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Thomas Spray cardiac

Jeremy L Herrmann, Leah A Goldberg, Abigail M Khan, Sara L Partington, Julie A Brothers, Christopher E Mascio, Thomas L Spray, Yuli Y Kim, Stephanie Fuller
BACKGROUND: Anomalous aortic origin of a coronary artery (AAOCA) presents in varying age-groups. Assuming management algorithms differ between pediatric and adult institutions, we compared the perioperative management of patients with AAOCA at two such centers. METHODS: A retrospective review was conducted at a pediatric and an adult institution of patients 14 years or older who underwent surgical repair of AAOCA between January 2000 and May 2014. RESULTS: Twenty patients from the pediatric center (median age: 16...
November 2016: World Journal for Pediatric & Congenital Heart Surgery
Laura K Diaz, J William Gaynor, Shannon J Koh, Richard F Ittenbach, Marsha Gerdes, Judy C Bernbaum, Elaine H Zackai, Robert R Clancy, Mohamed A Rehman, Jeffrey W Pennington, Nancy Burnham, Thomas L Spray, Susan C Nicolson
OBJECTIVES: Despite improved survival in children with hypoplastic left heart syndrome (HLHS), significant concern persists regarding their neurodevelopmental (ND) outcomes. Previous studies have identified patient factors, such as prematurity and genetic syndromes, to be associated with worse ND outcomes. However, no consistent relationships have been identified among modifiable management factors, including cardiopulmonary bypass strategies, and ND outcomes after cardiac surgery in infancy...
August 2016: Journal of Thoracic and Cardiovascular Surgery
Vaidehi Nayar, Andrea Kennedy, Janine Pappas, Krista D Atchley, Cynthia Field, Sarah Smathers, Eva E Teszner, Julia S Sammons, Susan E Coffin, Jeffrey S Gerber, Thomas L Spray, James M Steven, Louis M Bell, Joan Forrer, Fernando Gonzalez, Albert Chi, William J Nieczpiel, John N Martin, J William Gaynor
BACKGROUND: The use of administrative data for surgical site infection (SSI) surveillance leads to inaccurate reporting of SSI rates [1]. A quality improvement (QI) initiative was conducted linking clinical registry and administrative databases to improve reporting and reduce the incidence of SSI [2]. METHODS: At our institution, The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and infection surveillance database (ISD) were linked to the enterprise data warehouse containing electronic health record (EHR) billing data...
January 2016: Annals of Thoracic Surgery
Mark A Fogel, Christine Li, Felice Wilson, Tom Pawlowski, Susan C Nicolson, Lisa M Montenegro, Laura Diaz Berenstein, Thomas L Spray, J William Gaynor, Stephanie Fuller, Marc S Keller, Matthew A Harris, Kevin K Whitehead, Robert Clancy, Okan Elci, Jim Bethel, Arastoo Vossough, Daniel J Licht
OBJECTIVE: Patients with single ventricle can develop aortic-to-pulmonary collaterals (APCs). Along with systemic-to-pulmonary artery shunts, these structures represent a direct pathway from systemic to pulmonary circulations, and may limit cerebral blood flow (CBF). This study investigated the relationship between CBF and APC flow on room air and in hypercarbia, which increases CBF in patients with single ventricle. METHODS: 106 consecutive patients with single ventricle underwent 118 cardiac magnetic resonance (CMR) scans in this cross-sectional study; 34 prior to bidirectional Glenn (BDG) (0...
August 2015: Heart: Official Journal of the British Cardiac Society
Maryam Y Naim, J William Gaynor, Jodi Chen, Susan C Nicolson, Stephanie Fuller, Thomas L Spray, Dennis J Dlugos, Robert R Clancy, Livia Vianez Costa, Daniel J Licht, Rui Xiao, Heather Meldrum, Nicholas S Abend
OBJECTIVES: The American Clinical Neurophysiology Society recommends continuous electroencephalographic monitoring after neonatal cardiac surgery because seizures are common, often subclinical, and associated with worse neurocognitive outcomes. We performed a quality improvement project to monitor for postoperative seizures in neonates with congenital heart disease after surgery with cardiopulmonary bypass. METHODS: We implemented routine continuous electroencephalographic monitoring and reviewed the results for an 18-month period...
July 2015: Journal of Thoracic and Cardiovascular Surgery
Catherine M Avitabile, Laura Mercer-Rosa, Chitra Ravishankar, Jonathan J Rome, J William Gaynor, Thomas L Spray, Meryl S Cohen
BACKGROUND: Mitral valve (MV) abnormalities may adversely impact outcomes after biventricular repair of critical left-side heart obstruction. METHODS: Neonates with left-side heart obstruction and MV abnormality (anatomically abnormal or hypoplastic but otherwise normal [Z-score -1.5 to -4]) who underwent biventricular repair from December 2005 to December 2012 were included. Institutional selection criteria determined suitability for biventricular repair. Primary outcomes (death, univentricular conversion, pulmonary hypertension) and secondary outcomes (reinterventions) were compared between hypoplastic and anatomically abnormal MV groups...
March 2015: Annals of Thoracic Surgery
Thomas L Spray
No abstract text is available yet for this article.
December 2014: Journal of Thoracic and Cardiovascular Surgery
Mark A Fogel, Christine Li, Susan C Nicolson, Thomas L Spray, J William Gaynor, Stephanie Fuller, Marc S Keller, Matthew A Harris, Ajit P Yoganathan, Kevin K Whitehead
Pulse-wave velocity (PWV), a measure of arterial stiffness, is a known independent risk factor for cardiovascular events. Patients with single ventricle who undergo aortic to pulmonary anastomosis (recon) have noncompliant patch material inserted into the neoaorta, possibly increasing vessel stiffness and afterload. The purpose of this study is to determine if PWV in patients with single ventricle differed between those who did and those who did not undergo aortic reconstruction (nonrecon). We retrospectively reviewed cardiac magnetic resonance anatomic, cine, and phase contrast evaluations in the ascending aorta and descending aorta (DAo) at the level of the diaphragm data from 126 patients with single ventricle (8...
December 15, 2014: American Journal of Cardiology
Mark A Fogel, Tom Pawlowski, Peter J Schwab, Susan C Nicolson, Lisa M Montenegro, Laura Diaz Berenstein, Thomas L Spray, J William Gaynor, Stephanie Fuller, Marc S Keller, Matthew A Harris, Kevin K Whitehead, Arastoo Vossough, Daniel J Licht
BACKGROUND: Single-ventricle patients undergoing surgical reconstruction experience a high rate of brain injury. Incidental findings on preoperative brain scans may result in safety considerations involving hemorrhage extension during cardiopulmonary bypass that result in surgical postponement. METHODS: Single-ventricle patients were studied with brain scans immediately preoperatively, as part of a National Institutes of Health study, and were reviewed by neuroradiology immediately before cardiopulmonary bypass...
November 2014: Annals of Thoracic Surgery
Daniel Seung Kim, Jerry H Kim, Amber A Burt, David R Crosslin, Nancy Burnham, Donna M McDonald-McGinn, Elaine H Zackai, Susan C Nicolson, Thomas L Spray, Ian B Stanaway, Deborah A Nickerson, Mark W Russell, Hakon Hakonarson, J William Gaynor, Gail P Jarvik
BACKGROUND: Survival after cardiac surgery in infancy requires adaptive responses from oxidative stress management and vascular regulation pathways. We tested the hypothesis that genetic variation in these pathways influences postoperative survival in nonsyndromic congenital heart disease children. METHODS: This is an analysis of a cohort of nonsyndromic congenital heart disease patients who underwent cardiac surgery with cardiopulmonary bypass before 6 months of age (n=422)...
July 2014: Annals of Thoracic Surgery
Mary T Donofrio, Anita J Moon-Grady, Lisa K Hornberger, Joshua A Copel, Mark S Sklansky, Alfred Abuhamad, Bettina F Cuneo, James C Huhta, Richard A Jonas, Anita Krishnan, Stephanie Lacey, Wesley Lee, Erik C Michelfelder, Gwen R Rempel, Norman H Silverman, Thomas L Spray, Janette F Strasburger, Wayne Tworetzky, Jack Rychik
BACKGROUND: The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. METHODS AND RESULTS: A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options...
May 27, 2014: Circulation
Krista D Atchley, Janine M Pappas, Andrea T Kennedy, Susan E Coffin, Jeffrey S Gerber, Stephanie M Fuller, Thomas L Spray, Kenneth McCardle, J William Gaynor
BACKGROUND: The National Healthcare Safety Network (NHSN) is a safety surveillance system managed by the Centers for Disease Control and Prevention that monitors procedure specific rates of surgical site infections (SSIs). At our institution, SSI data is collected and reported by three different methods: (1) the NHSN database with reporting to the Centers for Disease Control and Prevention; (2) the hospital billing database with reporting to payers; and (3) The Society of Thoracic Surgeons Congenital Heart Surgery Database...
February 2014: Annals of Thoracic Surgery
Carol A Wittlieb-Weber, Stephen M Paridon, J William Gaynor, Thomas L Spray, David R Weber, Julie A Brothers
BACKGROUND: Anomalous aortic origin of a coronary artery with an interarterial and intramural course (AAOCA) is a rare anomaly with increased risk of sudden cardiac death during or just after exercise among otherwise healthy youth. Risk stratification and management remain controversial, especially for the asymptomatic child with an anomalous right coronary artery from the left coronary sinus (ARCA). Medium-term surgical and quality-of-life (QOL) outcome data are lacking in this population...
May 2014: Journal of Thoracic and Cardiovascular Surgery
Robin H Kinsley, Frank Edwin, Kow Entsua-Mensah
The Pediatric Cardiac Centre for Africa (PCCA) was opened by national patron Mr Nelson Mandela on November 7, 2003. In 2008, the Centre's international pediatric cardiac symposium was introduced as a learning forum for pediatric cardiac surgeons and cardiologists in the continent. The symposium has consistently grown in attendance and attracted distinguished leaders in the field. The 2012 symposium featured Dr. Thomas Spray of Children's Hospital of Philadelphia, Dr. David Barron of Birmingham Children's Hospital, and Dr...
April 2013: World Journal for Pediatric & Congenital Heart Surgery
J William Gaynor, Gail P Jarvik, Marsha Gerdes, Daniel S Kim, Ramakrishnan Rajagopalan, Judy Bernbaum, Gil Wernovsky, Susan C Nicolson, Thomas L Spray, Robert R Clancy
OBJECTIVE: The occurrence of an electroencephalographic (EEG) seizure after surgery for complex congenital heart defects has been associated with worse neurodevelopmental (ND) outcomes. We previously identified postoperative seizures documented by 48-hour EEG monitoring in 11% of 178 neonates and infants. Evaluation at 1 year of age did not identify an adverse effect of an EEG seizure on ND outcomes. The current study was undertaken to determine if testing in the preschool period would identify deficits that become apparent as children develop...
July 2013: Journal of Thoracic and Cardiovascular Surgery
Roxanne E Kirsch, Andrew C Glatz, J William Gaynor, Susan C Nicolson, Thomas L Spray, Gil Wernovsky, Geoffrey L Bird
OBJECTIVE: To report practice and outcomes in infants undergoing elective repair of tetralogy of Fallot. METHODS: A review of a retrospective cohort of elective complete repair of infants age 6 months or younger from 1995 to 2009 was performed. Patients were excluded because of previous interventions, hypercyanotic episodes, intensive care admissions, additional major cardiac defects, or if they were not discharged after birth. Length of stay, mortality, and complications were recorded...
February 2014: Journal of Thoracic and Cardiovascular Surgery
Brett R Anderson, Kristen N Stevens, Susan C Nicolson, Stephen B Gruber, Thomas L Spray, Gil Wernovsky, Peter J Gruber
OBJECTIVES: Surgical closure of ventricular septal defects remains the most common pediatric cardiac surgical procedure. No studies, however, have comprehensively analyzed risk factors and drivers of nonmortality outcomes in the current era. The purpose of this study was to assess both baseline characteristics and outcomes of children undergoing surgical repair of ventricular septal defects in a contemporary cohort. METHODS: This retrospective study examined a consecutive series of 369 ventricular septal defect closures at a single institution...
March 2013: Journal of Thoracic and Cardiovascular Surgery
Erin M Buckley, Maryam Y Naim, Jennifer M Lynch, Donna A Goff, Peter J Schwab, Laura K Diaz, Susan C Nicolson, Lisa M Montenegro, Natasha A Lavin, Turgut Durduran, Thomas L Spray, J William Gaynor, Mary E Putt, A G Yodh, Mark A Fogel, Daniel J Licht
BACKGROUND: Sodium bicarbonate (NaHCO3) is a common treatment for metabolic acidemia; however, little definitive information exists regarding its treatment efficacy and cerebral hemodynamic effects. This pilot observational study quantifies relative changes in cerebral blood flow (ΔrCBF) and oxy- and deoxyhemoglobin concentrations (ΔHbO2 and ΔHb) due to bolus administration of NaHCO3 in patients with mild base deficits. METHODS: Infants and children with hypoplastic left heart syndrome (HLHS) were enrolled before cardiac surgery...
May 2013: Pediatric Research
Erin M Buckley, Jennifer M Lynch, Donna A Goff, Peter J Schwab, Wesley B Baker, Turgut Durduran, David R Busch, Susan C Nicolson, Lisa M Montenegro, Maryam Y Naim, Rui Xiao, Thomas L Spray, A G Yodh, J William Gaynor, Daniel J Licht
OBJECTIVE: The early postoperative period following neonatal cardiac surgery is a time of increased risk for brain injury, yet the mechanisms underlying this risk are unknown. To understand these risks more completely, we quantified changes in postoperative cerebral metabolic rate of oxygen (CMRO(2)), oxygen extraction fraction (OEF), and cerebral blood flow (CBF) compared with preoperative levels by using noninvasive optical modalities. METHODS: Diffuse optical spectroscopy and diffuse correlation spectroscopy were used concurrently to derive cerebral blood flow and oxygen utilization postoperatively for 12 hours...
January 2013: Journal of Thoracic and Cardiovascular Surgery
Christopher M Haggerty, Diane A de Zélicourt, Maria Restrepo, Jarek Rossignac, Thomas L Spray, Kirk R Kanter, Mark A Fogel, Ajit P Yoganathan
Virtual modeling of cardiothoracic surgery is a new paradigm that allows for systematic exploration of various operative strategies and uses engineering principles to predict the optimal patient-specific plan. This study investigates the predictive accuracy of such methods for the surgical palliation of single ventricle heart defects. Computational fluid dynamics (CFD)-based surgical planning was used to model the Fontan procedure for four patients prior to surgery. The objective for each was to identify the operative strategy that best distributed hepatic blood flow to the pulmonary arteries...
December 2012: Annals of Biomedical Engineering
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