read/26714998/training-pathways-in-pediatric-cardiac-intensive-care-proceedings-from-the-10th-international-conference-of-the-pediatric-cardiac-intensive-care-society
#11
REVIEW
Vijay Anand, David M Kwiatkowski, Nancy S Ghanayem, David M Axelrod, James DiNardo, Darren Klugman, Ganga Krishnamurthy, Stephanie Siehr, Daniel Stromberg, Andrew R Yates, Stephen J Roth, David S Cooper
The increase in pediatric cardiac surgical procedures and establishment of the practice of pediatric cardiac intensive care has created the need for physicians with advanced and specialized knowledge and training. Current training pathways to become a pediatric cardiac intensivist have a great deal of variability and have unique strengths and weaknesses with influences from critical care, cardiology, neonatology, anesthesiology, and cardiac surgery. Such variability has created much confusion among trainees looking to pursue a career in our specialized field...
January 2016: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/26675610/perioperative-feeding-management-of-neonates-with-chd-analysis-of-the-pediatric-cardiac-critical-care-consortium-pc4-registry
#12
MULTICENTER STUDY
Jeffrey A Alten, Leslie A Rhodes, Sarah Tabbutt, David S Cooper, Eric M Graham, Nancy Ghanayem, Bradley S Marino, Mayte I Figueroa, Nikhil K Chanani, Jeffrey P Jacobs, Janet E Donohue, Sunkyung Yu, Michael Gaies
UNLABELLED: Introduction The optimal perioperative feeding strategies for neonates with CHD are unknown. In the present study, we describe the current feeding practices across a multi-institutional cohort. METHODS: Inclusion criteria for this study were as follows: all neonates undergoing cardiac surgery admitted to the cardiac ICU for ⩾24 hours preoperatively between October, 2013 and July, 2014 in the Pediatric Cardiac Critical Care Consortium registry. RESULTS: The cohort included 251 patients from eight centres...
December 2015: Cardiology in the Young
https://www.readbyqxmd.com/read/26620919/a-pilot-study-of-antithrombin-replacement-prior-to-cardiopulmonary-bypass-in-neonates
#13
RANDOMIZED CONTROLLED TRIAL
Robert A Niebler, Katherine J Woods, Kathleen Murkowski, Nancy S Ghanayem, George Hoffman, Michael E Mitchell, Rowena C Punzalan, J Paul Scott, Pippa Simpson, James S Tweddell
Neonates have low levels of antithrombin. Inadequate anticoagulation during cardiopulmonary bypass (CPB) due to low antithrombin activity may result in a poor preservation of the coagulation system during bypass. We hypothesize that antithrombin replacement to neonates prior to CPB will preserve the hemostatic system and result in less postoperative bleeding. A randomized, double-blinded, placebo-controlled pilot study of antithrombin replacement to neonates prior to CPB was conducted. Preoperative antithrombin levels determined the dose of recombinant antithrombin or placebo to be given...
January 2016: Artificial Organs
https://www.readbyqxmd.com/read/26279364/impact-of-intrauterine-growth-restriction-on-cardiac-surgical-outcomes-and-resource-use
#14
Ryan Graf, Nancy S Ghanayem, Raymond Hoffmann, Mahua Dasgupta, Maryanne Kessel, Michael E Mitchell, James S Tweddell, Ronald K Woods
BACKGROUND: We sought to evaluate outcomes of congenital heart operations and resource use in patients with intrauterine growth restriction (IUGR). METHODS: This was a retrospective matched case-control study of 41 consecutive patients with IUGR matched 1:2 with a comparison cohort of 82 contemporaneous patients without IUGR who underwent congenital heart operations during the interval from January 1, 2000 to January 1, 2012. Matching was based on the Risk Adjustment for Congenital Heart Surgery (RACHS)-1 risk category, diagnostic category, age at operation, and gestational age...
October 2015: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/26147841/ventricular-assist-device-in-single-ventricle-heart-disease-and-a-superior-cavopulmonary-anastomosis
#15
Robert A Niebler, Tejas K Shah, Michael E Mitchell, Ronald K Woods, Steven D Zangwill, James S Tweddell, Stuart Berger, Nancy S Ghanayem
Our objective is to describe the use of a ventricular assist device (VAD) in single-ventricle patients with circulatory failure following superior cavopulmonary anastomosis (SCPA). We performed a retrospective chart review of all single-ventricle patients supported with a VAD following SCPA. Implantation techniques, physiologic parameters while supported, medical and surgical interventions postimplant, and outcomes were reviewed. Four patients were supported with an EXCOR Pediatric (Berlin Heart Inc., The Woodlands, TX, USA) following SCPA for a median duration of 10...
February 2016: Artificial Organs
https://www.readbyqxmd.com/read/25917996/neurodevelopmental-outcomes-after-cardiac-surgery-in-infancy
#16
J William Gaynor, Christian Stopp, David Wypij, Dean B Andropoulos, Joseph Atallah, Andrew M Atz, John Beca, Mary T Donofrio, Kim Duncan, Nancy S Ghanayem, Caren S Goldberg, Hedwig Hövels-Gürich, Fukiko Ichida, Jeffrey P Jacobs, Robert Justo, Beatrice Latal, Jennifer S Li, William T Mahle, Patrick S McQuillen, Shaji C Menon, Victoria L Pemberton, Nancy A Pike, Christian Pizarro, Lara S Shekerdemian, Anne Synnes, Ismee Williams, David C Bellinger, Jane W Newburger
BACKGROUND: Neurodevelopmental disability is the most common complication for survivors of surgery for congenital heart disease (CHD). METHODS: We analyzed individual participant data from studies of children evaluated with the Bayley Scales of Infant Development, second edition, after cardiac surgery between 1996 and 2009. The primary outcome was Psychomotor Development Index (PDI), and the secondary outcome was Mental Development Index (MDI). RESULTS: Among 1770 subjects from 22 institutions, assessed at age 14...
May 2015: Pediatrics
https://www.readbyqxmd.com/read/25647388/preoperative-management-of-the-neonate-with-critical-aortic-valvar-stenosis
#17
REVIEW
Jeremy T Affolter, Nancy S Ghanayem
Neonatal critical aortic stenosis is a rare form of CHD that often presents with cardiogenic shock. Although surgical and cardiac catheterisation-based interventions have been successful in alleviating left ventricular outflow tract obstruction, it remains associated with high morbidity and mortality. Critical aortic stenosis results in elevated left ventricular wall stress, which ultimately increases myocardial oxygen consumption and disrupts coronary artery perfusion during diastole, leading to ventricular dysfunction and cardiogenic shock...
December 2014: Cardiology in the Young
https://www.readbyqxmd.com/read/25282659/validation-of-association-of-the-apolipoprotein-e-%C3%AE%C2%B52-allele-with-neurodevelopmental-dysfunction-after-cardiac-surgery-in-neonates-and-infants
#18
J William Gaynor, Daniel Seung Kim, Cammon B Arrington, Andrew M Atz, David C Bellinger, Amber A Burt, Nancy S Ghanayem, Jeffery P Jacobs, Teresa M Lee, Alan B Lewis, William T Mahle, Bradley S Marino, Stephen G Miller, Jane W Newburger, Christian Pizarro, Chitra Ravishankar, Avni B Santani, Nicole S Wilder, Gail P Jarvik, Seema Mital, Mark W Russell
OBJECTIVE: Apolipoprotein E (APOE) genotype is a determinant of neurologic recovery after brain ischemia and traumatic brain injury. The APOE ε2 allele has been associated with worse neurodevelopmental (ND) outcome after repair of congenital heart defects (CHD) in infancy. Replication of this finding in an independent cohort is essential to validate the observed genotype-phenotype association. METHODS: The association of APOE genotype with ND outcomes was assessed in a combined cohort of patients with single-ventricle CHD enrolled in the Single Ventricle Reconstruction and Infant Single Ventricle trials...
December 2014: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/25167212/collaborative-quality-improvement-in-the-cardiac-intensive-care-unit-development-of-the-paediatric-cardiac-critical-care-consortium-pc4
#19
Michael Gaies, David S Cooper, Sarah Tabbutt, Steven M Schwartz, Nancy Ghanayem, Nikhil K Chanani, John M Costello, Ravi R Thiagarajan, Peter C Laussen, Lara S Shekerdemian, Janet E Donohue, Gina M Willis, J William Gaynor, Jeffrey P Jacobs, Richard G Ohye, John R Charpie, Sara K Pasquali, Mark A Scheurer
Despite many advances in recent years for patients with critical paediatric and congenital cardiac disease, significant variation in outcomes remains across hospitals. Collaborative quality improvement has enhanced the quality and value of health care across specialties, partly by determining the reasons for variation and targeting strategies to reduce it. Developing an infrastructure for collaborative quality improvement in paediatric cardiac critical care holds promise for developing benchmarks of quality, to reduce preventable mortality and morbidity, optimise the long-term health of patients with critical congenital cardiovascular disease, and reduce unnecessary resource utilisation in the cardiac intensive care unit environment...
June 2015: Cardiology in the Young
https://www.readbyqxmd.com/read/25086944/anterior-tracheal-suspension-for-tracheobronchomalacia-in-infants-and-children
#20
Michael E Mitchell, Nisreen Rumman, Robert H Chun, Aparna Rao, Timothy Martin, David J Beste, Richard J Berens, Daiva E Parakininkas, Nancy S Ghanayem, Mary J Hubert, Michael Uhing, Pippa Simpson, Thomas T Sato, James S Tweddell, Joseph E Kerschner
BACKGROUND: Severe tracheobronchomalacia significantly complicates the postoperative course of infants and children with congenital heart disease, tracheoesophageal fistula, and tracheal stenosis. We have found that traditional approaches, including aortopexy, have been inconsistent in preventing acute life threatening events (ALTEs). In order to directly support the anterior tracheal wall, we have adopted the use of direct anterior tracheal suspension (ATS). METHODS: Twenty-one children, median age 5 months (35 days to 11 years) and weight 5...
October 2014: Annals of Thoracic Surgery
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