Preoperative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate

Clancy, Robert R.; McGaurn, Susan A.; Wernovsky, Gil; Spray, Thomas L.; Norwood, William I.; Jacobs, Marshall L.; Murphy, John D.; Gaynor, J. William; Goin, James E.

doi:10.1016/s0022-5223(00)70191-7

Cited by 135 publications

(103 citation statements)

References 21 publications

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“…Our findings are in keeping with previously published studies that report incidences of WMI ranging from 10% to 38% and infarcts or hemorrhage ranging from 0% to 33%. 12,14,15,20 In our analysis, HUS proved to not only be unreliable but also potentially misleading in the preoperative evaluation of the CHD population, with a falsepositive rate of 80%. False-positive findings on HUS have the potential of increasing parental stress and anxiety, and of potentially influencing management decisions.…”

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confidence: 73%

“…Infants were categorized according to preoperative physiology into 1 of 4 groups as described previously. 20 Briefly, the 4 groups were single ventricle (SV; n = 16), single ventricle with arch obstruction (SVA; n = 73), biventricular (2V; n = 63), and biventricular with arch obstruction (2VA; n = 15). Within each group, the most common diagnosis was as follows: SV, pulmonary atresia in 9 (56%) patients; SVA, hypoplastic left heart syndrome in 61 (84%) patients; 2V, transposition of the great arteries in 47 (75%) patients; and 2VA, coarctation of the aorta in 11 (73%) patients.…”

Section: Resultsmentioning

confidence: 99%

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Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Routine head ultrasound scans (HUSs) are frequently performed in the preoperative evaluation of the infants with congenital heart disease, and brain MRI is being increasingly used in the research setting. The utility of HUSs in this population has not yet been established. WHAT THIS STUDY ADDS:This is the first study to prospectively evaluate the utility of routine HUSs compared with MRIs in asymptomatic newborns and young infants undergoing cardiac surgery. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD.abstract OBJECTIVE: The purpose of this study was to assess the utility of preoperative head ultrasound scan (HUS) in a cohort of newborns also undergoing preoperative MRI as part of a prospective research study of brain injury in infants having surgery for congenital heart disease (CHD). METHODS: A total of 167 infants diagnosed with CHD were included in this 3-center study. None of the patients had clinical signs or symptoms of preoperative brain injury, and all patients received both HUS and brain MRI before undergoing surgical intervention. HUS and MRI results were reported by experienced neuroradiologists who were blinded to any specific clinical details of the study participants. The findings of the individual imaging modes were compared to evaluate for the presence of brain injury. RESULTS: Preoperative brain injury was present on HUS in 5 infants (3%) and on MRI in 44 infants (26%) (P , .001). Four of the HUS showed intraventricular hemorrhage not seen on MRI, suggesting false-positive results, and the fifth showed periventricular leukomalacia. The predominant MRI abnormality was white matter injury (n = 32). Other findings included infarct (n = 16) and hemorrhage (n = 5). CONCLUSIONS: Preoperative brain injury on MRI was present in 26% of infants with CHD, but only 3% had any evidence of brain injury on HUS. Among positive HUS, 80% were false-positive results. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD, and MRI may be a preferable tool when the assessment of these infants is warranted. Pediatrics 2013;131:e1765-e1770 Neurodevelopmental impairment is the most common long-term, noncardiac morbidityaffecting neonates undergoing surgery for congenital heart disease (CHD). The impact of this impairment is far-reaching and may not be manifest very early in life but instead may become apparent in later childhood, often extending into adolescence. [1][2][3][4][5] Given the potential relationship between brain injury and impaired outcome, and the possibility that aspects of cardiac surgery could further worsen preexisting brain injury, preoperative brain imaging is commonly used in the clinical setting as well as in the context of prospective investigations of brain injury in this highrisk group.The spectrum of brain injury affecting newborns with heart disease includes stroke or infarct, hemorrhage, and white matter injury (...

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confidence: 73%

Section: Resultsmentioning

confidence: 99%

Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease

et al. 2013

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“…Our own experience and that reported from other centers suggests that early survival is significantly higher for those patients who do not have associated risks, such as genetic anomalies, low birth weight, and low Apgar scores. 6,14 Subsequent staging surgery also evolved considerably over the study period. In 1989, we began routine intermediate staging with the BCPA.…”

Section: Discussionmentioning

confidence: 99%

Survival After Reconstructive Surgery for Hypoplastic Left Heart Syndrome : A 15-Year Experience From a Single Institution

Mahle

Spray²,

Wernovsky³

et al. 2000

Circulation

306

261

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Background-There are limited data regarding the long-term survival of patients who have undergone reconstructive surgery for hypoplastic left heart syndrome (HLHS). We reviewed the 15-year experience at our institution to examine survival in the context of continued improvements in early operative results. Methods and Results-Between 1984 and 1999, 840 patients underwent stage I surgery for HLHS. From review of medical records and direct patient contact, survival status was determined. The 1-, 2-, 5-, 10-, and 15-year survival for the entire cohort was 51%, 43%, 40%, 39%, and 39%, respectively. Late death occurred in 14 of the 291 patients discharged to home after the Fontan procedure, although only 1 patient has died beyond 5 years of age. Heart transplantation after stage I reconstruction was performed in 5 patients. Later era of stage I surgery was associated with significantly improved survival (PϽ0.001). Three-year survival for patients undergoing stage I reconstruction from 1995 to 1998 was 66% versus 28% for those patients undergoing surgery from 1984 to 1988. Age Ͼ14 days at stage I and weight Ͻ2.5 kg at stage I were also associated with higher mortality (Pϭ0.004 and Pϭ0.01, respectively). Other variables, including anatomic subtype, heterotaxia, and age at subsequent staging procedures, were not associated with survival. Conclusions-Over

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“…Cardiac lesions were divided into 4 diagnostic categories according to a previously described classification: 2 ventricles without aortic arch obstruction, 2 ventricles with aortic arch obstruction, single ventricle without aortic arch obstruction, and single ventricle with aortic arch obstruction. 14 Normally distributed data are presented as mean±SD; data that have an irregular or skewed distribution are presented as median with interquartile range. Proportions and odds ratios are presented with 95% confidence intervals.…”

Section: Data and Statisticsmentioning

confidence: 99%

New White Matter Brain Injury After Infant Heart Surgery Is Associated With Diagnostic Group and the Use of Circulatory Arrest

et al. 2013

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Background-Abnormalities on magnetic resonance imaging scans are common both before and after surgery for congenital heart disease in early infancy. The aim of this study was to prospectively investigate the nature, timing, and consequences of brain injury on magnetic resonance imaging in a cohort of young infants undergoing surgery for congenital heart disease both with and without cardiopulmonary bypass. Methods and Results-A total of 153 infants undergoing surgery for congenital heart disease at <8 weeks of age underwent serial magnetic resonance imaging scans before and after surgery and at 3 months of age, as well as neurodevelopmental assessment at 2 years of age. White matter injury (WMI) was the commonest type of injury both before and after surgery. It occurred in 20% of infants before surgery and was associated with a less mature brain. New WMI after surgery was present in 44% of infants and at similar rates after surgery with or without cardiopulmonary bypass. The most important association was diagnostic group (P<0.001). In infants having arch reconstruction, the use and duration of circulatory arrest were significantly associated with new WMI. New WMI was also associated with the duration of cardiopulmonary bypass, postoperative lactate level, brain maturity, and WMI before surgery. Brain immaturity but not brain injury was associated with impaired neurodevelopment at 2 years of age. Conclusions-New WMI is common after surgery for congenital heart disease and occurs at the same rate in infants undergoing surgery with and without cardiopulmonary bypass. New WMI is associated with diagnostic group and, in infants undergoing arch surgery, the use of circulatory arrest. (Circulation. 2013;127:971-979.)

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Preoperative risk-of-death prediction model in heart surgery with deep hypothermic circulatory arrest in the neonate

Abstract: In this selected population, postoperative mortality risk is significantly affected by preoperative conditions. Identification of infants with varying mortality risks may affect family counseling, therapeutic intervention, and risk stratification for future study designs.

Cited by 135 publications

References 21 publications

Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease

Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease

Survival After Reconstructive Surgery for Hypoplastic Left Heart Syndrome : A 15-Year Experience From a Single Institution

New White Matter Brain Injury After Infant Heart Surgery Is Associated With Diagnostic Group and the Use of Circulatory Arrest

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