Saturday, May 14, 2016 – Congenital Heart Disease Skills: Toward Technical Perfection
Ballroom III, Level 300, BCC Saturday, May 14, 2016 | 8:00 AM – 3:30 PM
Course Chair: *E. Dean McKenzie, Texas Children’s Hospital Course Co-Chair: *Krishna S. Iyer, Fortis Escorts Heart Institute Mitral Valve
Echocardiograpic Evaluation of the Mitral Valve
Gerald R. Marx, Boston Children’s Hospital
Mitral Valve Reparative Techniques in Small Children
*Pedro J. Del Nido, Boston Children’s Hospital
Mitral Valve Replacement in Newborns and Infants
*Yves d’Udekem, Children’s Hospital of Philadelphia Anomalous Aortic Origin of a Coronary Artery
Imaging Evaluation of AAOCA
Rajesh Krishnamurthy, Texas Children’s Hospital
Technique for Unroofing and Pulmonary Artery Translocation *Frank L. Hanley, Stanford University
Technique for Ostial Translocation
Neo-Ostial Creation Carlos M. Mery, Texas Children’s Hospital / Baylor College of Medicine
How I Conduct Operations Using DHCA
*Christian Pizarro, Alfred Dupont Hospital for Children
How I Conduct Operations Using Selective Cerebral Perfusion
*Frank A. Pigula, Boston Children’s Hospital
Repair of IAA
*Kirk R. Kanter, Emory University
Subaortic resection/VSD Closure/Autologous Arch Repair
*Charles D. Fraser, Texas Children’s Hospital
One Patch Method
*Richard A. Jonas, Children’s National Medical Center
Two Patch Method
*Krishna S. Iyer, Fortis Escorts Heart Institute
*Tom R. Karl, Johns Hopkins All Children’s Hospital
Combined Luncheon Video Interview
*Denton A. Cooley, Texas Heart Institute
Echocardiographic Evaluation for AVSD and Ebstein’s Anomaly
Girish S. Shirali, Children’s Mercy Hospital
Newborn Repair: How I Really Do This Operation
*Christopher J. Knott-Craig, Le Bonheur Children’s Hospital
Newborn Tricuspid Exclusion – How I Really Do This Operation
*Vaughn A. Starnes, Keck Hospital of USC
Technical Tricks for Adult Ebstein’s Repair
*Joseph A. Dearani, Mayo Clinic
HLHS Technical Refinement
MRI Assessment for Stage Single Ventricle Palliation
Shi-Joon Yoo, Hospital for Sick Children
Avoiding Arch Obstruction
*Thomas L. Spray, Children’s Hospital of Philadelphia
Avoiding Conduit Obstruction and Pulmonary Artery Distortion
*Shunji Sano, Okayama University
Comprehensive Stage II
Hakan Akintürk, Universitätsklinikun Giessen und Marburg
Sunday, May 15, 2016 – AATS/STS Congenital Heart Disease Symposium: Respecting Our Past; Embracing Our Future
Sunday, May 15, 2016 | 8:00 AM – 5:00 PM
Course Chair: *Charles D. Fraser, Texas Children’s Hospital Course Co-Chair: *George E. Sarris, Athens Heart Surgery Institute
Session I Moderators: *Marshall L. Jacobs, Johns Hopkins Hospital and *George E. Sarris, Athens Heart Surgery Institute
Pediatric VAD Update
Overview of Current Pediatric and Adult Devices in Congenital Heart Disease Iki Adachi, Texas Children’s Hospital
The Pumpkin Trial: We Are Close
Tim Baldwin, NHLBI
Total Artificial Heart Trial
*David L. Morales, Cincinnati Children’s Hospital
VAD’s in Adults with Failing Single Ventricles
Ronald K. Woods, Medical College of Wisconsin
Getting Increasingly Complex: Adult Congenital Cardiac Surgery
Controversy #1: Evolution of Adult-Congenital Heart Surgery – Optimal Environment?
The Emory System
*Brian E. Kogon, Emory University
The University of Pennsylvania System
*Michael A. Acker, University of Pennsylvania
Rescuing the Late Failing Fontan: Focus on Dysrhythmias
*Carl L. Backer, Lurie Children’s Hospital of Chicago
Session II Moderators: *Charles D. Fraser, Texas Children’s Hospital and *James S. Tweddell, Cincinnati Children’s Hospital
The Complex Arterial Switch Operation: Techniques and Outcomes
*Charles D. Fraser, Texas Children’s Hospital
Controversy #2: Ready or Not, Here Comes Public Reporting
What Every Parent Must Know
Annie Garcia, OpHeart
The STS CHS Public Reporting Initiative: It Is Here
*Jeffrey P. Jacobs, All Children’s Hospital
A Word of Caution in Public Reporting
*Thomas Spray, Children’s Hospital of Philadelphia
Complex Aortic Surgery in Children
Genetics of Aortopathies in Childhood
Hal Dietz, Johns Hopkins Hospital
Decisions and Operations in Childhood Marfan’s/Loeys-Dietz/Ehler-Danlos
*Luca A. Vricella, Johns Hopkins Hospital
Aortic Arch Advancement and Slide Aortoplasty
*E. Dean McKenzie, Texas Children’s Hospital
Session III Moderators: *Charles D. Fraser, Texas Children’s Hospital and *George E. Sarris, Athens Heart Surgery Institute
Controversy #3: The ABTS Congenital Fellowship: How is it Working?
*James S. Tweddell, Cincinnati Children’s Hospital
Recent Graduate’s Perspective
Carlos M. Mery, Texas Children’s Hospital / Baylor College of Medicine
Have We Lost Our International Heritage?
*Vaughn A. Starnes, University of Southern California
Tough Case Scenarios: Cases I Struggled With Expert Panelists:
*E. Dean McKenzie, Texas Children’s Hospital
*George E. Sarris, Athens Heart Surgery Institute
*Christian Pizarro, Alfred Dupont Hospital for Children
*Jonathan M. Chen, Seattle Children’s Hospital
Case I *Charles D. Fraser, Texas Children’s Hospital
Case II *Gosta Pettersson, Cleveland Clinic
Case III *Krishna S. Iyer, Fortis Escorts Heart Institute
Case IV *Sertac Cicek, Anadolu Medical Center
AATS Consensus Guideline: Anomalous Coronary Artery Origin from Wrong Sinus
*James S. Tweddell, Cincinnati Children’s Hospital
Tetralogy Surgery: Back To Baltimore 70 Years Later
*Emile A. Bacha, Children’s Hospital of New York
Melbourne Heritage and Group Tribute to Juan Comas
*George E. Sarris, Athens Heart Surgery Institute
MONDAY AFTERNOON, MAY 16, 2016
***Info gathered from Annual Meeting Abstract – When Copying and pasting a lot of font letters turn into symbols. Not sure if this is on purpose to cause issues with people using their work or if it is just an accident. I tried to correct all issues, but if you see a random symbol or odd spacing, that is what it is from
Congenital Heart Disease Simultaneous Scientific Session
8 minute presentation, 12 minute discussion
Moderators: *Duke E. Cameron and *Jennifer C. Hirsch-Romano
- Five-Year Experience with Arterial Switch Operation in the First Hours of Life Using Autologous Umbilical Cord Blood
Kyrylo Chasovskyi, Yaroslav Mykychak, Nadiya Rudenko, Ganna Vorobyova, Illya Yemets Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
Invited Discussant: *Christopher A. Caldarone
- Five-Year Experience with Immediate Extubation After Arterial Switch Operation for Transposition of Great Arteries
Joby Varghese, Shelby Kutty, Sandy Hall, Mary Craft, Ibrahim Abdullah, James M. Hammel Children’s Hospital and Medical Center Omaha, Omaha, NE
Invited Discussant: *Emile A. Bacha
- Should All Patients with Congenitally Corrected Transposition of Great Arteries (ccTGA) Undergo Anatomic Repair?
Maryam Alomair, Mohammed Al-Jughiman, Andrew Redington, *Christopher Caldarone, Luc Mertens, *Glen Van Arsdell
University of Toronto, Toronto, ON, Canada
Invited Discussant: *Bahaaldin AlSoufi
- Pediatric Cardiac Surgical Outcomes Following Implementation of a Novel Acuity Adaptable Care Model
John M. Costello, Elizabeth Preze, Nguyenvu Nguyen, Mary E. McBride, James W. Collins, Jr., Osama Eltayeb, Michael C. Monge, Barbara J. Deal, Michelle M. Stephenson, *Carl L. Backer
Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
Invited Discussant: *Sertac Cicek
- Preoperative Hemodynamic Parameters Predict Adverse Outcomes in Patients Undergoing Biventricular Conversion with Damus-Kaye-Stansel Takedown
Melissa A. Herrin, Breanna L. Piekarsk, David Zurakowski, Christopher W. Baird, Wayne Tworetzky, Puja Banka, Gerald R. Marx, Roger E. Breitbart, Audrey C. Marshall, *Pedro J. del Nido, Sitaram M. Emani
Boston Children’s Hospital, Harvard Medical School, Boston, MA
Invited Discussant: *E. Dean McKenzie
- Effect of Preoperative Administration of Allopurinol on Postoperative Outcomes in Patients Undergoing Repair of Tetralogy of Fallot
Sachin Talwar, Murugan Selvam Sathiya, Vishnubhatla Sreenivas, Shiv Kumar Choudhary, Balram Airan All India Institute of Medical Sciences, New Delhi, India
Invited Discussant: *J. William Gaynor
Late-Breaking Clinical Trial LB2. The Miniaturized Pediatric Continuous Flow Device: Pre-Clinical Assessment in the Chronic Sheep Model
Iki Adachi (1) , Sarah Burki (1), David Horne (1) , Gil G. Costas (2), Robert Jarvik (3) , John Teal (3) , J. Timothy Baldwin (4) , Kurt Dasse (5) , Jeff Conger (2) , *William E. Cohn (2) , *Charles D. Fraser, Jr.(1)
1 Texas Children’s Hospital, Houston, TX
2 Texas Heart Institute, Houston, TX;
3 Jarvik Heart, Inc., New York, NY;
4 National Heart, Lung and Blood Institute, Bethesda, MD;
5 Geno, LLC, Cocoa, FL
Invited Discussant: *Christopher A. Caldarone
Congenital Heart Disease Moderated Poster Competition Moderator:
*Carl L. Backer, Lurie Children’s Hospital
P14. Outcomes of Multistage Palliation of Patients with Single Ventricle and Atrioventricular Septal Defect
*Bahaaldin AlSoufi, Courtney McCracken, Subhadra Shashidharan, *Kirk Kanter, *Brian Kogon
Emory University, Atlanta, GA
Objectives: Unbalanced atrioventricular septal defect (AVSD) represents less than 10% of single ventricle anomalies. Few reports focusing on multi-stage palliation outcomes of those patients exist in the literature and show poor survival that is inferior to that of hypoplastic left heart syndrome, in addition to high intervention rate for atrioventricular valve (AVV) regurgitation. We report recent results from our institution.
Methods: From 2002 to 2012, 80 infants with functional single ventricle and AVSD underwent multi-stage palliation. Competing risk analyses were performed to model events after first stage surgery (death, transition to Glenn) and after Glenn (death, transition to Fontan). Risk factors associated with outcomes were analyzed.
Results: Among the 80 patients in our cohort, the balance of the ventricles was 34% left-dominant and 66% right-dominant. Antegrade pulmonary blood flow was absent in 14 (18%), restricted in 29 (36%) and unrestricted in 37 (46%). Systemic outflow tract obstruction was evident in 26 (13%). Twenty-nine (36%) had total anomalous pulmonary venous connection (TAPVC, obstructed in 8/29). Extracardiac anomalies were common and present in 63 patients (79%). Sixty-eight patients (85%) required neonatal first stage palliation including modified BlalockTaussig shunt (n = 33, 41%), Norwood (n = 20, 25%), pulmonary artery band (n = 15, 19%) while primary Glenn was the initial surgery in the remaining patients (n = 12, 15%). Hospital mortality occurred in 15 patients (19%). By 2 years after first stage surgery, 68% had Glenn and 32% had died. Risk factors for death without Glenn included concomitant TAPVC repair (HR = 8.5 (2.1–34.3), p < 0.001) and extra-cardiac lesions (HR = 3.6 (0.4–33.8), p = 0.036). By 5 years after Glenn, 68% had Fontan, 9% had died, and 23% remained alive awaiting Fontan. Overall survival following initial surgery was 63% at 8 years (53% after shunt, 63% after Norwood, 52% after band and 100% after primary Glenn). Concomitant TAPVC repair (HR = 2.3 (1.0–5.2), p < 0.001), extra-cardiac lesions (HR = 2.0 (0.5–7.5), p = 0.08), and neonatal palliation (HR = 1.3 (0.5–3.1), p = 0.05) were associated with overall death. At initial presentation, AVV regurgitation was ≥ moderate in 14 patients (18%). Freedom from AVV repair or replacement was 75% at 5 years with 72% of patients with AVV regurgitation ≥ moderate progressing to AVV intervention or death.
Conclusions: Patients with functional single ventricle and AVSD are a distinct group with the common presence of additional cardiac and extra-cardiac lesions. Those lesions are associated with increased early mortality risk following first stage palliation surgery. Several patients develop progressive AVV regurgitation requiring surgical intervention at initial palliation or subsequent follow up. The management of those patients continues to be challenging and associated with low mid-term survival.
P15. Cognitive, Neuropsychological and Social Status Is Impaired Two Decades After Neonatal Arterial Switch Operation
David Kalfa (1) , Leila Kasmi (2) , Michele Montreuil (2) , Nikoletta Geronikola (2) , Virginie Lambert (3) , Eleonora Murzi (2) , *Emre Belli (4) , Damien Bonnet (5)
1 Columbia University, New York, NY; 2 Université Paris, Saint Denis, France; 3 Université Paris Sud, Le Plessis Robinson, France; 4 Institut Jacques Cartier, Massy, France; 5 Université Paris Descartes, Sorbonne Paris Cité, Paris, France
Objective: Neuropsychological and psychosocial outcomes in adults who underwent neonatal open-heart surgery still need to be investigated. The objective is to determine the neuropsychological and psychosocial outcomes of adult patients who had a neonatal arterial switch operation (ASO) for Transposition of the Great Arteries (TGA) and determine factors associated with pejorative outcomes.
Methods: Sixty-seven adults (>18 year-old) with operated d-TGA with or without ventricular septal defect (22.9 ± 3.3 years) and 43 healthy adults (23.8 ± 2.8 years) were matched in age, gender and socio-cultural level. The neuropsychological outcome was evaluated using Wechsler Adult Intelligence Scale (WAIS- III), Wisconsin Card Sorting test and California Verbal Learning test. The psychosocial outcome and quality of life were assessed using Mini International Neuropsychiatric Interview, SF-36 health survey and Qolibri.
Results: TGA patients had overall IQ scores within the normal range. But the mean scores of full-scale IQ, verbal IQ and performance IQ scores were significantly lower in TGA patients (94.9 ± 15.3; 96.8 ± 16.2; 93.7 ± 14.6 respectively) than in healthy subjects (103.4 ± 12.3; 102.5 ± 11.5; 103.7 ± 14.3 respectively). Working Memory Index (91.6 ± 14.4), Perceptual Organization Index (93.1 ± 15.9) and Processing Speed Index (95.4 ± 13.9) were also significantly lower than normal. TGA patients showed poorer performance in 8/13 WAIS-III subtests evaluating attentional capacities, visuospatial abilities and executive functions. They also had more depression (46.3% (n = 31) vs. 20.9% (n = 9), p = 0.007) and social phobia (23.9% (n = 16) vs 7% (n = 3), p = 0.022). Although the presence of cognitive or psychosocial deficits was significantly associated with a poorer quality of life, TGA patients have an overall good quality of life. Lower parents’ educational level, longer aortic clamping time and the absence of prenatal diagnosis were significantly associated with lower patient’s IQ (p < 0.001), altered episodic memory (p = 0.021) and working memory (p = 0.023) respectively.
Conclusion: Adults who underwent neonatal ASO for TGA appear to present an increased risk of cognitive, psychological and social impairments. An early identification of emerging difficulties could be helpful.
P16. Univentricular Pathway for Severe Neonatal Ebstein Anomaly and Tricuspid Dysplasia Is Superior to Total Biventricular Approach at Late Follow-Up
Jack Luxford (1) , Nitin Arora (2) , Julian Ayer (2) , Charlotte Verrall (2) , *Yves D’Udekem (3) , Gary Sholler (2) , David Winlaw (2)
1 University of Sydney, Sydney, Australia; 2 Children’s Hospital at Westmead, Sydney, Australia; 3 The Royal Children’s Hospital, Parkville, Australia
Objectives: This study reviewed our 30-year experience of surgical and medical management of symptomatic neonates presenting with Ebstein anomaly or tricuspid dysplasia.
Methods: Between January 1985 and September 2015, we managed 78 neonates with Ebstein anomaly and 19 with tricuspid dysplasia. Their medical and surgical records were reviewed, and available neonatal echocardiogram re-assessed. Ebstein anomaly was confirmed where the septal leaflet was displaced more than 8 mm/m2, whilst tricuspid dysplasia involved variable forms of valve dysplasia, without displacement. Primary outcome measures were early and late survival, freedom from re-operation and functional status. Nine patients with Ebstein anomaly from a bi-national Fontan Registry were combined with the 3 who achieved Fontan in the current study to assess single ventricle outcomes. Primary outcome measures were survival post-Fontan and functional status.
Results: Median age at presentation was one day old. Pulmonary atresia was present in 25 and critical pulmonary stenosis in 5. Thirty-nine (40%) patients required intervention: 17 received systemic-to-pulmonary (SP) shunts, 7 underwent balloon pulmonary valvotomy, 5 had right ventricular outlet tract obstruction relief (2 with a SP shunt), 4 underwent a Starnes, and 4 had other surgical procedures. Tricuspid dysplasia was associated with higher rates of pulmonary atresia (10, 53%; p = 0.006), prostaglandin infusion (15, 83%; p = 0.008), and neonatal intervention (12, 63%; p = 0.027), than Ebstein anomaly. Early survival was 81% (79/97); 86% (67/78) for Ebstein anomaly and 63% (12/19) for tricuspid dysplasia (p = 0.043). One, 5, and 15-year survival estimates (with standard error) were 74% (4.5), 70% (4.8) and 64% (5.9). Fifteen-year survival estimate was 42% (9.8) for those in whom a biventricular repair was achieved, and 58% (18.9) for those who achieved a ‘1.5’ or single ventricle pathway (p = 0.043). Fifteen-year survival estimate was improved from 51% (7.7) for those managed before 2000, to 81% (5.8) for those after (p = 0.004). In early survivors managed initially with two ventricles, freedom from re-operation at 10 years was only 22%. Functional status for long-term survivors was New York Heart Association (NYHA) class I/II for 97%. In the 12 patients who have undergone Fontan completion there were no early deaths, and 10-year survival estimate was 88% (12). At recent follow-up, 10 (91%) of survivors were in NYHA class I/II.
Conclusions: Tricuspid dysplasia represents a more severe neonatal pathology than Ebstein anomaly. Intention to preserve a biventricular anatomy confers a higher mortality than early or late commitment to a single ventricle pathway. The single ventricle pathway should be considered in more severe cases, particularly those with pulmonary atresia or severe pulmonary stenosis.
P17. Detrimental Effects of High Flow Mechanical Assistance of Systemic Ventricle in a Fontan Circulation-Insights from a Unique Ex-Vivo Model
Pranava Sinha (1) , Nina Deutsch (1) , Dingchao He (1) , Mark Nuszkowski (1) , Erin Montague (1) , Gerald Mikesell (1) , Karthik Ramakrishnan (1), Edem Ziadinov (1) , David Zurakowski (2) , *Richard Jonas (1)
1 Children’s National Medical Center, Washington, DC; 2 Harvard Catalyst, Boston, MA
Objective: We have previously demonstrated the efficacy of the ‘Pull Strategy’ in supporting a Fontan Circulation by mechanical assistance of the systemic ventricle in a large animal model. While mechanical assistance of the systemic ventricle may be helpful in a failing Fontan secondary to ventricular failure, higher flows with a ventricular assist device (VAD) may be detrimental, due to elevation of central venous pressure (CVP) and transpulmonary gradient (TPG). We sought to identify the effects of increasing systemic VAD flows on total cardiac output, CVP and TPG with differing preloading conditions, using a unique ex-vivo model of the Fontan circulation.
Methods: An ex-vivo model of the Fontan Circulation was created by connecting a 45 kg porcine systemic ventricle to simulated systemic vascular resistance (perfusion tubing using C clamps) and simulated lung (membrane oxygenator) in series. A centrifugal pump was attached to the circuit as a systemic VAD with atrial inflow and aortic outflow. Conditions I [no preload modulation-mean left atrial pressure responsive to VAD decompression, isovolemic circuit] and II [preload modulation-mean left atrial pressure maintained at 15 mmHg] were tested. Native cardiac output, VAD fl ow, total cardiac output, TPG, CVP and coronary blood flow (CBF) were measured. Conditions I & II were compared by two-way mixed model ANOVA, with pump RPMs as repeated measures and the F-test to compare slopes.
Results: A significant increase in TPG was seen with higher pump RPM (Rotations Per Minute) in both conditions. The rise in TPG was faster in condition II (F = 4.7, P < .001). A rise in the CVP was seen with both conditions with increasing VAD RPM, however reduced LAP with increasing pump RPM blunted the rise in CVP in condition I at lower flows (F = 14.6, P < .001). Similar VAD flows were achieved with both conditions, however higher native cardiac output at higher RPM led to an overall higher total cardiac output in condition II (F = 2.6, P = .02). A significant increase in CBF was observed in condition II with increasing VAD RPM whereas CBF remained unchanged in condition I (F = 59.5, P < .001). (Figure 1).
Conclusions: High flow systemic ventricular assistance with VADs (Pull Strategy) can paradoxically increase the CVP and transpulmonary gradient in a Fontan circulation. Low flow assistance in a low preload situation may be the preferred strategy for supporting a failing systemic ventricle in a Fontan patient. The ex-vivo Fontan model allows easy and versatile testing of conditions optimal for mechanically supporting a Fontan circulation.
P18. Long-Term Results of Anatomical Correction for Congenitally Corrected Transposition of the Great Arteries: A 19-Year Experience
Christian P. Brizard, Alice Lee, Tyson A. Fricke, *Yves d’Udekem, *Igor E. Konstantinov, Johann Brink, Michael M.H. Cheung
Royal Children’s Hospital, Parkville, Australia
Objective: To review the long-term results of a policy of anatomical correction for congenitally corrected transposition of the great arteries (ccTGA) using one of the 3 procedures: double switch (DS) (Senning and arterial switch operation), Senning and Rastelli (SR) or Senning and Bex-Nikaidoh (SBN).
Methods: Retrospective, single institution study of all patients (pt) who underwent one of the 3 procedures between June 1996 and August 2015.
Results: Thirty-two pt underwent anatomical correction at a median age of 1.9 years (range 0.1 to 13.5). There were 21 DS (65.6%), 6 SBN (18.8%) and 5 SR (15.6%) performed. Eight pt received a sutureless Senning modification after 2012. One international pt was lost to follow-up, leaving 142.73 pt. year of follow-up for 31 pt. There were 4 deaths: one early (neurological complication) and 3 late: (2 congestive cardiac failure, 1 pulmonary hypertension). Freedom from reoperation was 95.7%, 65.6% and 49.2% at 1, 5 and 10 years, respectively. Seven pt had a Senning revision (2 early, 5 late). Median follow-up time is 4.7 years (range 0.1 to 17.8). One pt required a heart transplant 7 months after surgery. Of the remaining 25 pt, left(LV) and right ventricular function was normal in 18 (72.0%) and 23 (92.0%) pt, respectively. Previous pulmonary artery band (PAB) was related to late LV dysfunction (p = 0.021). The risk of LV dysfunction at follow-up increased with age at surgery (OR = 1.403, 95%CI 1.023–1.924, p = 0.036). Postoperatively, the degree of tricuspid regurgitation improved or remained stable except in one pt (p = 0.003). Two pt (1 DS, 1 SR) had a change from no aortic regurgitation preoperatively to moderate or greater at late follow-up. Two pt had early aortic valve (AV) replacement and one had an early AV repair. Previous PAB was correlated with the need for AV surgery or neo-AV regurgitation moderate or greater (p = 0.014). Senning pulmonary venous baffles were mildly obstructed in 2 (8.0%) pt (one received an early Senning revision) but no pt with the Senning modification have obstruction or required revision. No SR pt had obstructed conduits. Overall, 7 (21.9%) pt required a pacemaker due to the development of iatrogenic AV block (4 DS, 2 SBN, 1 SR) with no difference across the 3 surgery types. At last follow-up, 23 (92.0%) pt were in NYHA class I, one in class II and one in class III.
Conclusions: Anatomical correction provides excellent haemodynamic outcomes in 70% of our patients. Continuous technical improvement should reduce the significant need for reoperations. The PAB may damage the neo-aortic valve and provide inadequate LV training. DS may be safer in infancy than later in life with PAB training. The Senning modification provides stable venous pathways. Surgery without need for LV training has better long-term LV function. The risk of iatrogenic AV block remains a significant challenge. Ongoing surveillance is required to monitor functional status over time.
P19. Re-Intervention Type and Rates Following Neonatal Tetralogy of Fallot (TOF) Repair Vary by Operative Intervention on the Right Ventricular Outflow Tract (RVOT)
Shyamasundar Balasubramanya, Michele J. Borisuk, Aditya K. Kaza, *Frank Pigula, Hua Liu, Sitaram Emani, *Pedro J. del Nido, Christopher W. Baird
Boston Children’s Hospital, Boston, MA
Objective: The goal of this single-center series following neonatal repair of Tetralogy of Fallot (TOF) was to assess outcomes, differences in re-intervention and to identify independent predictors of re-intervention.
Methods: Data was retrospectively collected for 55 patients undergoing TOF repair with pulmonary stenosis (PS) or pulmonary atresia (PA) under 33 days of age from January 2005 to September 2015. Kaplan-Meier estimation and Cox proportional hazards regression methodologies were employed.
Results: Median age and weight at repair were 15 days (IQR, 9–23) and 2.9 kg (IQR, 2.5–3.6). Diagnosis was TOF/PS in 43 patients (78%) and TOF/PA in 12 patients (22%). Median pulmonary valve annulus diameter was 45 mm (Z-score -2.6) and RVOT gradient was 50 mm Hg. Operative approach on the right ventricular outflow tract (RVOT) was transannular patch (TAP) in 36 (65%; median age 14 days) and valve sparing repair in 19 (35%, median age 16 days). Median follow-up was 3.8 years (IQR, 1.1–7.0). Overall survival was 98% with one early death. Early (<6 months) RVOT re-intervention (Table 1) occurred in 15% of patients and was higher in patients having a valve-sparing approach (26%) vs. TAP (6%) (Hazard ratio 4.3, P value = 0.028). Median time to RVOT re-intervention (73 vs. 109 days) was also shorter in valve sparing patients. The median number of total RVOT re-interventions per patient was 2 (range, 1–5). RVOT re-intervention was not associated with gender, age, PV annulus, RVOT gradient or TAP. The only identifiable independent risk factor for RVOT re-intervention was weight (P = 0.011). Late pulmonary valve replacement occurred in 18% of patients and was higher in TAP patients (22% vs.11%, Hazard ratio = 2.0, P = 0.602). Other re-interventions included left pulmonary artery (15), right pulmonary artery (6) and tricuspid valve repair (1).
Conclusions: Complete neonatal TOF repair in patients with pulmonary stenosis and atresia have excellent early outcomes. Smaller patients and those undergoing a valve-sparing approach had more than a 4-fold greater risk of early RVOT re-intervention while those undergoing TAP had a trend towards more late pulmonary valve replacements. Valve sparing repair can be performed safely in small patients; however, they are at an increased risk for early RVOT re-interventions.
P20. Twenty-Five Year Outcomes of the Lateral Tunnel Fontan Procedure
Thomas G. Wilson(1) , William Y. Shi(1) , Ajay J. Iyengar (1) , David S. Winlaw(2) , Rachael L. Cordina(3) , Gavin R. Wheaton(4) , Andrew Bullock(5) , Thomas L. Gentles(6) , Robert G. Weintraub(1) , Robert N. Justo(7) , Leeanne E. Grigg(8) , Dorothy J. Radford(9) , *Yves d’Udekem(1)
1 Royal Children’s Hospital, Parkville, Australia; 2 The Children’s Hospital at Westmead, Sydney, Australia; 3 Royal Prince Alfred Hospital, Sydney, Australia; 4 Women’s and Children’s Hospital, Adelaide, Australia; 5 Princess Margaret Hospital for Children, Perth, Australia; 6 Starship Children’s Hospital, Auckland, New Zealand; 7 Mater Children’s Hospital, Brisbane, Australia; 8 Royal Melbourne Hospital, Parkville, Australia; 9 The Prince Charles Hospital, Brisbane, Australia
Objective: To identify specific late outcomes of the lateral tunnel Fontan procedure.
Methods: The outcomes of all patients who underwent a lateral tunnel Fontan procedure in Australia and New Zealand were analyzed. Original files were reviewed and outcomes data were obtained through a binational Registry. Late failure of the Fontan circulation was defined as death, transplantation, Fontan conversion/revision/takedown, NYHA class III/IV or protein-losing enteropathy.
Results: Between 1980 and 2014, a total of 301 patients underwent a lateral tunnel Fontan procedure across 6 major centres. There were 13 hospital mortalities (4%), 24 late deaths, 8 Fontan conversions/revisions, 8 Fontan takedowns and 4 heart transplantations. Survival at 15 and 25 years was 90% (95% confidence interval [CI]: 86–93%) and 80% (95% CI: 69–91%), respectively. Protein-losing enteropathy or plastic bronchitis was observed in 14 patients (5%). Freedom from Fontan failure at 15 and 25 years was 87% (95% CI: 83–91%) and 80% (95% CI: 75–86%), respectively. Predictors of late Fontan failure were hypoplastic left heart syndrome (HR 4.6, 95% CI 1.3–16.3, p = 0.018), age >7 years at Fontan (vs. 3–5 years, HR 4.0, 1.6–10.0, p = 0.003), prolonged pleural effusions (HR 2.6, 1.0–6.8, p = 0.049) and greater length of hospital stay (per day, HR 1.02, 1.00–1.03, p = 0.007). The rates of death and late failure per 100 patient-years were 0.8 and 1.0, respectively. Supraventricular tachyarrhythmias (SVT) occurred in 59 patients (20%), bradyarrhythmias in 16 (5%), and pacemakers were implanted in 39 patients (13%). Freedom from dysrhythmia (SVT and/or bradyarrhythmias) after 15 and 25 years was 82% (95% CI:-77–87%) and 64% (95% CI: 54–74%), respectively. Independent predictors of late-onset dysrhythmia included age >5 years at Fontan (vs 3–5 years, HR 2.3, 95% CI 1.0–5.2, p = 0.041). At last follow-up, 112 of the 250 surviving patients with an intact Fontan circulation (45%) were on warfarin, and 93 (37%) were on aspirin. A patent fenestration was identified in 32 patients at last follow up. Thromboembolic events occurred in 46 patients (18 strokes), and freedom from symptomatic thromboembolism at 15 and 25 years was 88% (95% CI: 84–92%) and 77% (95% CI: 70–84%), respectively.
Conclusions: Over a twenty-five year period, the lateral tunnel technique has achieved excellent late survival. As this population ages, they are at an increasing risk of failure and adverse events, with evidence of significant arrhythmic burden. We are likely to see an increasing proportion of these survivors requiring heart transplantation and late reintervention.
P21. Predictors of Successful Biventricular Repair After Hybrid Treatment for Borderline Hypoplastic Left Heart
Can Yerebakan(1) , Uygar Yörüker (1) , Klaus Valeske1 , Hatem Elmontaser(1) , Josephine Murray(1) , Anita Windhorst(2) , Josef Thul(1) , Matthias Müller(1) , Dietmar Schranz(1) , Hakan Akintürk(1)
1 Pediatric Heart Center, Giessen, Germany; 2 Justus-Liebig-University, Giessen, Germany
Objective: To identify factors to serve as predictors in a statistical model for the feasibility of a successful biventricular repair in patients with borderline univentricular structures who were treated with initial hybrid stage I procedure.
Methods: A group (I) of patients (n = 35) who are long-term survivors of biventricular repair after initial hybrid stage I was retrospectively compared to patients (group II, n = 20) who had to be directed to univentricular palliation following hybrid stage I procedure, non-survivors of biventricular repair (n = 4) or subsequently converted to univentricular palliation (n = 1). Both groups had at least two transthoracic echocardiographic studies before hybrid stage I (time point I) and biventricular repair or comprehensive stage II operation (time point II), respectively. The decision for the type of therapy was made before the second operation with the aid of echocardiographic parameters and cardiac magnetic resonance imaging 4 to 8 months after hybrid stage I. Echocardiographic measurements of univentricular structures (aortic valve dimension, mitral valve dimension, univentricular inflow length, univentricular to right ventricular length ratio), body surface area and body weight at two different time points were added to a logistic regression analysis to determine the most accurate model to estimate outcome of each patient. Positive predictive value (PPV, the probability to observe biventricular repair in group I) and negative predictive value (NPV, the probability to observe univentricular palliation in group II) were calculated for statistical models at each time point as well as for a combined multifactorial model.
Results: The pre-hybrid stage I model revealed a PPV of 83.7% and NPV of 85.7% (observed prevalence 64.7%). By employing only parameters before biventricular repair (group I) or comprehensive stage II (group II) PPV value reached 84.2% and NPV was 81.8% (observed prevalence 69.3%). The highest values for PPV and NPV were possible by combining parameter changes between time points I and II as well as echocardiographic parameters at time point II in a third model. These values were 88.6% and 91.7% for PPV and NPV (observed prevalence 68%), respectively.
Conclusions: In our small cohort the success of biventricular repair in patients with borderline left heart structures after initial hybrid stage I treatment was retrospectively predictable with a statistical accuracy of 89% based on a new multifactorial statistical model.
P22. Outcomes of Univentricular Repair in Children with Unbalanced Atrio-Ventricular Septal Defect
Edward Buratto, Xin Tao Ye, Robert G. Weintraub, *Yves d’Udekem, Christian P. Brizard, *Igor E. Konstantinov
The Royal Children’s Hospital, Parkville, Australia
Objectives: Repair of unbalanced atrio-ventricular septal defect (uAVSD) is associated with poor outcomes. Limited data is available on the long-term results. We assessed the long-term outcomes in children, who underwent univentricular repair of uAVSD in a single institution.
Methods: From 1987 to 2015, 112 patients with a diagnosis of uAVSD underwent surgery at our institution. Univentricular repair was performed in 97 of these patients. Data were retrospectively reviewed.
Results: Of the 112 patients with uAVSD, 86.8% (97/112) underwent univentricular repair. Of these 97 patients, 50.5% (49/97) achieved Fontan completion, 28.9% (28/97) died prior to Fontan completion, 12.4% (12/97) were awaiting Fontan completion and 8.2% (8/97) were deemed unsuitable for Fontan completion. Early mortality after stage 1 repair was 10.3% (10/97), after stage 2 repair was 4.9% (4/81) and after Fontan completion was 4.1% (2/49). Although there were no statistical differences across decades, there have been no early deaths following Fontan completion in the last 10 years. Mean follow up time was 6.0 ± 6.9 years (median 3.0 years, range 1 month to 28.4 years). Long-term freedom from death or transplantation for the whole cohort was 59.3% (95% CI 47.8–69.0) at 10 years and 49.4% (95% CI 32.7–64.1) at 20 years, as shown in Figure 1A. For patients who underwent Fontan completion, the 10- and 20-year survival rates were 94.8% (95% CI 80.2–98.8) and 88.8% (95% CI 66.2– 96.6), respectively, as shown in Figure 1B. Surgery on the atrioventricular valve (AVV) was performed in 25.8% (25/97) of patients, but was not associated with poorer long-term survival. There was a significant rate of reoperation on the AVV following initial repair or replacement, reaching 24.1% at 5 years follow up. Since 2008, a “bridging technique” to facilitate AVV repair was used in 6 patients; none of these patients have required subsequent re-operations on the AVV.
Conclusion: Univentricular repair for uAVSD is associated with substantial mortality. Selected patients who survive to achieve Fontan completion have much better long-term survival. Surgery on the AVV is associated with a high rate of reoperation, necessitating better strategies for AVV repair.
P23. Exercise Restriction Is Not Associated with Increasing Body Mass Index Over Time in Patients with Coronary Arteries of Anomalous Aortic Origin
James M. Meza(1) , Matthew Elias(2) , Travis Wilder(3) , James E. O’Brien(4) , Richard W. Kim(5) , *Constantine Mavroudis(6) , *William G. Williams(1) , Julie Brothers(2) , Meryl Cohen(2), Brian W. McCrindle(1)
1 The Hospital for Sick Children, Toronto, ON, Canada; 2 The Children’s Hospital of Philadelphia, Philadelphia, PA; 3 University of California San Diego, La Jolla, CA; 4 Children’s Mercy Hospital, Kansas City, MO; 5 Children’s Hospital of Los Angeles, Los Angeles, CA; 6 Florida Hospital for Children, Orlando, FL
Objective: Physicians may restrict the exercise level of patients with anomalous aortic origin of the coronary arteries (AAOCA) to mitigate the risk of sudden death. We sought to determine if exercise restriction results in increasing body mass index (BMI) over time.
Methods: Between 2009 and 2015, 440 patients 5–30 years old were enrolled into the Congenital Heart Surgeons’ Society AAOCA Registry. Exercise restriction status was recorded for 143 of the 440 patients, which comprised the study population. Patient demographic, anthropometric, and exercise capacity measures were summarized. Using linear mixed model repeated measures analysis, risk factors for increasing BMI z-score over time were investigated.
Results: The 143 patients attended 558 clinic visits with exercise restriction status recorded. The mean number of clinic visits was 5 ± 3 visits and the median duration of follow-up was 1.7 years [interquartile range (IQR) = 0.5–4.4 years]. The mean age at first clinic visit was 9.9 ± 4.7 years and 71% (101/143) were male. All patients were alive at their most recent follow-up. Surgical intervention occurred in 64% (92/143); 5% (5/92) had an operation before their first visit during the study. At the first clinic visit, 54% (78/143) were exercise restricted. During follow-up, exercise restriction status changed in 4% (6/143). Restricted patients were older at diagnosis (11.7 vs. 7.6 years, p < 0.0001) and had shorter mean overall follow-up intervals (2.2 vs. 3.3 years, p < 0.0001). More restricted patients underwent surgical intervention [72% (56/78) vs. 28% (22/78), p = 0.03] and were older on the day of surgery (12.4 vs. 11.0 years, p = 0.08). Exercise capacity measures, including maximum aerobic capacity (VO2max), VO2¬max at anaerobic threshold, and working capacity, were available for 9% (13/143), 8% (12/143), and 3% (5/143) patients, respectively. These baseline measures did not differ significantly between restricted and non-restricted patients. BMI z-scores were calculated from heights and weights documented during the 558 clinic visits. The median baseline BMI z-score was 0.2 (IQR = -0.30.9) and was greater in restricted patients (0.4 vs. -0.1, p = 0.02). BMI z-score showed no significant association with time. Univariate repeated measures analysis demonstrated that exercise restriction at baseline, higher baseline BMI z-score, male gender, grade 4 dual orifices of the left coronary sinus, exercise restriction over time, and surgical intervention over time were all weakly associated with higher BMI z-score. In a multivariable model, only a higher baseline BMI z-score remained independently associated with increasing BMI z-score over time. No other variables reached significance.
Conclusions: In a multi-institutional cohort of patients with AAOCA, over a short follow-up period, exercise restriction does not appear to be linked to increasing BMI over time.
P24. Oral Thyroxin Supplementation in Infants Undergoing Cardiac Surgery: A Double Blind Randomized Clinical Trial
Sachin Talwar, Amolkumar Bhoje, Rajesh Khadgawat, Vishnubhatla Sreenivas, Shiv Kumar Choudhary, Balram Airan
All India Institute of Medical Sciences, New Delhi, India
Objectives: Decrease in serum thyroxin and triiodothyronin (T3) levels occurs after cardiopulmonary bypass (CPB) reflected as poor outcomes in immediate postoperative period. Intravenous T3 is shown to be having some role in improving postoperative outcomes. We studied oral thyroxin supplementation and its effect on perioperative period in infants undergoing cardiac surgery under CPB.
Methods: The study was a prospective, double blind randomized, placebo controlled trial involving 62 patients, 30 in the thyroxin group and 32 in the placebo group younger than 6 months age, undergoing cardiac surgery with CPB. Each mL of either drug A or B contained 5 mcg of oral Thyroxin tablet or placebo in a suspension form. Dose of the drug given was weight of the baby ´ 1 ml of the assigned solution. First dose was given at 9 pm a day before the surgery considering the time of surgery as 9 am on the next morning. This was continued after surgery while the infant was in the ICU. The clinical endpoints were time for extubation, Intensive care unit (ICU) stay, and occurrence of low cardiac output syndrome (LCOS). Cardiac index was measured at different time points. Perioperative serum thyroid hormone and serum inflammatory markers Interleukin-6 (IL-6) and tumor necrosis factor (TNF-α) were measured.
Results: Demographic features were comparable between the groups. Mean duration of mechanical ventilation was 92.47 ± 22.21 and 111.81 ± 37.30 hours in thyroid and placebo groups respectively (p = 0.017). Mean ICU stay and hospital stay were 163.03 ± 54.32 and 199.88 ± 74.22 hours (p = 0.03) and 15.73 ± 4.77 and 19.88 ± 5.34 days (p = 0.002) in thyroid and placebo group respectively. Cardiac indices were higher in thyroid group at all-time points with overall p = 0.004. Average therapeutic interventional scores (TISS) for first 2 days were higher in placebo group. Area under curve for total thyroxine (TT4) were 479.90 ± 92.05 and 252.15 ± 58.95 for thyroid and placebo group (p < 0.001). Area under curve for total triiodothyronine (TT3) were 107.34 ± 11.21 and 43.44 ± 8.58 for thyroid and placebo group (p < 0.001).
Conclusion: Thyroid supplementation improves cardiac index but does not affect the incidence of clinical LCOS. Thyroxin supplementation reduces duration of mechanical ventilation, ICU stay and hospital stay and TISS scores thus reducing the cost of intensive care. Oral route maintained adequate serum levels of thyroid hormones which translated into desired physiological effects. Oral thyroxin supplementation in infants undergoing open heart surgery is safe and effective.
Congenital Heart Disease Simultaneous Scientific Session 8 minute presentation, 12 minute discussion
Moderators: *J. William Gaynor and *Jorge D. Salazar
Late-Breaking Clinical Trial
LB10. A Novel Bioabsorbable Vascular Graft in a Modified Fontan Procedure – the First Clinical Experience
*Leo Bockeria(1) , Oleg Svanidze(2) , Alex Kim(1) , Konstantin Shatalov(1) , Vladimir Makarenko(1)
1 Bakoulev Center for Cardiovascular Surgery, Moscow, Russian Federation; 2 Xeltis AG, Zurich, Switzerland
- Concept of an Expandable Cardiac Valve for Surgical Implantation in Infants and Children
Sitaram M. Emani, Breanna L. Piekarski, David Zurakowski, Christopher A. Baird, Gerald Marx, Wayne Tworetzky, Audrey C. Marshall, James E. Lock, *Pedro J. del Nido
Boston Children’s Hospital, Boston, MA
Invited Discussant: *Thomas L. Spray
- 10-Year Outcomes After Implant of Decellularized Pulmonary Allografts for RVOT Reconstruction
*John W. Brown(2) , John D. Oswalt(2) , Jennifer Christel Romano(3) , *James S. Tweddell(4) , *Pirooz Eghtesday(5) , Kent E. Ward(6) , Michael Felix Teodori(7) , John Paul Kupferschmid(8) , Donna Johnson(2)
1 Indiana University, Indianapolis, IN; 2 Cardiothoracic and Vascular Surgeons, P.A., Austin, TX; 3 University of Michigan, Ann Arbor, MI; 4 Cincinnati Children’s Hospital, Cincinnati , OH; 5 Washington University, St. Louis, MO; 6 University of Oklahoma, Oklahoma City, OK; 7 Phoenix Children’s Hospital, Phoenix, AZ; 8 Methodist Children’s Hospital, San Antonio, TX
Invited Discussant: *Richard A. Hopkins
- Small Sized Conduits in the Right Ventricular Outflow Tract in Young Children: Bicuspidalized Homografts Perform Better than Xenografts
Katrien François, Katya De Groote, Kristof Vandekerckhove, Joseph Panzer, Hans De Wilde, Daniel De Wolf, Julie De Backer, Laurent Demulier, Thierry Bové
University Hospital Gent, Gent, Belgium
Invited Discussant: *John W. Brown
- Pulmonary Root Translocation Is an Effective Approach for Left Coronary Artery Arising Anomalously from the Aorta with an Intramuscular Course in the Right Ventricle
Timothy Martens, S. Ram Kumar, Subhadra Shashidharan, *Vaughn A. Starnes Children’s Hospital Los Angeles, Los Angeles, CA
Invited Discussant: *James S. Tweddell
- Comparison of Thoracotomy Versus Thoracoscopic Vascular Ring Division in Children and Young Adults
Melissa A. Herrin (1) , David Zurakowski(2) , Francis Fynn-Thompson(1) , Christopher W. Baird(1) , *Pedro J. del Nido(1) , Sitaram M. Emani(1)
1 Boston Children’s Hospital, Harvard Medical School, Boston, MA; 2 Harvard Catalyst, Boston, MA
Invited Discussant: *Carl L. Backer
- A Common Polymorphism in the Mannose-Binding Lectin Gene MBL2 Is Associated with Poor Neurodevelopmental Outcomes Following Infant Cardiac Surgery
Ryan Robert Davies, Julia S. Barthold, Erica Sood, Yanping Wang, Edward Woodford, *Christian Pizarro
Nemours/A.I. duPont Hospital for Children, Wilmington, DE
Invited Discussant: *Jorge D. Salazar
- Interrupted Arch Repair with Direct Anastamosis and Homograft Augmentation Patch: Outcome at 25 Years with a Standardised Technique
Mohammed Mohsin Uzzaman(1) , Ben Davies(2) , John Stickley(1) , Natasha Khan(1) , Timothy Jones(1) , William Brawn(1) , David Barron(1)
1 Birmingham Children’s Hospital, Birmingham, United Kingdom; 2 Great Ormond Street Hospital, London, United Kingdom
Invited Discussant: *Jeffrey M. Pearl
WEDNESDAY MORNING, MAY 17, 2016
Congenital Heart Disease Simultaneous Scientific Session
5 minute presentation, 6 minute discussion
Moderators: *Jonathan M. Chen and *Pedro J. del Nido
- Left Ventricular Assist Device As Destination Therapy in Cardiac End Stage Distrophinopaties: Midterm Results
Gianluigi Perri(1) , Sergio Filippelli(2) , Rachele Adorisio(2) , Roberta Iacobelli(2) , Francesca Iodice(2) , Giuseppina Testa(2) , Fabrizio Gandolfo(2) , Domenico D’Amario(1) , Massimo Masseƫ (1) , Antonio Amodeo(2)
1 A. Gemelli Hospital, Rome, Italy; 2 Bambino Gesù Children Hospital, Rome, Italy
Invited Discussant: *KrisƟ ne J. Guleserian
- A Transapical to Aorta Double Lumen Cannula-Based Neonate LVAD Efficiently Unloads the LV in Neonate Lambs
Cheng Zhou, Dongfang Wang, Cherry Croft, Francesca Condemi, Hassan K. Reda, *Joseph B. Zwischenberger
University of Kentucky, Lexington, KY
Invited Discussant: *David L. Morales
- Preservation of Umbilical Vein Segments for Use As an Autologous Shunt Conduit in Neonates
David M. Hoganson(1) , Dane A. Cooper(1) , Kimberly N. Rich(1) , Breanna L. Piekarski(1) , Joseph P. Gaut(2) , *John E. Mayer(1) , Elena Aikawa(3) , Sitaram M. Emani(1)
1 Boston Children’s Hospital, Boston, MA; 2 Washington University in St. Louis, St. Louis, MO; 3 Brigham and Womens Hospital, Boston, MA
Invited Discussant: *Minoo Kavarana
- Routine Preoperative Laboratory Testing in Elective Pediatric Cardiothoracic Surgery Is Largely Unnecessary
- Michael Nieto, Luis E. De León, Kimberly A. Krauklis, *Charles D. Fraser, Jr.
Texas Children’s Hospital, Houston, TX
Invited Discussant: *Andrew J. Lodge
MCS for Failing Fontan
*Mark D. Rodefeld, Indiana University School of Medicine, Indianapolis, IN
- Another Look at the Appropriateness of Technical Performance Scores: A Single Center Exploratory Analysis of Surgical Factors Associated with Complications, Reoperation, and Length of Stay Following Tetralogy of Fallot Repair
Daud Lodin(1) , Orestes Mavrothalassitis(2) , Naveen Swami(3) , Tara Karamlou(3)
1 San Juan Bautista, Caguas, PR; 2 University of Maryland, Baltimore, MD; 3 University of California, San Francisco, CA
Invited Discussant: *Christian Pizarro
- Proactive Platelet and Cryoprecipitate Transfusion During Neonatal Cardiopulmonary Bypass Rapidly Normalizes Platelet Count, Fibrinogen and Functional Rotational Thromboelastometry Parameters
John P. Scott(1) , Robert A. Niebler(1) , Eckehard A.E. Stuth(1) , D. Woodrow Benson(1) , Ronald K. Woods(1) , *James S. Tweddell(1) , Regina Cole(1) , *Michael E. Mitchell(1) , Rachel S. Bercovitz(1) , Pippa Simpson(1) , Robert Montgomery(1) , Alan Mast(2) , Susan Maroney(2) , Ke Yan(1) , Rowena Punzalan(1) , Debra K. Newman(2)
1 Medical College of Wisconsin, Milwaukee, WI; 2 Blood Research Institute, Milwaukee, WI
Invited Discussant: *Mark S. Bleiweis
- Shape Does Matter: 3-D Statistical Shape Analysis of the Aortic Arch After Coarctation Repair Reveals Shape Correlation with Left Ventricular Function
Jan L. Bruse(1) , Kristin McLeod(2) , Giovanni Biglino(1) , Maxime Sermesant(3) , Xavier Pennec(3) , Tain-Yen Hsia(1) , Andrew M. Taylor(1) , Silvia Schievano(1)
1 Great Ormond Street Hospital for Children, London, United Kingdom; 2 Simula Research Laboratory, Lysaker, Norway; 3 INRIA Sophia Antipolis-Méditeranée, Sophia Antipolis, France
Invited Discussant: *Luca A. Vricella
- Surgical Strategy for Aortic Arch Reconstruction After Norwood Procedure Based on a Virtual Operation with Numerical Flow Analysis
Shohei Miyazaki(1) , Keiichi Itatani(2) , Norihiko Oka(1) , Shinji Goto(3) , Masanori Nakamura(3) , Tadashi Kitamura(1) , Tetsuya Horai(1) , Yuki Nakamura(1) , Kagami Miyaji(1)
1 Kitasato University, Sagamihara, Japan; 2 Kyoto Prefectural University of Medicine, Kyoto City, Japan; 3 Saitama University, Saitama-Shi, Japan
Invited Discussant: *Charles D. Fraser