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James M. Drake - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for Shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study
Journal of neurosurgery. Pediatrics, 2015Co-Authors: Jay Riva-cambrin, John R W Kestle, James M. Drake, Chevis N. Shannon, John C. Wellons, Abhaya V. Kulkarni, William E. Whitehead, Richard Holubkov, Jerry Butler, Mandeep S. TamberAbstract:OBJECT The rate of CSF Shunt Failure remains unacceptably high. The Hydrocephalus Clinical Research Network (HCRN) conducted a comprehensive prospective observational study of hydrocephalus management, the aim of which was to isolate specific risk factors for Shunt Failure. METHODS The study followed all first-time Shunt insertions in children younger than 19 years at 6 HCRN centers. The HCRN Investigator Committee selected, a priori, 21 variables to be examined, including clinical, radiographic, and Shunt design variables. Shunt Failure was defined as Shunt revision, subsequent endoscopic third ventriculostomy, or Shunt infection. Important a priori-defined risk factors as well as those significant in univariate analyses were then tested for independence using multivariate Cox proportional hazard modeling. RESULTS A total of 1036 children underwent initial CSF Shunt placement between April 2008 and December 2011. Of these, 344 patients experienced Shunt Failure, including 265 malfunctions and 79 infections. The mean and median length of follow-up for the entire cohort was 400 days and 264 days, respectively. The Cox model found that age younger than 6 months at first Shunt placement (HR 1.6 [95% CI 1.1-2.1]), a cardiac comorbidity (HR 1.4 [95% CI 1.0-2.1]), and endoscopic placement (HR 1.9 [95% CI 1.2-2.9]) were independently associated with reduced Shunt survival. The following had no independent associations with Shunt survival: etiology, payer, center, valve design, valve programmability, the use of ultrasound or stereotactic guidance, and surgeon experience and volume. CONCLUSIONS This is the largest prospective study reported on children with CSF Shunts for hydrocephalus. It confirms that a young age and the use of the endoscope are risk factors for first Shunt Failure and that valve type has no impact. A new risk factor-an existing cardiac comorbidity-was also associated with Shunt Failure.
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Patterns of Shunt Failure According to the Hydrodynamic Features of the Valve: Lessons from the Shunt Design Trial
Pediatric Hydrocephalus, 2005Co-Authors: John R W Kestle, James M. DrakeAbstract:In the early 1990s, two new valves came on the market for the management of hydrocephalus. They were designed to limit the tendency to overdrainage and to provide a more physiologic management of hydrocephalus. They were widely used based on reports of reduced Shunt Failure in uncontrolled series [3,9,10]. The Shunt Design Trial was initiated to compare the function of these valves with that of the differential pressure valves that had been on the market for many years previously. Surgeons from ten pediatric neurosurgery centers in Canada, the United States, and Europe participated in the trial and accrued patients from 1993 to 1995. A total of 344 children less than 18 years old were identified and randomized. All of them had hydrocephalus requiring a single ventriculoperitoneal Shunt. Patients were only enrolled in the trial if they were undergoing their first Shunt insertion; candidates for Shunt revision were not included. The patients were randomized to receive the Orbis-Sigma valve (which at the time was produced by Cordis Corporation), the Delta valve, or a differential pressure valve of the surgeons’ choice (“standard” group).
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Predicting Shunt Failure on the basis of clinical symptoms and signs in children
Journal of neurosurgery, 2001Co-Authors: Hugh J. L. Garton, John R W Kestle, James M. DrakeAbstract:Object. In evaluating pediatric patients for Shunt malfunction, predictive values for symptoms and signs are important in deciding which patients should undergo an imaging study, whereas determining clinical findings that correlate with a low probability of Shunt Failure could simplify management. Methods. Data obtained during the recently completed Pediatric Shunt Design Trial (PSDT) were analyzed. Predictive values were calculated for symptoms and signs of Shunt Failure. To refine predictive capability, a Shunt score based on a cluster of signs and symptoms was derived and validated using multivariate methods. Four hundred thirty-one patient encounters after recent Shunt insertions were analyzed. For encounters that took place within 5 months after Shunt insertion (early encounters), predictive values for symptoms and signs included the following: nausea and vomiting (positive predictive value [PPV] 79%, likelihood ratio [LR] 10.4), irritability (PPV 78%, LR 9.8), decreased level of consciousness (LOC) (PPV 100%), erythema (PPV 100%), and bulging fontanelle (PPV 92%, LR 33.1). Between 9 months and 2 years after Shunt insertion (late encounters), only loss of developmental milestones (PPV 83%, LR 36.7) and decreased LOC (PPV 100%) were strongly associated with Shunt Failure. However, the absence of a symptom or sign still left a 15 to 29% (early encounter group) or 9 to 13% (late encounter group) chance of Shunt Failure. Using the Shunt score developed for early encounters, which sums from 1 to 3 points according to the specific symptoms or signs present, patients with scores of 0, 1, 2, and 3 or greater had Shunt Failure rates of 4%, 50%, 75%, and 100%, respectively. Using the Shunt score derived from late encounters, patients with scores of 0, 1, and 2 or greater had Shunt Failure rates of 8%, 38%, and 100%, respectively. Conclusions. In children, certain symptoms and signs that occur during the first several months following Shunt insertion are strongly associated with Shunt Failure; however, the individual absence of these symptoms and signs offers the clinician only a limited ability to rule out a Shunt malfunction. Combining them in a weighted scoring system improves the ability to predict Shunt Failure based on clinical findings.
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long term follow up data from the Shunt design trial
Pediatric Neurosurgery, 2000Co-Authors: John R W Kestle, Ruth Milner, Christian Sainterose, Giuseppe Cinalli, Frederick A Boop, J Piatt, Stephen J Haines, James M. Drake, Steven J SchiffAbstract:Background: A previously reported multicenter randomized trial assessed whether 2 new Shunt valve designs would reduce Shunt Failure rates compared to differential pressure valves.
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Randomized trial of cerebrospinal fluid Shunt valve design in pediatric hydrocephalus.
Neurosurgery, 1998Co-Authors: James M. Drake, John R W Kestle, Ruth Milner, Giuseppe Cinalli, Frederick A Boop, Stephen J Haines, Steven J Schiff, Joseph H. Piatt, D. Douglas Cochrane, Paul SteinbokAbstract:OBJECTIVE: Forty percent of standard cerebrospinal fluid Shunts implanted for the treatment of pediatric hydrocephalus fail within the first year. Two new Shunt valves designed to limit excess flow, particularly in upright positions, were studied to compare treatment Failure rates with those for standard differential-pressure valves. METHODS: Three hundred-forty-four hydrocephalic children (age, birth to 18 yr) undergoing their first cerebrospinal fluid Shunt insertion were randomized at 12 North Arnerican or European pediatric neurosurgical centers. Patients received one of three valves, i.e., a standard differential-pressure valve; a Delta valve (Medtronic PS Medical, Goleta, CA), which contains a siphon-control component designed to reduce siphoning in upright positions; or an Orbis-Sigma valve (Cordis, Miami, FL), with a variable-resistance, flow-limiting component. Patients were monitored for a minimum of 1 year. Endpoints were defined as Shunt Failure resulting from Shunt obstruction, overdrainage, loculations of the cerebral ventricles, or infection. Outcome events were assessed by blinded independent case review. RESULTS: One hundred-fifty patients reached an endpoint; Shunt obstruction occurred in 108 (31.4%), overdrainage in 12 (3.5%), loculated ventricles in 2 (0.6%), and infection in 28 (8.1%). Sixty-one percent were Shunt Failure-free at 1 year and 47% at 2 years, with a median Shunt Failure-free duration of 656 days. There was no difference in Shunt Failure-free duration among the three valves (P = 0.24). CONCLUSION: Cerebrospinal fluid Shunt Failure, predominantly from Shunt obstruction and infection, remains a persistent problem in pediatric hydrocephalus. Two new valve designs did not significantly affect Shunt Failure rates.
John R W Kestle - One of the best experts on this subject based on the ideXlab platform.
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Machine learning predicts risk of cerebrospinal fluid Shunt Failure in children: a study from the hydrocephalus clinical research network
Child's Nervous System, 2021Co-Authors: Andrew T. Hale, John R W Kestle, John C. Wellons, Robert P. Naftel, Jay Riva-cambrin, Eric M. Jackson, Todd C. Hankinson, Chevis N. ShannonAbstract:Purpose While conventional statistical approaches have been used to identify risk factors for cerebrospinal fluid (CSF) Shunt Failure, these methods may not fully capture the complex contribution of clinical, radiologic, surgical, and Shunt-specific variables influencing this outcome. Using prospectively collected data from the Hydrocephalus Clinical Research Network (HCRN) patient registry, we applied machine learning (ML) approaches to create a predictive model of CSF Shunt Failure. Methods Pediatric patients (age < 19 years) undergoing first-time CSF Shunt placement at six HCRN centers were included. CSF Shunt Failure was defined as a composite outcome including requirement for Shunt revision, endoscopic third ventriculostomy, or Shunt infection within 5 years of initial surgery. Performance of conventional statistical and 4 ML models were compared. Results Our cohort consisted of 1036 children undergoing CSF Shunt placement, of whom 344 (33.2%) experienced Shunt Failure. Thirty-eight clinical, radiologic, surgical, and Shunt-design variables were included in the ML analyses. Of all ML algorithms tested, the artificial neural network (ANN) had the strongest performance with an area under the receiver operator curve (AUC) of 0.71. The ANN had a specificity of 90% and a sensitivity of 68%, meaning that the ANN can effectively rule-in patients most likely to experience CSF Shunt Failure (i.e., high specificity) and moderately effective as a tool to rule-out patients at high risk of CSF Shunt Failure (i.e., moderately sensitive). The ANN was independently validated in 155 patients (prospectively collected, retrospectively analyzed). Conclusion These data suggest that the ANN, or future iterations thereof, can provide an evidence-based tool to assist in prognostication and patient-counseling immediately after CSF Shunt placement.
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Machine learning predicts risk of cerebrospinal fluid Shunt Failure in children: a study from the hydrocephalus clinical research network
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2021Co-Authors: Andrew T. Hale, John R W Kestle, John C. Wellons, Robert P. Naftel, Jay Riva-cambrin, Eric M. Jackson, Todd C. Hankinson, Chevis N. ShannonAbstract:While conventional statistical approaches have been used to identify risk factors for cerebrospinal fluid (CSF) Shunt Failure, these methods may not fully capture the complex contribution of clinical, radiologic, surgical, and Shunt-specific variables influencing this outcome. Using prospectively collected data from the Hydrocephalus Clinical Research Network (HCRN) patient registry, we applied machine learning (ML) approaches to create a predictive model of CSF Shunt Failure. Pediatric patients (age < 19 years) undergoing first-time CSF Shunt placement at six HCRN centers were included. CSF Shunt Failure was defined as a composite outcome including requirement for Shunt revision, endoscopic third ventriculostomy, or Shunt infection within 5 years of initial surgery. Performance of conventional statistical and 4 ML models were compared. Our cohort consisted of 1036 children undergoing CSF Shunt placement, of whom 344 (33.2%) experienced Shunt Failure. Thirty-eight clinical, radiologic, surgical, and Shunt-design variables were included in the ML analyses. Of all ML algorithms tested, the artificial neural network (ANN) had the strongest performance with an area under the receiver operator curve (AUC) of 0.71. The ANN had a specificity of 90% and a sensitivity of 68%, meaning that the ANN can effectively rule-in patients most likely to experience CSF Shunt Failure (i.e., high specificity) and moderately effective as a tool to rule-out patients at high risk of CSF Shunt Failure (i.e., moderately sensitive). The ANN was independently validated in 155 patients (prospectively collected, retrospectively analyzed). These data suggest that the ANN, or future iterations thereof, can provide an evidence-based tool to assist in prognostication and patient-counseling immediately after CSF Shunt placement.
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Predictors of fast and ultrafast Shunt Failure in pediatric hydrocephalus: a Hydrocephalus Clinical Research Network study.
Journal of neurosurgery. Pediatrics, 2020Co-Authors: Jason S. Hauptman, John R W Kestle, Samuel R Browd, Abhaya V. Kulkarni, Robert P. Naftel, Curtis J. Rozzelle, Jay Riva-cambrin, William E. Whitehead, Jonathan Pindrik, David D. LimbrickAbstract:Objective The primary objective of this study was to use the prospective Hydrocephalus Clinical Research Network (HCRN) registry to determine clinical predictors of fast time to Shunt Failure (≤ 30 days from last revision) and ultrafast time to Failure (≤ 7 days from last revision). Methods Revisions (including those due to infection) to permanent Shunt placements that occurred between April 2008 and November 2017 for patients whose entire Shunt experience was recorded in the registry were analyzed. All registry data provided at the time of initial Shunt placement and subsequent revision were reviewed. Key variables analyzed included etiology of hydrocephalus, age at time of initial Shunt placement, presence of slit ventricles on imaging at revision, whether the ventricles were enlarged at the time of revision, and presence of prior fast Failure events. Univariable and multivariable analyses were performed to find key predictors of fast and ultrafast Failure events. Results A cohort of 1030 patients with initial Shunt insertions experienced a total of 1995 revisions. Of the 1978 revision events with complete records, 1216 (61.5%) Shunts remained functional for more than 1 year, and 762 (38.5%) failed within 1 year of the procedure date. Of those that failed within 1 year, 423 (55.5%) failed slowly (31-365 days) and 339 (44.5%) failed fast (≤ 30 days). Of the fast Failures, 131 (38.6%) were ultrafast (≤ 7 days). In the multivariable analysis specified a priori, etiology of hydrocephalus (p = 0.005) and previous Failure history (p = 0.011) were independently associated with fast Failure. Age at time of procedure (p = 0.042) and etiology of hydrocephalus (p = 0.004) were independently associated with ultrafast Failure. These relationships in both a priori models were supported by the data-driven multivariable models as well. Conclusions Neither the presence of slit ventricle syndrome nor ventricular enlargement at the time of Shunt Failure appears to be a significant predictor of repeated, rapid Shunt revisions. Age at the time of procedure, etiology of hydrocephalus, and the history of previous Failure events seem to be important predictors of fast and ultrafast Shunt Failure. Further work is required to understand the mechanisms of these risk factors as well as mitigation strategies.
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Risk factors for Shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study
Journal of neurosurgery. Pediatrics, 2015Co-Authors: Jay Riva-cambrin, John R W Kestle, James M. Drake, Chevis N. Shannon, John C. Wellons, Abhaya V. Kulkarni, William E. Whitehead, Richard Holubkov, Jerry Butler, Mandeep S. TamberAbstract:OBJECT The rate of CSF Shunt Failure remains unacceptably high. The Hydrocephalus Clinical Research Network (HCRN) conducted a comprehensive prospective observational study of hydrocephalus management, the aim of which was to isolate specific risk factors for Shunt Failure. METHODS The study followed all first-time Shunt insertions in children younger than 19 years at 6 HCRN centers. The HCRN Investigator Committee selected, a priori, 21 variables to be examined, including clinical, radiographic, and Shunt design variables. Shunt Failure was defined as Shunt revision, subsequent endoscopic third ventriculostomy, or Shunt infection. Important a priori-defined risk factors as well as those significant in univariate analyses were then tested for independence using multivariate Cox proportional hazard modeling. RESULTS A total of 1036 children underwent initial CSF Shunt placement between April 2008 and December 2011. Of these, 344 patients experienced Shunt Failure, including 265 malfunctions and 79 infections. The mean and median length of follow-up for the entire cohort was 400 days and 264 days, respectively. The Cox model found that age younger than 6 months at first Shunt placement (HR 1.6 [95% CI 1.1-2.1]), a cardiac comorbidity (HR 1.4 [95% CI 1.0-2.1]), and endoscopic placement (HR 1.9 [95% CI 1.2-2.9]) were independently associated with reduced Shunt survival. The following had no independent associations with Shunt survival: etiology, payer, center, valve design, valve programmability, the use of ultrasound or stereotactic guidance, and surgeon experience and volume. CONCLUSIONS This is the largest prospective study reported on children with CSF Shunts for hydrocephalus. It confirms that a young age and the use of the endoscope are risk factors for first Shunt Failure and that valve type has no impact. A new risk factor-an existing cardiac comorbidity-was also associated with Shunt Failure.
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Shunt Failure due to intracranial migration of BioGlide ventricular catheters.
Journal of neurosurgery. Pediatrics, 2011Co-Authors: Hsin Hung Chen, Jay Riva-cambrin, Douglas L. Brockmeyer, Marion L. Walker, John R W KestleAbstract:Object In late 2008, the authors recognized a new type of ventriculoperitoneal Shunt Failure specific to the Bio-Glide Snap Shunt ventricular catheters. This prompted a retrospective review of the patient cohort and resulted in a recall by the FDA in the US. Methods After the index cases were identified, the FDA was notified by the hospital, leading to a recall of the product. Hospital operative logs were used to identify patients in whom the affected products were used. A letter describing the risk was sent to all patients offering a free screening CT scan to look for disconnection. A call center was established to respond to patient questions, and an informational video was made available on the hospital website. The authors reviewed the records of the index cases and other cases subsequently identified. Results Seven index cases and an additional 16 cases of disconnection were identified in the 466 patients in whom a BioGlide Snap Shunt ventricular catheter had been implanted. Mean time to disconnectio...
Stephen E Sullivan - One of the best experts on this subject based on the ideXlab platform.
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comparison of the accuracy and proximal Shunt Failure rate of freehand placement versus intraoperative guidance in parietooccipital ventricular catheter placement
Neurosurgical Focus, 2016Co-Authors: Thomas J Wilson, Kathleen E Mccoy, Wajd N Alholou, Sergio L Molina, Matthew D Smyth, Stephen E SullivanAbstract:OBJECTIVE The aim of this paper is to compare the accuracy of the freehand technique versus the use of intraoperative guidance (either ultrasound guidance or frameless stereotaxy) for placement of parietooccipital ventricular catheters and to determine factors associated with reduced proximal Shunt Failure. METHODS This retrospective cohort study included all patients from 2 institutions who underwent a ventricular cerebrospinal fluid (CSF) Shunting procedure in which a new parietooccipital ventricular catheter was placed between January 2005 and December 2013. Data abstracted for each patient included age, sex, method of ventricular catheter placement, side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic studies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of Shunt Failure requiring revision. Standard statistical methods were used for analysis. RESULTS A total of 257 patients were included in the study: 134 from the University of Michigan and 123 from Washington University in St. Louis. Accurate ventricular catheter placement was achieved in 81.2% of cases in which intraoperative guidance was used versus 67.3% when the freehand technique was used. Increasing age reduced the likelihood of accurate catheter placement (OR 0.983, 95% CI 0.971-0.995; p = 0.005), while the use of intraoperative guidance significantly increased the likelihood (OR 2.809, 95% CI 1.406-5.618; p = 0.016). During the study period, 108 patients (42.0%) experienced Shunt Failure, 79 patients (30.7%) had Failure involving the proximal catheter, and 53 patients (20.6%) had distal Failure (valve or distal catheter). Increasing age reduced the likelihood of being free from proximal Shunt Failure (OR 0.983, 95% CI 0.970-0.995; p = 0.008), while both the use of intraoperative guidance (OR 2.385, 95% CI 1.227-5.032; p = 0.011), and accurate ventricular catheter placement (OR 3.424, 95% CI 1.796-6.524; p = 0.009) increased the likelihood. CONCLUSIONS The use of intraoperative guidance during parietooccipital ventricular catheter placement as part of a CSF Shunt system significantly increases the likelihood of accurate catheter placement and subsequently reduces the rate of proximal Shunt Failure.
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Comparison of the accuracy and proximal Shunt Failure rate of freehand placement versus intraoperative guidance in parietooccipital ventricular catheter placement.
Neurosurgical focus, 2016Co-Authors: Thomas J Wilson, Kathleen E Mccoy, Sergio L Molina, Matthew D Smyth, Wajd N. Al-holou, Stephen E SullivanAbstract:OBJECTIVE The aim of this paper is to compare the accuracy of the freehand technique versus the use of intraoperative guidance (either ultrasound guidance or frameless stereotaxy) for placement of parietooccipital ventricular catheters and to determine factors associated with reduced proximal Shunt Failure. METHODS This retrospective cohort study included all patients from 2 institutions who underwent a ventricular cerebrospinal fluid (CSF) Shunting procedure in which a new parietooccipital ventricular catheter was placed between January 2005 and December 2013. Data abstracted for each patient included age, sex, method of ventricular catheter placement, side of ventricular catheter placement, Evans ratio, and bifrontal ventricular span. Postoperative radiographic studies were reviewed for accuracy of ventricular catheter placement. Medical records were also reviewed for evidence of Shunt Failure requiring revision. Standard statistical methods were used for analysis. RESULTS A total of 257 patients were i...
Sara K. Pasquali - One of the best experts on this subject based on the ideXlab platform.
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Shunt Failure—Risk Factors and Outcomes: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database
The Annals of thoracic surgery, 2017Co-Authors: Kevin D. Hill, Amelia S. Wallace, Luca A. Vricella, E. Cameron, James A. Quintessenza, Neil A. Goldenberg, Constantine D. Mavroudis, Tom R. Karl, Sara K. PasqualiAbstract:Background Systemic-to-pulmonary Shunt Failure is a potentially catastrophic complication. We analyzed a large multicenter clinical registry to describe the prevalence and evaluate risk factors. Methods Infants (aged ≤365 days) undergoing Shunt operations (systemic artery-to-pulmonary artery or systemic ventricle-to-pulmonary artery) in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) from 2010 to 2015 were included. Multivariable logistic regression was used to evaluate risk factors for in-hospital Shunt Failure. Model covariates included patient characteristics, preoperative factors, procedural factors including Shunt type, and center effects. Centers with more than 15% missing data for key covariates were excluded. Results Shunt operations were performed in 9,172 infants (118 centers). In-hospital Shunt Failure occurred in 674 (7.3%). In multivariable analysis, risk factors for in-hospital Shunt Failure included lower weight at operation (odds ratio [OR], 1.35; p = 0.001), preoperative hypercoagulable state (OR, 2.47; p = 0.031), and the presence of any other STS-CHSD preoperative risk factors (OR, 1.24; p = 0.038). Shunt Failure was less likely with a systemic ventricle-to-pulmonary artery Shunt than a systemic artery-to-pulmonary artery Shunt (OR, 0.65; p = 0.020). Neither cardiopulmonary bypass nor single-ventricle diagnosis was a risk factor for Shunt Failure. Patients with in-hospital Shunt Failure had significantly higher rates of operative mortality (31.9% vs 11.1%, p p p Conclusions In-hospital Shunt Failure is common, and associated mortality risk is high. These data highlight at-risk patients and procedural cohorts that warrant expectant surveillance and may benefit from enhanced antithrombotic prophylaxis or other management strategies to reduce Shunt Failure. These findings may inform planning of future clinical trials.
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Shunt Failure risk factors and outcomes an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2017Co-Authors: Kevin D. Hill, Amelia S. Wallace, Luca A. Vricella, James A. Quintessenza, Neil A. Goldenberg, Constantine D. Mavroudis, Tom R. Karl, Sara K. Pasquali, Duke E Cameron, Jeffrey P JacobsAbstract:Background Systemic-to-pulmonary Shunt Failure is a potentially catastrophic complication. We analyzed a large multicenter clinical registry to describe the prevalence and evaluate risk factors. Methods Infants (aged ≤365 days) undergoing Shunt operations (systemic artery-to-pulmonary artery or systemic ventricle-to-pulmonary artery) in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) from 2010 to 2015 were included. Multivariable logistic regression was used to evaluate risk factors for in-hospital Shunt Failure. Model covariates included patient characteristics, preoperative factors, procedural factors including Shunt type, and center effects. Centers with more than 15% missing data for key covariates were excluded. Results Shunt operations were performed in 9,172 infants (118 centers). In-hospital Shunt Failure occurred in 674 (7.3%). In multivariable analysis, risk factors for in-hospital Shunt Failure included lower weight at operation (odds ratio [OR], 1.35; p = 0.001), preoperative hypercoagulable state (OR, 2.47; p = 0.031), and the presence of any other STS-CHSD preoperative risk factors (OR, 1.24; p = 0.038). Shunt Failure was less likely with a systemic ventricle-to-pulmonary artery Shunt than a systemic artery-to-pulmonary artery Shunt (OR, 0.65; p = 0.020). Neither cardiopulmonary bypass nor single-ventricle diagnosis was a risk factor for Shunt Failure. Patients with in-hospital Shunt Failure had significantly higher rates of operative mortality (31.9% vs 11.1%, p p p Conclusions In-hospital Shunt Failure is common, and associated mortality risk is high. These data highlight at-risk patients and procedural cohorts that warrant expectant surveillance and may benefit from enhanced antithrombotic prophylaxis or other management strategies to reduce Shunt Failure. These findings may inform planning of future clinical trials.
Kevin D. Hill - One of the best experts on this subject based on the ideXlab platform.
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Shunt Failure—Risk Factors and Outcomes: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database
The Annals of thoracic surgery, 2017Co-Authors: Kevin D. Hill, Amelia S. Wallace, Luca A. Vricella, E. Cameron, James A. Quintessenza, Neil A. Goldenberg, Constantine D. Mavroudis, Tom R. Karl, Sara K. PasqualiAbstract:Background Systemic-to-pulmonary Shunt Failure is a potentially catastrophic complication. We analyzed a large multicenter clinical registry to describe the prevalence and evaluate risk factors. Methods Infants (aged ≤365 days) undergoing Shunt operations (systemic artery-to-pulmonary artery or systemic ventricle-to-pulmonary artery) in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) from 2010 to 2015 were included. Multivariable logistic regression was used to evaluate risk factors for in-hospital Shunt Failure. Model covariates included patient characteristics, preoperative factors, procedural factors including Shunt type, and center effects. Centers with more than 15% missing data for key covariates were excluded. Results Shunt operations were performed in 9,172 infants (118 centers). In-hospital Shunt Failure occurred in 674 (7.3%). In multivariable analysis, risk factors for in-hospital Shunt Failure included lower weight at operation (odds ratio [OR], 1.35; p = 0.001), preoperative hypercoagulable state (OR, 2.47; p = 0.031), and the presence of any other STS-CHSD preoperative risk factors (OR, 1.24; p = 0.038). Shunt Failure was less likely with a systemic ventricle-to-pulmonary artery Shunt than a systemic artery-to-pulmonary artery Shunt (OR, 0.65; p = 0.020). Neither cardiopulmonary bypass nor single-ventricle diagnosis was a risk factor for Shunt Failure. Patients with in-hospital Shunt Failure had significantly higher rates of operative mortality (31.9% vs 11.1%, p p p Conclusions In-hospital Shunt Failure is common, and associated mortality risk is high. These data highlight at-risk patients and procedural cohorts that warrant expectant surveillance and may benefit from enhanced antithrombotic prophylaxis or other management strategies to reduce Shunt Failure. These findings may inform planning of future clinical trials.
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Shunt Failure risk factors and outcomes an analysis of the society of thoracic surgeons congenital heart surgery database
The Annals of Thoracic Surgery, 2017Co-Authors: Kevin D. Hill, Amelia S. Wallace, Luca A. Vricella, James A. Quintessenza, Neil A. Goldenberg, Constantine D. Mavroudis, Tom R. Karl, Sara K. Pasquali, Duke E Cameron, Jeffrey P JacobsAbstract:Background Systemic-to-pulmonary Shunt Failure is a potentially catastrophic complication. We analyzed a large multicenter clinical registry to describe the prevalence and evaluate risk factors. Methods Infants (aged ≤365 days) undergoing Shunt operations (systemic artery-to-pulmonary artery or systemic ventricle-to-pulmonary artery) in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) from 2010 to 2015 were included. Multivariable logistic regression was used to evaluate risk factors for in-hospital Shunt Failure. Model covariates included patient characteristics, preoperative factors, procedural factors including Shunt type, and center effects. Centers with more than 15% missing data for key covariates were excluded. Results Shunt operations were performed in 9,172 infants (118 centers). In-hospital Shunt Failure occurred in 674 (7.3%). In multivariable analysis, risk factors for in-hospital Shunt Failure included lower weight at operation (odds ratio [OR], 1.35; p = 0.001), preoperative hypercoagulable state (OR, 2.47; p = 0.031), and the presence of any other STS-CHSD preoperative risk factors (OR, 1.24; p = 0.038). Shunt Failure was less likely with a systemic ventricle-to-pulmonary artery Shunt than a systemic artery-to-pulmonary artery Shunt (OR, 0.65; p = 0.020). Neither cardiopulmonary bypass nor single-ventricle diagnosis was a risk factor for Shunt Failure. Patients with in-hospital Shunt Failure had significantly higher rates of operative mortality (31.9% vs 11.1%, p p p Conclusions In-hospital Shunt Failure is common, and associated mortality risk is high. These data highlight at-risk patients and procedural cohorts that warrant expectant surveillance and may benefit from enhanced antithrombotic prophylaxis or other management strategies to reduce Shunt Failure. These findings may inform planning of future clinical trials.