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Susan C Nicolson - One of the best experts on this subject based on the ideXlab platform.
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early extubation after repair of tetralogy of fallot and the Fontan Procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Sara K Pasquali, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan Procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan Procedure. Early extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate ( p = 0.04). No association was found between center early extubation rate and PLOS for Fontan Procedures ( p = 0.08). Conclusions Early extubation is common after repair of TOF and the Fontan Procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
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early extubation after repair of tetralogy of fallot and the Fontan Procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Sara K Pasquali, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Sunghee Kim, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan Procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan Procedure. Early extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate ( p = 0.04). No association was found between center early extubation rate and PLOS for Fontan Procedures ( p = 0.08). Conclusions Early extubation is common after repair of TOF and the Fontan Procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
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neurodevelopmental outcomes in preschool survivors of the Fontan Procedure
The Journal of Thoracic and Cardiovascular Surgery, 2014Co-Authors: William J Gaynor, Susan C Nicolson, Gil Wernovsky, Richard F. Ittenbach, Marsha Gerdes, Judy Bernbaum, Robert R Clancy, Donna M Mcdonaldmcginn, Elaine H Zackai, Thomas L SprayAbstract:Objectives The study objectives were to compare the neurodevelopmental outcomes of preschool survivors of the Fontan Procedure with those of children with congenital heart disease undergoing biventricular repair and to investigate predictors of neurodevelopmental outcome for those with single ventricle congenital heart disease, including hypoplastic left heart syndrome. Methods Neurodevelopmental outcomes were assessed at 4 years of age, including cognition, visual–motor integration, behavior, social skills, and academic achievement. Unadjusted outcomes were compared between patients with biventricular circulation and patients with single ventricles. Predictors of neurodevelopmental outcome were assessed in the patients with single ventricles. Multiple covariate models were evaluated using patient-related, operative, and postoperative covariates. Results Neurodevelopmental evaluation was performed in 365 children, 112 after the Fontan Procedure (hypoplastic left heart syndrome, n = 91; other single ventricle, n = 21) and 253 after biventricular repair. Compared with patients with biventricular circulation, patients with single ventricles performed worse in terms of processing speed, inattention, and impulsivity. Otherwise, there were no significant differences between the groups for any domain. There was a trend toward lower performance for patients with single ventricles on visual motor integration. Outcomes for patients with hypoplastic left heart syndrome were not worse than for other forms of functional single ventricle. Patient factors were more important predictors of neurodevelopmental outcomes than were operative management variables. Conclusions In this cohort, unadjusted neurodevelopmental outcomes for preschool survivors of the Fontan Procedure are similar to those for children with congenital heart disease undergoing biventricular repair for most domains. Among the patients undergoing the Fontan Procedure, hypoplastic left heart syndrome was not associated with worse outcomes compared with other forms of single ventricle.
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Outcomes of the Fontan Procedure using cardiopulmonary bypass with aortic cross-clamping.
The Annals of thoracic surgery, 2006Co-Authors: David B. Meyer, Susan C Nicolson, Gil Wernovsky, Guillermo Zamora, Richard F. Ittenbach, Paul R. Gallagher, Sarah Tabbutt, Peter J. Gruber, J. William Gaynor, Thomas L SprayAbstract:Background Avoidance of cardiopulmonary bypass (CPB) and aortic cross-clamping during the Fontan Procedure has been advocated to improve outcomes. We continue to use CPB with aortic cross-clamping for the Fontan Procedure. Methods We performed a review of patients undergoing the Fontan Procedure between January 1, 2000 and December 31, 2004. Results The Fontan Procedure was performed in 160 patients. The median age was 2.2 years (range, 1.0 to 29.1 years). Hypoplastic left heart syndrome or a variant was present in 114 patients (71%), and heterotaxy was present in 19 (12%). CPB and modified ultrafiltration were used in all patients. Aortic cross-clamping was used in 154 (96%) of 160 patients and deep hypothermic circulatory arrest (DHCA) in 132 (83%). A lateral tunnel Fontan was performed in 69 patients (43%) and an extracardiac Fontan in 91 (57%). A fenestration was created in 144 patients (90%). Two patients died. Freedom from death or takedown was 98% (157/160). Median duration of pleural drainage was 2 days (range, 1 to 44 days) and was more than 14 days in 16 patients. Median duration of hospitalization was 6 days (range, 3 to 55 days). The small number of deaths precluded assessment of risk factors for mortality. By multivariable analysis, risk factors for pleural drainage longer than 3 days were extracardiac connection ( p p = 0.033). By multivariable analysis, risk factors for hospitalization for more than 7 days were extracardiac connection ( p = 0.003), increasing duration of total support (CPB and DHCA, p = 0.027), and decreasing systemic oxygen saturation before the Fontan Procedure ( p = 0.048). Conclusions The Fontan Procedure can be performed using CPB and aortic cross-clamping with low morbidity and mortality.
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intermediate outcomes after the Fontan Procedure in the current era
The Journal of Thoracic and Cardiovascular Surgery, 2006Co-Authors: Michael Mitchell, Susan C Nicolson, Gil Wernovsky, William J Gaynor, Richard F. Ittenbach, Thomas L SprayAbstract:Objective This study was undertaken to investigate the intermediate outcomes after the Fontan operation in the current era. Methods A cross-sectional analysis was performed by using data gathered between October 13, 2003, and February 22, 2005, on all 310 survivors of the Fontan Procedure between January 1, 1992, and December 31, 1999. Medical records were reviewed, and a customized questionnaire was administered to caregivers. Outcome variables included failure of the Fontan operation (ie, death, takedown of Fontan, or transplantation), number of cardiac-related rehospitalizations, parental assessment of health, school performance, and cardiac functional status. Results A total of 332 patients underwent the Fontan Procedure during the study period. A lateral tunnel was constructed in 281 (85%), and an extracardiac Fontan Procedure was performed in 51 (15%). A total of 210 (63%) children had undergone previous stage I reconstruction, and 162 (49%) had received an initial diagnosis of hypoplastic left heart syndrome. There were 310 hospital survivors of the Fontan Procedure (93.4%), with an additional 16 deaths (5.2%) during follow-up and 1 living heart transplant patient before the cross-sectional period. For initial hospital survivors, Kaplan-Meier estimates of freedom from death or transplantation were 98.0% (95% confidence interval, 95.6%-99.1%) at 1 year after the Fontan Procedure, 94.9% (91.6%-97.0%) at 5 years, and 93.9% (90.1%-96.2%) at 8 years. Questionnaires were completed for 240 (81.9%) of the 293 available patients. By parental recollection, a total of 130 (54.2%) children required cardiac-related rehospitalization at some point during the follow-up period. At a median follow-up of 8.6 years (range, 4.1-12.8 years), 94.6% of guardians described their child's overall health as excellent or good, and 5.4%, as fair or poor. School performance was described as above average in 30.2%, average in 39.9%, and below average in 29.8%. With regard to cardiac functional status, 34.2% responded that their child had no limitations to physical activity, 52.5% reported a slight limitation, 12.1% reported a significant limitation, and 1.2% reported a severe limitation. Conclusions Acceptable survival outcomes have been observed at intermediate follow-up of the Fontan operation in this cohort; a significant proportion of patients had hypoplastic left heart syndrome. Although cardiac-related rehospitalization is common, the parents and guardians believed that overall health, school performance, and cardiac functional status were good to excellent for most patients.
William T Mahle - One of the best experts on this subject based on the ideXlab platform.
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early extubation after repair of tetralogy of fallot and the Fontan Procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Sara K Pasquali, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan Procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan Procedure. Early extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate ( p = 0.04). No association was found between center early extubation rate and PLOS for Fontan Procedures ( p = 0.08). Conclusions Early extubation is common after repair of TOF and the Fontan Procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
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early extubation after repair of tetralogy of fallot and the Fontan Procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Sara K Pasquali, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Sunghee Kim, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan Procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan Procedure. Early extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate ( p = 0.04). No association was found between center early extubation rate and PLOS for Fontan Procedures ( p = 0.08). Conclusions Early extubation is common after repair of TOF and the Fontan Procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
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magnetic resonance imaging identifies unsuspected liver abnormalities in patients after the Fontan Procedure
The Journal of Pediatrics, 2013Co-Authors: Ozlem Pinar Bulut, William T Mahle, Rene Romero, Michael E Mcconnell, Kiery Braithwaite, Bahig M Shehata, Nitika A Gupta, Miriam B Vos, Adina AlazrakiAbstract:Objective To determine whether abdominal magnetic resonance imaging (MRI) detects hepatic abnormalities before clinical or biochemical perturbations in patients after the Fontan Procedure. Study design Thirty-nine children and adolescents who underwent the Fontan Procedure and were referred to a pediatric hepatologist by cardiology services between 2011 and 2012 were reviewed retrospectively. Physical examination findings, routine laboratory tests of liver function, evaluation for chronic liver disease, and abdominal MRI findings were recorded. MRI findings were evaluated relative to time elapsed since surgery by 2 radiologists (blinded). Results Assessment for coexisting chronic liver disease was negative in all patients. All patients had a normal serum albumin level and International Normalized Ratio. Twenty-six of the 39 patients (67%) underwent abdominal MRI, 4 had MRI-incompatible hardware, and 9 did not undergo MRI because of insurance denial. All MRI scans demonstrated morphologic liver changes with varying degrees of reticular contrast enhancement compatible with fibrosis and congestion. Reticular contrast enhancement was often nonuniform, and 9 patients (35%) had multifocal arterially enhancing lesions. Conclusion MRI can identify hepatic abnormalities in patients after Fontan surgery that go undetected by standard clinical and laboratory assessments. These abnormalities are not uniformly distributed throughout the liver, and thus assessment by liver biopsy analysis is subject to sampling error.
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heart transplantation in children with a Fontan Procedure
The Annals of Thoracic Surgery, 2011Co-Authors: Kirk R Kanter, William T Mahle, Robert N Vincent, Alexandria M Berg, Brian Kogon, Paul M KirshbomAbstract:Background Previous studies have reported that children with a prior Fontan Procedure have decreased survival after heart transplantation. We examined 190 primary pediatric heart transplants. Methods Since 1988, 27 (14.2%) of 190 children less than 18 years old undergoing primary heart transplantation had a Fontan Procedure 3.7 ± 4.3 years before transplantation. Compared with 163 (85.8%) non-Fontan primary transplants, the Fontan patients were similar in age (8.2 ± 5.0 vs 6.5 ± 6.0 years), presensitization, and pretransplant clinical status. More Fontan patients had prior operations (100% vs 50%; p Results Donor ischemic times (211 ± 72 vs 170 ± 61 minutes; p = 0.0018) and cardiopulmonary bypass times (197 ± 91 vs 121 ± 53 minutes; p Conclusions Contrary to prior reports, we did not identify any early or midterm disadvantage for children undergoing heart transplantation after a previous Fontan Procedure despite more complex transplant operations. We contend that carefully selected children with a failing Fontan circulation can do as well as other children with heart transplantation.
Kevin D Hill - One of the best experts on this subject based on the ideXlab platform.
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early extubation after repair of tetralogy of fallot and the Fontan Procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Sara K Pasquali, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan Procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan Procedure. Early extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate ( p = 0.04). No association was found between center early extubation rate and PLOS for Fontan Procedures ( p = 0.08). Conclusions Early extubation is common after repair of TOF and the Fontan Procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
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early extubation after repair of tetralogy of fallot and the Fontan Procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Sara K Pasquali, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Sunghee Kim, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan Procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan Procedure. Early extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate ( p = 0.04). No association was found between center early extubation rate and PLOS for Fontan Procedures ( p = 0.08). Conclusions Early extubation is common after repair of TOF and the Fontan Procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
Marshall L Jacobs - One of the best experts on this subject based on the ideXlab platform.
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early extubation after repair of tetralogy of fallot and the Fontan Procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Sara K Pasquali, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan Procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan Procedure. Early extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate ( p = 0.04). No association was found between center early extubation rate and PLOS for Fontan Procedures ( p = 0.08). Conclusions Early extubation is common after repair of TOF and the Fontan Procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
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early extubation after repair of tetralogy of fallot and the Fontan Procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Sara K Pasquali, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Sunghee Kim, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan Procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan Procedure. Early extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate ( p = 0.04). No association was found between center early extubation rate and PLOS for Fontan Procedures ( p = 0.08). Conclusions Early extubation is common after repair of TOF and the Fontan Procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
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Fontan Procedure for hypoplastic left heart syndrome
The Annals of Thoracic Surgery, 1992Co-Authors: William I Norwood, Marshall L Jacobs, John D MurphyAbstract:Since 1985, 354 neonates have undergone palliative reconstruction for hypoplastic left heart syndrome with 109 early deaths and 12 late deaths. Of the survivors, before 1989, 77 patients underwent a subsequent modified Fontan operation, consisting of baffling the atrial septal defect to the tricuspid valve (initial 25 patients) or intraatrial baffling of the inferior vena cava to the pulmonary arteries and superior vena cava (52 patients). There were 17 early deaths and three late deaths. Major serous effusions developed in 42 patients (54%) after Fontan operation. Since 1989, a staged approach to Fontan's operation was undertaken in an effort to reduce the volume load of the right ventricle as early as possible, to minimize the impact of rapid changes in ventricular geometry and diastolic function that can accompany a primary Fontan operation, and to reduce effusive complications. Thus, at a mean age of 6 months, 121 patients have undergone closure of aortopulmonary shunt, augmentation of central pulmonary arteries, and association of the superior vena cava with the branch pulmonary arteries (hemi-Fontan Procedure). Of these, 61 patients have already undergone completion of the Fontan Procedure with six early deaths and three late deaths. Major serous effusions developed in 28 patients (46%) with the staged Fontan. For perspective, the contemporary experience since January 1991 consists of 58 neonates who have undergone initial palliation with 11 deaths (19%), 17 patients who have undergone the hemi-Fontan Procedure with one death (6%), and 21 patients who have undergone completion of the Fontan operation with one death (5%).(ABSTRACT TRUNCATED AT 250 WORDS)
Paul M Kirshbom - One of the best experts on this subject based on the ideXlab platform.
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early extubation after repair of tetralogy of fallot and the Fontan Procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Sara K Pasquali, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan Procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan Procedure. Early extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate ( p = 0.04). No association was found between center early extubation rate and PLOS for Fontan Procedures ( p = 0.08). Conclusions Early extubation is common after repair of TOF and the Fontan Procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
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early extubation after repair of tetralogy of fallot and the Fontan Procedure an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2016Co-Authors: William T Mahle, Sara K Pasquali, Jeffrey P Jacobs, Marshall L Jacobs, Paul M Kirshbom, Erle H Austin, Kirk R Kanter, Susan C Nicolson, Sunghee Kim, Kevin D HillAbstract:Background There is increasing interest in reducing the duration of mechanical ventilation after pediatric cardiac operations. However, the contemporary use of an early extubation strategy and its effect on clinical outcomes is poorly understood. Methods Data from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) were analyzed to determine the association of early extubation with postoperative length of stay (PLOS). Two operations were analyzed: complete repair of tetralogy of Fallot (TOF) in patients older than 45 days and the Fontan Procedure. Centers were stratified into tertiles by frequency of early extubation, defined as less than 6 hours after leaving the operating room. Patients extubated after 48 hours were excluded. Results Among 92 centers, early extubation was performed in 31.5% (478 of 1,519) of children undergoing TOF repair and in 69.8% (1,153 of 1,653) of those undergoing the Fontan Procedure. Early extubation after TOF repair was associated with heavier weight at operation ( p p = 0.016). After adjustment for covariates, average PLOS after TOF repair was shorter for centers in the highest tertile of early extubation rate than for the lowest tertile centers, which have low early extubation rate ( p = 0.04). No association was found between center early extubation rate and PLOS for Fontan Procedures ( p = 0.08). Conclusions Early extubation is common after repair of TOF and the Fontan Procedure. A high institutional rate of early extubation after TOF repair is associated with shorter PLOS. Further analysis is needed to understand what effect early extubation might have on other meaningful measures such as resource use.
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heart transplantation in children with a Fontan Procedure
The Annals of Thoracic Surgery, 2011Co-Authors: Kirk R Kanter, William T Mahle, Robert N Vincent, Alexandria M Berg, Brian Kogon, Paul M KirshbomAbstract:Background Previous studies have reported that children with a prior Fontan Procedure have decreased survival after heart transplantation. We examined 190 primary pediatric heart transplants. Methods Since 1988, 27 (14.2%) of 190 children less than 18 years old undergoing primary heart transplantation had a Fontan Procedure 3.7 ± 4.3 years before transplantation. Compared with 163 (85.8%) non-Fontan primary transplants, the Fontan patients were similar in age (8.2 ± 5.0 vs 6.5 ± 6.0 years), presensitization, and pretransplant clinical status. More Fontan patients had prior operations (100% vs 50%; p Results Donor ischemic times (211 ± 72 vs 170 ± 61 minutes; p = 0.0018) and cardiopulmonary bypass times (197 ± 91 vs 121 ± 53 minutes; p Conclusions Contrary to prior reports, we did not identify any early or midterm disadvantage for children undergoing heart transplantation after a previous Fontan Procedure despite more complex transplant operations. We contend that carefully selected children with a failing Fontan circulation can do as well as other children with heart transplantation.