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9. Hybrid palliation versus nonhybrid management for a multi-institutional cohort of infants with critical left heart obstruction

Author

Argo, Madison B., Barron, David J., Bondarenko, Igor, Eckhauser, Aaron, Gruber, Peter J., Lambert, Linda M., Paramananthan, Tharini, Rahman, Maha, Winlaw, David S., Yerebakan, Can, Alsoufi, Bahaaldin, DeCampli, William M., Honjo, Osami, Kirklin, James K., Prospero, Carol, Ramakrishnan, Karthik, St. Louis, James D., Turek, Joseph W., O'Brien, James E., Jr, Pizarro, Christian, Anagnostopoulos, Petros V., Blackstone, Eugene H., Jacobs, Marshall L., Jegatheeswaran, Anusha, Karamlou, Tara, Stephens, Elizabeth H., Polimenakos, Anastasios C., Haw, Marcus P., and McCrindle, Brian W.

Published
2023
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10. Norwood operation versus comprehensive stage II after bilateral pulmonary artery banding palliation for infants with critical left heart obstruction

Author

Argo, Madison B., Barron, David J., Eghtesady, Pirooz, Alsoufi, Bahaaldin, Honjo, Osami, Yerebakan, Can, DeCampli, William M., Jacobs, Jeffrey P., Carrillo, Sergio A., Jegatheeswaran, Anusha, Karamlou, Tara, Paramananthan, Tharini, Rahman, Maha, Lambert, Linda M., Nelson, Jennifer, Caldarone, Christopher A., Husain, S. Adil, Galantowicz, Mark E., Ramakrishnan, Karthik, Kirklin, James K., Turek, Joseph W., Mannie, Chelsea, Blackstone, Eugene H., Mitchell, Michael E., and McCrindle, Brian W.

Published
2023
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17. Connecting transcriptomics with computational modeling to reveal developmental adaptations in pediatric human atrial tissue.

Author

Salameh, Shatha, Guerrelli, Devon, Miller, Jacob A., Desai, Manan, Moise, Nicolae, Yerebakan, Can, Bruce, Alisa, Sinha, Pranava, d'Udekem, Yves, Weinberg, Seth H., and Posnack, Nikki Gillum

Subjects
ACTION potentials, GENE expression, CARDIAC patients, CHILD patients, CONGENITAL heart disease
Abstract

Nearly 1% of babies are born with congenital heart disease—many of whom will require heart surgery within the first few years of life. A detailed understanding of cardiac maturation can help to expand our knowledge on cardiac diseases that develop during gestation, identify age-appropriate drug therapies, and inform clinical care decisions related to surgical repair and postoperative management. Yet, to date, our knowledge of the temporal changes that cardiomyocytes undergo during postnatal development is limited. In this study, we collected right atrial tissue samples from pediatric patients (n = 117) undergoing heart surgery. Patients were stratified into five age groups. We measured age-dependent adaptations in cardiac gene expression and used computational modeling to simulate action potential and calcium transients. Enrichment of differentially expressed genes revealed age-dependent changes in several key biological processes (e.g., cell cycle, structural organization), cardiac ion channels, and calcium handling genes. Gene-associated changes in ionic currents exhibited age-dependent trends, with changes in calcium handling (INCX) and repolarization (IK1) most strongly associated with an age-dependent decrease in the action potential plateau potential and increase in triangulation, respectively. We observed a shift in repolarization reserve, with lower IKr expression in younger patients, a finding potentially tied to an increased amplitude of IKs that could be triggered by elevated sympathetic activation in pediatric patients. Collectively, this study provides valuable insights into age-dependent changes in human cardiac gene expression and electrophysiology, shedding light on molecular mechanisms underlying cardiac maturation and function throughout development. NEW & NOTEWORTHY: To date, our knowledge of the temporal changes that cardiomyocytes undergo during postnatal development is limited. In this study, we demonstrate age-dependent adaptations in the gene expression profile of >100 atrial tissue samples collected from congenital heart disease patients. We coupled transcriptomics datasets with computational modeling to simulate action potentials and calcium transients for different pediatric age groups. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Abstract 10158: Initial Bilateral Pulmonary Artery Banding for Infants With Critical Left Heart Obstruction: A Multi-Institutional Analysis of Outcomes

Author

Argo, Madison B, Barron, David J, Eghtesady, Pirooz, Alsoufi, Bahaaldin, Carrillo, Sergio A, Honjo, Osami, Husain, Adil, Jacobs, Jeffrey P, Jegatheeswaran, Anusha, Kirklin, James K, Lambert, Linda M, Paramananthan, Tharini, Rahman, Maha, Ramakrishnan, Karthik, Yerebakan, Can, Galantowicz, Mark E, Caldarone, Christopher A, Decampli, William M, Karamlou, Tara, Nelson, Jennifer, Romano, Jennifer C, Turek, Joseph W, and McCrindle, Brian W

Published
2022
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26. Pediatric Tele-Critical Care: Initial Experience with a Continuous Surveillance Model Aiming to Prevent Cardiac Arrest in Children with Critical Heart Disease.

Author

Lopez Magallon, Alejandro, Saenz, Lucas, Mehta, Rittal, Chacón, Maria Angelica, Martinez Ransanz, Santiago, Swink, Kellie, Berris, Menchee, Hanabergh, Sofia, Yerebakan, Can, Wessel, David, and Munoz, Ricardo

Subjects
CARDIAC intensive care, CONGENITAL heart disease, CORONARY care units, ELECTRONIC health records, THERAPEUTICS
Abstract

Introduction: Despite advances in treatment of children with critical heart disease, cardiac arrest (CA) remains a common occurrence. We provided virtual support to bedside teams (BTs) from a tele-critical care (TCC) unit in a pediatric cardiac intensive care unit (CICU) and focused on early detection of concerning trends (CT) and avoidance of CA. Virtual surveillance workflows included a review of remote monitoring, video feed from patient room cameras, medical records, and artificial intelligence tools. We present our initial experience with a focus on critical communications (CCs) to BTs. Methods: A retrospective, descriptive review of TCC activities was conducted from January 2019 to December 2022, involving electronic databases and electronic medical records of patients in the CICU, including related CCs to BTs, responses from BTs, and related CA. Results: We conducted 18,171 TCC activities, including 2,678 non-CCs and 248 CCs. Over time, there was a significant increase in the proportion of CCs related with CT (p = 0.002), respiratory concerns (<0.001), and abnormalities in cardiac rhythm (p = 0.04). Among a sample of 244 CCs, subsequent interventions by BTs resulted in adjustment of medical treatment (127), respiratory support (68), surgery or intervention (19), cardiac rhythm control (17), imaging study (14), early resuscitation (9), and others (10). Conclusions: CCs from a TCC unit in a pediatric CICU changed over time with an increased focus on CT and resulted in early interventions, potentially contributing to avoiding CA. This model of care in pediatric cardiac critical care has the potential to improve patient safety. [ABSTRACT FROM AUTHOR]

Published
2024
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33. The Technique of Bilateral Pulmonary Artery Banding in High-Risk Patients With Hypoplastic Left Heart Syndrome.

Author

Yerebakan, Can, Tongut, Aybala, Ozturk, Mahmut, Ceneri, Nicolle M., and d'Udekem, Yves

Abstract

The management of high-risk neonates with hypoplastic left heart syndrome or its variants remains a tremendous surgical and medical challenge for our specialty. The hybrid strategy has been shown to improve outcomes in high-risk patients. This article illustrates the specific technical details of bilateral branch pulmonary artery banding for such high-risk patients. [ABSTRACT FROM AUTHOR]

Published
2023
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36. Tiny pacemakers for tiny babies

Author

Berul, Charles I., Dasgupta, Soham, LeGras, Marc D., Peer, S. Murfad, Alsoufi, Bahaaldin, Sherwin, Elizabeth D., Desai, Manan, Yerebakan, Can, and Johnsrude, Christopher

Published
2023
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47. Exercise-dependent changes in ventricular–arterial coupling and aortopulmonary collateral flow in Fontan patients: a real-time CMR study.

Author

Latus, Heiner, Hofmann, Lucas, Gummel, Kerstin, Khalil, Markus, Yerebakan, Can, Waschulzik, Birgit, Schranz, Dietmar, Voges, Inga, Jux, Christian, and Reich, Bettina

Subjects
PULMONARY circulation, VENA cava superior, COLLATERAL circulation, MAGNETIC resonance imaging, EXERCISE, RESEARCH funding, EMPLOYEES' workload, AORTA, CARDIOPULMONARY bypass, ERGOMETRY, VENA cava inferior, HEMODYNAMICS, HEART failure
Abstract

Aims Inefficient ventricular–arterial (V–A) coupling has been described in Fontan patients and may result in adverse haemodynamics. A varying amount of aortopulmonary collateral (APC) flow is also frequently present that increases volume load of the single ventricle. The aim of the study was to assess changes in V–A coupling and APC flow during exercise CMR. Methods and results Eighteen Fontan patients (age 24 ± 3 years) and 14 controls (age 23 ± 4 years) underwent exercise CMR using a cycle ergometer. Ventricular volumetry and flow measurements in the ascending aorta (AAO), inferior (IVC), and superior (SVC) vena cava were assessed using real-time sequences during stepwise increases in work load. Measures of systemic arterial elastance Ea, ventricular elastance Ees, and V–A coupling (Ea/Ees) were assessed. APC flow was quantified as AAO − (SVC + IVC). Ea remained unchanged during all levels of exercise in both groups (P = 0.39 and P = 0.11). Ees increased in both groups (P = 0.001 and P < 0.001) with exercise but was lower in the Fontan group (P = 0.04). V–A coupling was impaired in Fontan patients at baseline (P = 0.04). Despite improvement during exercise (P = 0.002) V–A coupling remained impaired compared with controls (P = 0.001). Absolute APC flow in Fontan patients did not change during exercise even at maximum work load (P = 0.98). Conclusions Inefficient V–A coupling was already present at rest in Fontan patients and aggravated during exercise due to a limited increase in ventricular contractility which demonstrates the importance of a limited functional reserve of the single ventricle. APC flow remained unchanged suggesting no further increase in volume load during exercise. [ABSTRACT FROM AUTHOR]

Published
2023
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48. Cardiovascular surgery in very low birth weight (≤1500 g) neonates.

Author

Henmi, Soichiro, Essa, Yasin, Öztürk, Mahmut, Tongut, Aybala, Desai, Manan, Yerebakan, Can, and d'Udekem, Yves

Subjects
VERY low birth weight, CARDIOVASCULAR surgery, NEONATAL surgery, LOW birth weight, NEWBORN infants, CEREBRAL hemorrhage
Abstract

Open in new tab Download slide OBJECTIVES Low birth weight and prematurity are known risks of increased morbidity and mortality with undergoing cardiovascular surgery. Our aim was to review the outcomes of very low birth weight (≤1500 g) patients who have undergone cardiovascular surgery. METHODS A retrospective review was performed for 32 very low birth weight (≤1500 g) patients who underwent cardiovascular surgery from 2004 to 2021 in our institution. RESULTS Fifteen patients weighting ≤1500 g at surgery (≤1500-g group) were compared to 17 patients born with a weigh of ≤1500 g and weighting between 1500 and 2500 g at surgery (>1500- to ≤2500-g group) in this study. In-hospital mortality was 33% (5/15) in the ≤1500-g group and 24% (4/17) in the >1500- to ≤2500-g group (P  = 0.55). All patients with simple biventricular lesion survived following full repair. The occurrence of postoperative intracerebral haemorrhage was significantly higher in those operated at weight ≤1500 g than those weighting >1500 to ≤2500 g (40% vs 0%; P  = 0.01). The 1- and 3-year survival rates were 66.0 ± 12.4% and 46.2 ± 14.8% in the ≤1500-g group and 76.5 ± 10.3% and 70.6 ± 11.1% in the >1500- to ≤2500-g group (log-rank P  = 0.12). CONCLUSIONS Cardiac surgery for a very low birth weight neonate resulted in a high early and late mortality. Early surgery is only acceptable for simple biventricular lesions if needed. Delayed surgery seems to provide better long-term outcomes in patients with complex lesions. Alternative strategies for neonatal cardiopulmonary bypass should be investigated in patients with complex biventricular and single ventricular lesions. [ABSTRACT FROM AUTHOR]

Published
2023
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49. The Ross Procedure With the Inclusion Technique.

Author

Ozturk, Mahmut, Tongut, Aybala, Hanabergh, Sofia S., Yerebakan, Can, Khoury, Gebrine El, and d'Udekem, Yves

Abstract

The Ross procedure is superior as a valve substitute in children and early adulthood because of its clear survival benefits. The free standing-root implantation is associated with failure of the autograft and inclusion techniques that support externally the autograft warrants its longevity. The current technique consists in the implantation of the autograft within the native aortic root thereby both supporting the autograft and avoiding any coronary distortion. [ABSTRACT FROM AUTHOR]

Published
2022
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