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https://www.readbyqxmd.com/read/29684375/cumulative-effect-of-preoperative-risk-factors-on-mortality-after-pediatric-heart-transplantation
#1
Matthew J O'Connor, Andrew C Glatz, Joseph W Rossano, Robert E Shaddy, Rachel Ryan, Chitra Ravishankar, Stephanie Fuller, Christopher E Mascio, J William Gaynor, Kimberly Y Lin
BACKGROUND: Risk assessment in heart transplantation is critical for candidate selection, but current models inadequately assess individual risk of postoperative mortality. We sought to identify risk factors and develop a scoring system to predict mortality following heart transplantation in children. METHODS: The records of patients undergoing heart transplantation at our institution from 2010 - 2016 were reviewed. Clinical characteristics were recorded and compared between survivors and non-survivors...
April 20, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29601806/remote-ischemic-preconditioning-does-not-prevent-white-matter-injury-in-neonates
#2
J William Gaynor, Susan C Nicolson, Diane M Spray, Nancy B Burnham, Jesse L Chittams, Therese Sammarco, Kevin W Walsh, Thomas L Spray, Daniel J Licht
BACKGROUND: Remote ischemic preconditioning (RIPC) is a mechanism to protect tissues from injury during ischemia and reperfusion. We investigated the neuroprotective effects of RIPC in neonates undergoing cardiac surgery. METHODS: The outcome was white matter injury (WMI), assessed by the change in volume of WMI from preoperative to postoperative brain MRI. Subjects were randomized to RIPC or SHAM. RIPC was induced prior to cardiopulmonary bypass by four 5 minute cycles of blood pressure cuff inflation to produce ischemia of the lower extremity...
March 27, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29452463/autosomal-dominant-mannose-binding-lectin-deficiency-is-associated-with-worse-neurodevelopmental-outcomes-after-cardiac-surgery-in-infants
#3
Daniel Seung Kim, Yatong K Li, Jerry H Kim, Curtis S Bergquist, Marsha Gerdes, Judy C Bernbaum, Nancy Burnham, Donna M McDonald-McGinn, Elaine H Zackai, Susan C Nicolson, Thomas L Spray, Deborah A Nickerson, Hakon Hakonarson, Gail P Jarvik, J William Gaynor
OBJECTIVES: The MBL2 gene is the major genetic determinant of mannose-binding lectin (MBL)-an acute phase reactant. Low MBL levels have been associated with adverse outcomes in preterm infants. The MBL2Gly54Asp missense variant causes autosomal dominant MBL deficiency. We tested the hypothesis that MBL2Gly54Asp is associated with worse neurodevelopmental outcomes after cardiac surgery in neonates. METHODS: This is an analysis of a previously described cohort of patients with nonsyndromic congenital heart disease who underwent cardiac surgery with cardiopulmonary bypass before age 6 months (n = 295)...
March 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29447332/the-impact-of-the-maternal-foetal-environment-on-outcomes-of-surgery-for-congenital-heart-disease-in-neonates
#4
James William Gaynor, Samuel Parry, Julie S Moldenhauer, Rebecca A Simmons, Jack Rychik, Richard F Ittenbach, William W Russell, Erin Zullo, John Laurenson Ward, Susan C Nicolson, Thomas L Spray, Mark P Johnson
OBJECTIVES: Pregnancies with congenital heart disease in the foetus have an increased prevalence of pre-eclampsia, small for gestational age and preterm birth, which are evidence of an impaired maternal-foetal environment (MFE). METHODS: The impact of an impaired MFE, defined as pre-eclampsia, small for gestational age or preterm birth, on outcomes after cardiac surgery was evaluated in neonates (n = 135) enrolled in a study evaluating exposure to environmental toxicants and neuro-developmental outcomes...
February 13, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29399723/evolution-of-the-application-of-techniques-derived-from-abdominal-transplant-surgery-in-urologic-oncology
#5
REVIEW
Javier González, Jeffrey J Gaynor, Mahmoud Alameddine, Gaetano Ciancio
PURPOSE OF REVIEW: The techniques derived from abdominal transplant surgery have become a major actor in recent surgical evolution by providing a more optimal solution for urologic malignancies hosted in the upper abdomen. To describe in detail the objectives, rationale, relevant milestones, and surgical maneuvers of the so-called transplant techniques as applied to complex urologic oncology cases. RECENT FINDINGS: The transplant-based surgical approach aims to decrease perioperative complications by improving tumor accessibility and field visibility through an enhanced exposure (via the use of a transverse incision, a specific retractor, and specific surgical maneuvers)...
February 5, 2018: Current Urology Reports
https://www.readbyqxmd.com/read/29353520/indications-complications-and-outcomes-following-surgical-management-of-locally-advanced-and-metastatic-renal-cell-carcinoma
#6
Javier González, Jeffrey J Gaynor, Mahmoud Alameddine, Manuel Esteban, Gaetano Ciancio
Surgery may set the basis for a potential cure or would provide the best achievable quality of life in locally advanced or metastatic renal cell carcinoma (mRCC). However, survival extension with this approach would be scarce and not exempt from adverse events, thus preventing its recommendation in an already frail patient. An evidence based analysis on the role of surgery in each of the possible clinical scenarios involved under this heading may provide a clear picture on this issue and would be of value in the decision making process...
March 2018: Expert Review of Anticancer Therapy
https://www.readbyqxmd.com/read/29346537/cerebral-mitochondrial-dysfunction-associated-with-deep-hypothermic-circulatory-arrest-in-neonatal-swine
#7
Constantine D Mavroudis, Michael Karlsson, Tiffany Ko, Marco Hefti, Javier I Gentile, Ryan W Morgan, Ross Plyler, Kobina G Mensah-Brown, Timothy W Boorady, Richard W Melchior, Tami M Rosenthal, Brandon C Shade, Kellie L Schiavo, Susan C Nicolson, Thomas L Spray, Robert M Sutton, Robert A Berg, Daniel J Licht, J William Gaynor, Todd J Kilbaugh
OBJECTIVES: Controversy remains regarding the use of deep hypothermic circulatory arrest (DHCA) in neonatal cardiac surgery. Alterations in cerebral mitochondrial bioenergetics are thought to contribute to ischaemia-reperfusion injury in DHCA. The purpose of this study was to compare cerebral mitochondrial bioenergetics for DHCA with deep hypothermic continuous perfusion using a neonatal swine model. METHODS: Twenty-four piglets (mean weight 3.8 kg) were placed on cardiopulmonary bypass (CPB): 10 underwent 40-min DHCA, following cooling to 18°C, 10 underwent 40 min DHCA and 10 remained at deep hypothermia for 40 min; animals were subsequently rewarmed to normothermia...
January 15, 2018: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29246336/hearing-loss-after-cardiac-surgery-in-infancy-an-unintended-consequence-of-life-saving-care
#8
Madison A Grasty, Richard F Ittenbach, Carol Knightly, Cynthia B Solot, Marsha Gerdes, Judy C Bernbaum, Gil Wernovsky, Thomas L Spray, Susan C Nicolson, Robert R Clancy, Daniel J Licht, Elaine Zackai, J William Gaynor, Nancy B Burnham
OBJECTIVES: To investigate the prevalence of hearing loss after cardiac surgery in infancy, patient and operative factors associated with hearing loss, and the relationship of hearing loss to neurodevelopmental outcomes. STUDY DESIGN: Audiologic and neurodevelopmental evaluations were conducted on 348 children who underwent repair of congenital heart disease at the Children's Hospital of Philadelphia as part of a prospective study evaluating neurodevelopmental outcomes at 4 years of age...
January 2018: Journal of Pediatrics
https://www.readbyqxmd.com/read/29224753/castillo-morales-appliance-therapy-in-the-treatment-of-drooling-children
#9
Silvia Marinone, Wanda Gaynor, James Johnston, Murali Mahadevan
OBJECTIVE: To evaluate the efficacy of Castillo Morales Appliance Therapy (CMAT) in reducing the severity and frequency of problematic drooling in children. METHODS: A de-identified extraction of all hospital morbidity records belonging to patients with drooling who underwent treatment with CMAT was performed between June 22, 2000 and April 12, 2016. Data were obtained from Starship Children's Hospital clinical records department. Demographic, diagnostic, and procedural data were included...
December 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28927471/a-vascular-endothelial-growth-factor-a-genetic-variant-is-associated-with-improved-ventricular-function-and-transplant-free-survival-after-surgery-for-non-syndromic-chd
#10
Constantine D Mavroudis, Daniel Seung Kim, Nancy Burnham, Alexandra H Morss, Jerry H Kim, Amber A Burt, David R Crosslin, Donna M McDonald-McGinn, Elaine H Zackai, Meryl S Cohen, Susan C Nicolson, Thomas L Spray, Ian B Stanaway, Deborah A Nickerson, Mark W Russell, Hakon Hakonarson, Gail P Jarvik, J William Gaynor
BACKGROUND: We have previously shown that the minor alleles of vascular endothelial growth factor A (VEGFA) single-nucleotide polymorphism rs833069 and superoxide dismutase 2 (SOD2) single-nucleotide polymorphism rs2758331 are both associated with improved transplant-free survival after surgery for CHD in infants, but the underlying mechanisms are unknown. We hypothesised that one or both of these minor alleles are associated with better systemic ventricular function, resulting in improved survival...
January 2018: Cardiology in the Young
https://www.readbyqxmd.com/read/28826991/parents-preferences-regarding-public-reporting-of-outcomes-in-congenital-heart-surgery
#11
Mallory L Irons, J William Gaynor, Thomas L Spray, Chris Feudtner
BACKGROUND: Calls for public reporting of outcomes in congenital heart surgery have led to several different reporting schemes, including a star rating system and benchmark procedure-specific mortality data tables. Important unanswered questions remain about the optimal format and content of public reporting of congenital heart surgery outcomes. METHODS: In conjunction with three parent advocacy groups, we developed a questionnaire to gauge parents' attitudes regarding the format and content of an "optimal" public reporting scheme...
February 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28598945/long-term-outcomes-of-pediatric-cardiac-patients-supported-by-extracorporeal-membrane-oxygenation
#12
Matthew D Elias, Barbara-Jo Achuff, Richard F Ittenbach, Chitra Ravishankar, Thomas L Spray, Stephanie Fuller, Lisa M Montenegro, J William Gaynor, Matthew J O'Connor
OBJECTIVE: Extracorporeal membrane oxygenation is an important form of short-term mechanical support in children with cardiac disease, but information on long-term outcomes and quality of life is limited. The primary objective of this study was to determine the long-term outcomes of children previously supported by extracorporeal membrane oxygenation for cardiac etiologies. DESIGN: A retrospective analysis was performed on patients with cardiac disease managed with extracorporeal membrane oxygenation between January 1, 1995, and December 31, 2012, at the Children's Hospital of Philadelphia...
August 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28499652/lack-of-furosemide-responsiveness-predicts-acute-kidney-injury-in-infants-after-cardiac-surgery
#13
Aadil Kakajiwala, Ji Young Kim, John Z Hughes, Andrew Costarino, John Ferguson, J William Gaynor, Susan L Furth, Joshua J Blinder
BACKGROUND: This was a retrospective study to determine whether lack of furosemide responsiveness (LFR) predicts acute kidney injury (AKI) after cardiopulmonary bypass surgery in infants. METHODS: Infants (less than 1 year of age) undergoing cardiopulmonary bypass surgery, receiving routine postoperative furosemide (0.8 to 1.2 mg/kg per dose between 8 and 24 hours after surgery) were included. Urine output was measured 2 and 6 hours after furosemide dose. Lack of furosemide responsiveness was defined a priori as urine output less than 1 mL · kg(-1) · h(-1) after furosemide...
October 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28320512/effect-of-congenital-heart-disease-on-4-year-neurodevelopment-within-multiple-gestation-births
#14
Amy H Schultz, Richard F Ittenbach, Marsha Gerdes, Gail P Jarvik, Gil Wernovsky, Judy Bernbaum, Cynthia Solot, Robert R Clancy, Susan C Nicolson, Thomas L Spray, Donna McDonald-McGinn, Elaine Zackai, J William Gaynor
OBJECTIVES: We sought to assess the effect of congenital heart disease requiring infant surgery with cardiopulmonary bypass on neurodevelopmental outcomes and growth at 4 years of age, while matching for gestational age, socioeconomic status, maternal gestational conditions, home environment, and parental intelligence by studying multiple-gestation births. METHODS: We performed within-family comparison of 14 multiple-gestation births in which 1 child had congenital heart disease requiring surgery with cardiopulmonary bypass at ≤6 months of age...
July 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28287055/congenital-pulmonary-lymphangiectasia-and-early-mortality-after-stage-1-reconstruction-procedures
#15
Jeremy L Herrmann, Mallory L Irons, Christopher E Mascio, Jack Rychik, Thomas L Spray, J William Gaynor, Jennifer E Pogoriler
OBJECTIVES: Pulmonary lymphangiectasia associated with hypoplastic left heart syndrome with an intact or restrictive atrial septum may result from increased left atrial pressure, and is associated with worse outcomes following staged reconstruction due to lung dysfunction and significant hypoxaemia. Our objective was to characterise the incidence of pulmonary lymphangiectasia in cases of early mortality following stage 1 reconstructions. METHODS: An institutional cardiac surgical database was retrospectively searched for patients who died within 30 days following a stage 1 reconstruction between 1 January, 1984 and 31 December, 2013...
September 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/28284967/etiology-and-treatment-modalities-of-occipital-artery-aneurysms
#16
Nauman S Chaudhry, Brandon G Gaynor, Shahrose Hussain, Paul D Dernbach, Mohammad A Aziz-Sultan
BACKGROUND: Aneurysms of the external carotid artery represent approximately 2% of cervical carotid aneurysms, with the majority being traumatic pseudoaneurysms. Given the paucity of literature available for guidance, the diagnosis, treatment, and follow-up of such lesions are completely individualized. CASE DESCRIPTION: We report an 83-year-old woman with an 8-week history of headache in the occipital region, transient episode of gait disturbance, and pulsatile tinnitus on the right...
June 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28213856/inferior-vena-cava-system-anomalies-surgical-implications
#17
REVIEW
Javier González, Jeffrey J Gaynor, Luis F Albéniz, Gaetano Ciancio
PURPOSE OF REVIEW: The inferior vena cava (IVC) system is the major venous collecting blood network of the human body. This structure is formed in a complicated series of developmental stages between the fourth and eighth weeks of intrauterine life. Alterations in the developing process of the IVC system give rise to an array of different congenital variants or developmental anomalies. RECENT FINDINGS: IVC anomalies are uncommon, usually of little physiological consequence, and mostly discovered incidentally during cross-sectional imaging in otherwise healthy individuals...
February 2017: Current Urology Reports
https://www.readbyqxmd.com/read/28148316/design-and-initial-results-of-a-programme-for-routine-standardised-longitudinal-follow-up-after-congenital-heart-surgery
#18
Sara K Pasquali, Chitra Ravishankar, Jennifer C Romano, Kristin Kane, Suzanne Viers, Andrea Kennedy, Nancy Burnham, Ray Lowery, Karen Uzark, Lauren Retzloff, Jonathon J Rome, Joseph W Rossano, John R Charpie, Thomas L Spray, Michael G Gaies, Richard G Ohye, J William Gaynor
BACKGROUND: With improvements in early survival following congenital heart surgery, it has become increasingly important to understand longer-term outcomes; however, routine collection of these data is challenging and remains very limited. We describe the development and initial results of a collaborative programme incorporating standardised longitudinal follow-up into usual care at the Children's Hospital of Philadelphia (CHOP) and University of Michigan (UM). METHODS: We included children undergoing benchmark operations of the Society of Thoracic Surgeons...
December 2016: Cardiology in the Young
https://www.readbyqxmd.com/read/28007065/a-word-of-caution-in-public-reporting
#19
REVIEW
Thomas L Spray, J William Gaynor
Public reporting in its current form will lead to confusion amongst physicians, administrators, families, and the media. It is unclear that we are giving the families information they really need. At the current time there is no evidence that public reporting really leads to improved outcomes. Rather, it may lead to risk aversion and limit access to care. This is a problem not just for congenital heart surgery but for the entire field of medicine and the care that we provide to our patients. We must be very careful that we don't create a system where we are afraid to take on a patient with increased risk of mortality because it may affect our overall ranking...
January 2017: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
https://www.readbyqxmd.com/read/27919455/potential-benefits-and-consequences-of-public-reporting-of-pediatric-cardiac-surgery-outcomes
#20
EDITORIAL
J William Gaynor, Sara K Pasquali, Richard G Ohye, Thomas L Spray
No abstract text is available yet for this article.
October 28, 2016: Journal of Thoracic and Cardiovascular Surgery
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