Incidence and Risk Distribution of Heart Failure in Adolescents and Adults With Congenital Heart Disease After Cardiac Surgery

Norozi, Kambiz; Wessel, Armin; Alpers, Valentin; Arnhold, Jan O.; Geyer, Siegfried; Zoege, Monika; Buchhorn, Reiner

doi:10.1016/j.amjcard.2005.10.065

Cited by 221 publications

(130 citation statements)

References 25 publications

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“…This compares with non‐ACHD HF, which predominantly affected adults aged ≥65 years. The high prevalence of HF in different ACHD subtypes observed herein and in prior studies, including up to 50% of patients with TOF and 30% of patients who underwent Mustard/Senningrepair,19, 20 highlights the fact that these patients are not “cured” but instead remain at high risk for HF. Compared with early studies of subclinical HF reported in often asymptomatic patients with ACHD with elevated serum biomarkers,19 we are now witnessing an increasing number of patients with ACHD with clinically overt HF requiring in‐hospital care.…”

Section: Discussionmentioning

confidence: 44%

Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease–Related Heart Failure

Burchill

Gao

Kovacs

et al. 2018

JAHA

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BackgroundThis study assessed trends in heart failure (HF) hospitalizations and health resource use in patients with adult congenital heart disease (ACHD).Methods and ResultsThe Nationwide Inpatient Sample was used to compare ACHD with non‐ACHD HF hospitalization and health resource trends. Health resource use was assessed using total hospital charges, hospital length of stay, and procedural burden. A total of 87 175±2676 ACHD‐related HF hospitalizations occurred between 1998 and 2011. During this time, ACHD HF hospitalizations increased 91% (4620±438–8809±740, P<0.0001) versus a 21% increase in non‐ACHD HF hospitalizations (P=0.003). ACHD HF hospitalization was associated with longer length of stay (ACHD HF versus non‐ACHD HF, 7.2±0.09 versus 6.8±0.02 days; P<0.0001), greater procedural burden, and higher charges ($81 332±$1650 versus $52 050±$379; P<0.0001). ACHD HF hospitalization charges increased 258% during the study period ($26 533±$1816 in 1998 versus $94 887±$8310 in 2011; P=0.0002), more than double that for non‐ACHD HF (P=0.04). Patients with ACHD HF hospitalized in high‐volume ACHD centers versus others were more likely to undergo invasive hemodynamic testing (30.2±0.6% versus 20.7±0.5%; P<0.0001) and to receive cardiac resynchronization/defibrillator devices (4.7±0.3% versus 1.8±0.2%; P<0.0001) and mechanical circulatory support (3.9±0.2% versus 2.4±0.2%; P<0.0001).Conclusions ACHD‐related HF hospitalizations have increased dramatically in recent years and are associated with disproportionately higher costs, procedural burden, and health resource use.

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Section: Discussionmentioning

confidence: 44%

Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease–Related Heart Failure

Burchill

Gao

Kovacs

et al. 2018

JAHA

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“…This is of importance for the approach to patients with chronically increased RV load and for experimental studies in various types of RV failure. right ventricular failure; contractility; pressure-volume analysis; pulmonary hypertension; monocrotaline RIGHT VENTRICULAR FAILURE is a detrimental condition that is associated with significant morbidity and mortality in patients with congenital heart disease and/or pulmonary hypertension (PH) (11,19,34,38). In these conditions, persistent abnormal loading of the right ventricle (RV) leads to RV failure in the long term (17, 50).…”

mentioning

confidence: 99%

Distinct loading conditions reveal various patterns of right ventricular adaptation

Borgdorff

Bartelds

Dickinson

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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Borgdorff MA, Bartelds B, Dickinson MG, Steendijk P, de Vroomen M, Berger RM. Distinct loading conditions reveal various patterns of right ventricular adaptation. Am J Physiol Heart Circ Physiol 305: H354 -H364, 2013. First published May 31, 2013 doi:10.1152/ajpheart.00180.2013.-Right ventricular (RV) failure due to chronically abnormal loading is a main determinant of outcome in pulmonary hypertension (PH) and congenital heart disease. However, distinct types of RV loading have been associated with different outcomes. To determine whether the adaptive RV response depends on loading type, we compared hemodynamics, exercise, and hypertrophy in models of pressure overload due to pulmonary artery banding (PAB), pressure overload due to PH, combined pressure and volume overload, and isolated volume load. Ninety-four rats were subjected to either PAB, monocrotaline-induced PH (PH), aortocaval shunt (shunt), or combined monocrotaline and aortocaval shunt (PH ϩ shunt). We performed pressure-volume analysis and voluntary exercise measurements at 4 wk. We compared PAB to PH (part I) and PH ϩ shunt to either isolated PH or shunt (part II). In part I, enhanced contractility (end-systolic elastance and preload recruitable stroke work) was present in PH and PAB, but strongest in PAB. FrankStarling mechanism was active in both PAB and PH. In PAB this was accompanied by diastolic dysfunction (increased end-diastolic elastance, relaxation constant), clinical signs of RV failure, and reduced exercise. These distinct responses were not attributable to differences in hypertrophy. In part II, in PH ϩ shunt the contractility response was blunted compared with PH, which caused pseudonormalization of parameters. Additional volume overload strongly enhanced hypertrophy in PH. We conclude that different types of loading result in distinct patterns of RV adaptation. This is of importance for the approach to patients with chronically increased RV load and for experimental studies in various types of RV failure. right ventricular failure; contractility; pressure-volume analysis; pulmonary hypertension; monocrotaline RIGHT VENTRICULAR FAILURE is a detrimental condition that is associated with significant morbidity and mortality in patients with congenital heart disease and/or pulmonary hypertension (PH) (11,19,34,38). In these conditions, persistent abnormal loading of the right ventricle (RV) leads to RV failure in the long term (17, 50). However, physiological and molecular mechanisms of RV adaptation to these abnormal loading conditions and its derailment into RV failure are largely unknown (3, 50). As a consequence, no heart failure therapy exists that specifically targets the RV. Different animal models have been used to study the abnormally loaded RV, but interpretation of data and translation to the clinical setting are hampered by conceptual concerns.First, distinct types of RV overload are used in experimental models. These include the induction of PH, where the RV interacts with an increased dynamic load due to a highresistance p...

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“…18,19 A corresponding shift in the demographics of heart-transplanted patients has resulted from the successful palliation of complex heart diseases such as hypoplastic left heart syndrome, with an increasing population of adolescents and young adults referred for heart transplantation because of acute-onset or worsening heart failure. [20][21][22] New medical and device therapies developed for adult patients with heart failure have not proven to be broadly efficacious for the treatment of heart failure in patients with complex congenital heart disease. 20,[23][24][25][26] Thus, heart transplantation is often the only option for patients with congenital heart disease and heart failure unresponsive to conventional medical therapy.…”

mentioning

confidence: 99%

Changing Indications for Pediatric Heart Transplantation

Hsu

Lamour

2015

Circulation

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Incidence and Risk Distribution of Heart Failure in Adolescents and Adults With Congenital Heart Disease After Cardiac Surgery

Cited by 221 publications

References 25 publications

Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease–Related Heart Failure

Hospitalization Trends and Health Resource Use for Adult Congenital Heart Disease–Related Heart Failure

Distinct loading conditions reveal various patterns of right ventricular adaptation

Changing Indications for Pediatric Heart Transplantation

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