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57. Pathology of explanted pediatric hearts: An 11‐year study. Population characteristics and implications for outcomes.

Author

Yamasaki, Takato, Sanders, Stephen P., Hylind, Robyn J., Milligan, Caitlin, Fynn‐Thompson, Francis, Mayer, John E., Blume, Elizabeth D., Daly, Kevin P., and Carreon, Chrystalle Katte

Subjects
CONGENITAL heart disease, PEDIATRIC pathology, CHILD patients, GRAFT survival, HEART transplantation
Abstract

Background: As more pediatric patients become candidates for heart transplantation (HT), understanding pathological predictors of outcome and the accuracy of the pretransplantation evaluation are important to optimize utilization of scarce donor organs and improve outcomes. The authors aimed to investigate explanted heart specimens to identify pathologic predictors that may affect cardiac allograft survival after HT. Methods: Explanted pediatric hearts obtained over an 11‐year period were analyzed to understand the patient demographics, indications for transplant, and the clinical–pathological factors. Results: In this study, 149 explanted hearts, 46% congenital heart defects (CHD), were studied. CHD patients were younger and mean pulmonary artery pressure and resistance were significantly lower than in cardiomyopathy patients. Twenty‐one died or underwent retransplantation (14.1%). Survival was significantly higher in the cardiomyopathy group at all follow‐up intervals. There were more deaths and the 1‐, 5‐ and 7‐year survival was lower in patients ≤10 years of age at HT. Early rejection was significantly higher in CHD patients exposed to homograft tissue, but not late rejection. Mortality/retransplantation rate was significantly higher and allograft survival lower in CHD hearts with excessive fibrosis of one or both ventricles. Anatomic diagnosis at pathologic examination differed from the clinical diagnosis in eight cases. Conclusions: Survival was better for the cardiomyopathy group and patients >10 years at HT. Prior homograft use was associated with a higher prevalence of early rejection. Ventricular fibrosis (of explant) was a strong predictor of outcome in the CHD group. We presented several pathologic findings in explanted pediatric hearts. This study describes a large single‐center experience on the various pathologies encountered in the explanted heart specimens in the pediatric age group to identify possible pathologic predictors of outcome that could potentially influence pretransplant and/or posttransplant management. [ABSTRACT FROM AUTHOR]

Published
2024
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58. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2023 Update on Outcomes and Research.

Author

Kumar, S. Ram, Gaynor, J. William, Heuerman, Hannah, Mayer, John E., Nathan, Meena, O'Brien, James E., Pizarro, Christian, Subačius, Haris, Wacker, Leslie, Wellnitz, Chasity, and Eghtesady, Pirooz

Abstract

The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (CHSD) continues to be the most comprehensive database of congenital and pediatric cardiothoracic surgical procedures in the world and contains information on 664,210 operations as of June 30, 2023. The 35th harvest of the STS CHSD data was undertaken in Spring 2023, spanning the 4-year period January 1, 2019, through December 31, 2022, and included 144,919 operations performed at 114 participating sites in North America. The harvest analysis was successfully executed by the STS Research and Analytic Center. The overall unadjusted mortality rate was 2.68% and has remained stable over the 4 years included in the current harvest window. Mortality is highest in neonates (7.4%) and lowest in children (1.1%). As in prior analyses, observed mortality and postoperative length of stay in the database increase with an increase in STS-European Association for Cardio-Thoracic Surgery (STAT) Congenital Heart Surgery Mortality Categories. This quality report summarizes contemporary outcomes, provides the odds ratios for the CHSD risk model variables based on this analysis, and describes on-going efforts to improve data collection and augment analytical approaches. Lastly, 5 research publications completed in the last year using data from the CHSD are also summarized. [ABSTRACT FROM AUTHOR]

Published
2024
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62. Tissue formation and host remodeling of an elastomeric biodegradable scaffold in an ovine pulmonary leaflet replacement model

Author

Machaidze, Zurab, primary, D'Amore, Antonio, additional, Freitas, Renata C. C., additional, Joyce, Angelina J., additional, Bayoumi, Ahmed, additional, Rich, Kimberly, additional, Brown, David W., additional, Aikawa, Elena, additional, Wagner, William R., additional, Sacks, Michael S., additional, and Mayer, John E., additional

Published
2023
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68. Mortality Trends in Pediatric and Congenital Heart Surgery: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

Author

Jacobs, Jeffrey P., He, Xia, Mayer, John E., Jr., Austin, Erle H., III, Quintessenza, James A., Karl, Tom R., Vricella, Luca, Mavroudis, Constantine, O’Brien, Sean M., Pasquali, Sara K., Hill, Kevin D., Husain, S. Adil, Overman, David M., St. Louis, James D., Han, Jane M., Shahian, David M., Cameron, Duke, and Jacobs, Marshall L.

Published
2016
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71. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2016 Update on Outcomes and Quality

Author

Jacobs, Jeffrey P., Mayer, John E., Jr., Mavroudis, Constantine, O’Brien, Sean M., Austin, Erle H., III, Pasquali, Sara K., Hill, Kevin D., He, Xia, Overman, David M., St. Louis, James D., Karamlou, Tara, Pizarro, Christian, Hirsch-Romano, Jennifer C., McDonald, Donna, Han, Jane M., Dokholyan, Rachel S., Tchervenkov, Christo I., Lacour-Gayet, Francois, Backer, Carl L., Fraser, Charles D., Tweddell, James S., Elliott, Martin J., Walters, Hal, III, Jonas, Richard A., Prager, Richard L., Shahian, David M., and Jacobs, Marshall L.

Published
2016
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73. Tissue formation and host remodeling of an elastomeric biodegradable scaffold in an ovine pulmonary leaflet replacement model.

Author

Machaidze, Zurab, D'Amore, Antonio, Freitas, Renata C. C., Joyce, Angelina J., Bayoumi, Ahmed, Rich, Kimberly, Brown, David W., Aikawa, Elena, Wagner, William R., Rego, Bruno V., and Mayer, John E.

Abstract

In pursuit of a suitable scaffold material for cardiac valve tissue engineering applications, an acellular, electrospun, biodegradable polyester carbonate urethane urea (PECUU) scaffold was evaluated as a pulmonary valve leaflet replacement in vivo. In sheep (n = 8), a single pulmonary valve leaflet was replaced with a PECUU leaflet and followed for 1, 6, and 12 weeks. Implanted leaflet function was assessed in vivo by echocardiography. Explanted samples were studied for gross pathology, microscopic changes in the extracellular matrix, host cellular re‐population, and immune responses, and for biomechanical properties. PECUU leaflets showed normal leaflet motion at implant, but decreased leaflet motion and dimensions at 6 weeks. The leaflets accumulated α‐SMA and CD45 positive cells, with surfaces covered with endothelial cells (CD31+). New collagen formation occurred (Picrosirius Red). Accumulated tissue thickness correlated with the decrease in leaflet motion. The PECUU scaffolds had histologic evidence of scaffold degradation and an accumulation of pro‐inflammatory/M1 and anti‐inflammatory/M2 macrophages over time in vivo. The extent of inflammatory cell accumulation correlated with tissue formation and polymer degradation but was also associated with leaflet thickening and decreased leaflet motion. Future studies should explore pre‐implant seeding of polymer scaffolds, more advanced polymer fabrication methods able to more closely approximate native tissue structure and function, and other techniques to control and balance the degradation of biomaterials and new tissue formation by modulation of the host immune response. [ABSTRACT FROM AUTHOR]

Published
2024
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79. The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 2—Clinical Application

Author

Jacobs, Jeffrey P., O’Brien, Sean M., Pasquali, Sara K., Gaynor, J. William, Mayer, John E., Jr., Karamlou, Tara, Welke, Karl F., Filardo, Giovanni, Han, Jane M., Kim, Sunghee, Quintessenza, James A., Pizarro, Christian, Tchervenkov, Christo I., Lacour-Gayet, Francois, Mavroudis, Constantine, Backer, Carl L., Austin, Erle H., III, Fraser, Charles D., Tweddell, James S., Jonas, Richard A., Edwards, Fred H., Grover, Frederick L., Prager, Richard L., Shahian, David M., and Jacobs, Marshall L.

Published
2015
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82. Single Ventricle (Non HLHS)

Author

Banka, Puja, Porras, Diego, Mayer, John E., Emani, Sitaram M., Da Cruz, Eduardo M., editor, Ivy, Dunbar, editor, and Jaggers, James, editor

Published
2014
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87. Preoperative Transcatheter Closure of Congenital Muscular Ventricular Septal Defects

Author

Bridges, Nancy D, Perry, Stanton B, Keane, John F, Goldstein, Steven AN, Mandell, Valerie, Mayer, John E, Jonas, Richard A, Casteneda, Aldo R, and Lock, James E

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Cardiovascular, Pediatric, Congenital Structural Anomalies, Congenital Heart Disease, Lung, Heart Disease, Rare Diseases, 6.4 Surgery, Adult, Cardiac Catheterization, Catheterization, Child, Child, Preschool, Heart Septal Defects, Ventricular, Humans, Infant, Preoperative Care, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundSurgical repair of muscular ventricular septal defects, particularly those associated with complex heart lesions carries a higher risk of reoperation and death than the repair of membranous defects. Closing a muscular defect through an incision in the systemic ventricle may cause late ventricular dysfunction. In a collaborative approach to this problem, we undertook preoperative transcatheter closure of muscular ventricular septal defects remote from the atrioventricular and semilunar valves, followed by the surgical repair of associated conditions.MethodsIn 12 patients selected jointly by a cardiologist and a cardiac surgeon, we attempted preoperative transcatheter umbrella closure of 21 defects. Half the patients had associated complex heart lesions; the others had had pulmonary-artery banding to reduce the amount of left-to-right shunting. Half had severe ventricular septal deficiency.ResultsAll 21 defects were successfully closed without major complications. Subsequent cardiac surgery for associated conditions in 11 of the 12 patients resulted in a mean pulmonary-to-systemic flow ratio of 1.1, indicating minimal residual left-to-right shunting; 1 patient awaited surgical repair. No deaths, reoperations, or late complications have occurred after a follow-up of 7 to 20 months.ConclusionsA collaborative approach using transcatheter closure followed by the surgical repair of associated cardiac lesions may decrease rates of operative mortality, reoperation, and left ventricular dysfunction in patients with muscular ventricular septal defects.

Published
1991

91. The Importance of Patient-Specific Preoperative Factors: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

Author

Jacobs, Jeffrey Phillip, O’Brien, Sean M., Pasquali, Sara K., Kim, Sunghee, Gaynor, J. William, Tchervenkov, Christo Ivanov, Karamlou, Tara, Welke, Karl F., Lacour-Gayet, Francois, Mavroudis, Constantine, Mayer, John E., Jr., Jonas, Richard A., Edwards, Fred H., Grover, Frederick L., Shahian, David M., and Jacobs, Marshall Lewis

Published
2014
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