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1. Health-Related Quality of Life After Neonatal Treatment of Symptomatic Tetralogy of Fallot: Insights from the Congenital Cardiac Research Collaborative

Author

Nicholson, George T., Zampi, Jeffrey D., Glatz, Andrew C., Goldstein, Bryan H., Petit, Christopher J., Zhang, Yun, McCracken, Courtney E., Qureshi, Athar M., Goldberg, Caren S., Romano, Jennifer C., Law, Mark A., Meadows, Jeffery J., Shahanavaz, Shabana, Batlivala, Sarosh P., Maskatia, Shiraz A., Beshish, Asaad, O’Byrne, Michael L., Ligon, R. Allen, Stack, Kathryn O., Khan, Hala Q., Parekh, Shalin, and Ilardi, Dawn L.

Published
2024
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2. Correction: Health-Related Quality of Life After Neonatal Treatment of Symptomatic Tetralogy of Fallot: Insights from the Congenital Cardiac Research Collaborative

Author

Nicholson, George T., Zampi, Jeffrey D., Glatz, Andrew C., Goldstein, Bryan H., Petit, Christopher J., Zhang, Yun, McCracken, Courtney E., Qureshi, Athar M., Goldberg, Caren S., Romano, Jennifer C., Law, Mark A., Meadows, Jeffery J., Shahanavaz, Shabana, Batlivala, Sarosh P., Maskatia, Shiraz A., Beshish, Asaad, O’Byrne, Michael L., Ligon, R. Allen, Stack, Kathryn O., Khan, Hala Q., Parekh, Shalin, and Ilardi, Dawn L.

Published
2024
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4. Cumulative Radiation Exposure and Lifetime Cancer Risk in Patients With Tetralogy of Fallot Requiring Early Intervention

Author

Jeannette R. Wong-Siegel, MD, MPH, Andrew C. Glatz, MD, MSCE, Courtney McCracken, PhD, Choonsik Lee, PhD, Cari M. Kitahara, PhD, Lene H.S. Veiga, PhD, Yun Zhang, PhD, Bryan H. Goldstein, MD, Christopher J. Petit, MD, Athar M. Qureshi, MD, George T. Nicholson, III, MD, Mark A. Law, MD, Jeffery Meadows, MD, Shabana Shahanavaz, MD, Michael L. O’Byrne, MD, MSCE, Sarosh P. Batlivala, MD, Joelle Pettus, MPH, MS, Asaad Beshish, MD, Christopher E. Mascio, MD, Jennifer C. Romano, MD, Kathyrn O. Stack, MD, Ivor Asztalos, MD, MSCE, Tacy E. Downing, MD, and Jeffrey D. Zampi, MD

Subjects
congenital heart disease, cancer, outcomes, radiation exposure, staged repair, Diseases of the circulatory (Cardiovascular) system, RC666-701, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract

Background: Neonates with tetralogy of Fallot and symptomatic cyanosis (sTOF) require early intervention, utilizing either a staged repair (SR) or primary repair (PR) approach. They are exposed to several sources of low-dose ionizing radiation, which may contribute to increased cancer risk. Objectives: The purpose of this study was to compare cumulative radiation exposure and associated lifetime attributable risk (LAR) of cancer between treatment strategies in sTOF. Methods: Neonates with sTOF who underwent SR or PR from 2012 to 2017 were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Radiation exposure from all radiologic studies prior to 18 months of age was converted to organ-equivalent doses and projected LAR of cancer incidence using the National Cancer Institute dosimetry tools. Results: There were 242 neonates from 8 centers, including patients with 146 SR and 96 PR. Cumulative total effective dose was significantly higher for SR (median 8.3 mSv, IQR: 3.0-17.4 mSv) than PR (2.1 mSv, IQR: 0.8-8.5 mSv; P 1 mGy in females, the LAR was highest for breast in SR (mean 1.9/1,000 patients). The highest proportion of cancers attributable to radiation exposure was projected for thyroid cancer in females undergoing SR (7.3%). Conclusions: Cumulative radiation exposure and LARs were higher among those undergoing SR compared to PR. This will be an important factor to consider in determining the preferred neonatal treatment strategy and should substantiate efforts to reduce radiation exposure in this vulnerable population.

Published
2024
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5. Outcomes, mortality risk factors, and functional status post-Norwood: A single-center study

Author

Alaa Aljiffry, Ashley Harriott, Shayli Patel, Amy Scheel, Alan Amedi, Sean Evans, Yijin Xiang, Amanda Harding, Subhadra Shashidharan, and Asaad G. Beshish

Subjects
Univentricular physiology patients, Norwood operation, Functional status scale (FSS), New-morbidity, Unfavorable outcome, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: The Norwood operation (NO) for infants with univentricular physiology has high interstage mortality. This study evaluated outcomes and risk factors for mortality following NO. Methods: Retrospective single-center study of patients undergoing NO from 2010 to 2020. Analysis used appropriate statistics. Results: Of 269 patients undergoing NO, 213 (79.2 %) survived to discharge. Non-survivors had longer bypass times, delayed sternal closure, required nitric oxide, higher vasoactive scores, required post-operative catheterization, Extracorporeal Life Support (ECLS), and longer ventilation (p

Published
2024
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8. Cumulative Radiation Exposure and Lifetime Cancer Risk in Patients With Tetralogy of Fallot Requiring Early Intervention

Author

Wong-Siegel, Jeannette R., Glatz, Andrew C., McCracken, Courtney, Lee, Choonsik, Kitahara, Cari M., Veiga, Lene H.S., Zhang, Yun, Goldstein, Bryan H., Petit, Christopher J., Qureshi, Athar M., Nicholson, George T., III, Law, Mark A., Meadows, Jeffery, Shahanavaz, Shabana, O’Byrne, Michael L., Batlivala, Sarosh P., Pettus, Joelle, Beshish, Asaad, Mascio, Christopher E., Romano, Jennifer C., Stack, Kathyrn O., Asztalos, Ivor, Downing, Tacy E., and Zampi, Jeffrey D.

Published
2024
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10. Outcomes of Neonates Born with Symptomatic Tetralogy of Fallot and Absent Ductus Arteriosus

Author

Maskatia, Shiraz A., Glatz, Andrew C., Goldstein, Bryan H., Qureshi, Athar M., Zampi, Jeffrey D., McCracken, Courtney E., Nicholson, George T., Meadows, Jeffery J., Shahanavaz, Shabana, Law, Mark A., Batlivala, Sarosh P., Mascio, Christopher E., Chai, Paul J., Romano, Jennifer C., O'Byrne, Michael L., Ligon, Allen, Beshish, Asaad G., and Petit, Christopher J.

Published
2024
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11. Comparing Parent Perception of Neurodevelopment after Primary versus Staged Repair of Neonatal Symptomatic Tetralogy of Fallot

Author

Zampi, Jeffrey D., Ilardi, Dawn L., McCracken, Courtney E., Zhang, Yun, Glatz, Andrew C., Goldstein, Bryan H., Petit, Christopher J., Qureshi, Athar M., Goldberg, Caren S., Law, Mark A., Meadows, Jeffery J., Shahanavaz, Shabana, Batlivala, Sarosh P., Maskatia, Shiraz A., O'Byrne, Michael L., Ligon, R. Allen, Pettus, Joelle A., Beshish, Asaad, Romano, Jennifer C., Stack, Kathryn O., Khan, Hala Q., Parekh, Shalin, and Nicholson, George T.

Published
2025
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16. Abstract 12267: Timing and Mode of Death Following Treatment of Neonatal Symptomatic Tetralogy of Fallot

Author

Trucco, Sara M, Zhang, Yun, McCracken, Courtney, Glatz, Andrew C, Petit, Christopher J, Qureshi, Athar Mahmood, Zampi, Jeffrey, Shahanavaz, Shabana, Nicholson, George, Abejero, Nathalie, Ligon, Allen, Patel, Jay, Mascio, Christopher, Maskatia, Shiraz A, Romano, Jennifer, Obyrne, Michael L, Stack, Kathryn, Wong-Siegel, Jeannette, Beshish, Asaad, Law, Mark, Hock, Kristal, Batlivala, Sarosh P, Speed, Sarah, Meadows, Jeffery J, Goel, Disha, Khan, Hala, and Goldstein, Bryan H

Published
2023
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19. Early Pulmonary Vascular Disease in Young Adults Born Preterm

Author

Goss, Kara N, Beshish, Arij G, Barton, Gregory P, Haraldsdottir, Kristin, Levin, Taylor S, Tetri, Laura H, Battiola, Therese J, Mulchrone, Ashley M, Pegelow, David F, Palta, Mari, Lamers, Luke J, Watson, Andrew M, Chesler, Naomi C, and Eldridge, Marlowe W

Subjects
Lung, Prevention, Cardiovascular, Heart Disease, Infant Mortality, Pediatric, Perinatal Period - Conditions Originating in Perinatal Period, Preterm, Low Birth Weight and Health of the Newborn, Reproductive health and childbirth, Respiratory, Good Health and Well Being, Adult, Age Factors, Female, Humans, Hypertension, Pulmonary, Infant, Newborn, Infant, Premature, Male, Prospective Studies, Vascular Diseases, prematurity, pulmonary hypertension, exercise, bronchopulmonary dysplasia, right ventricular function, Medical and Health Sciences, Respiratory System
Abstract

Rationale: Premature birth affects 10% of live births in the United States and is associated with alveolar simplification and altered pulmonary microvascular development. However, little is known about the long-term impact prematurity has on the pulmonary vasculature.Objectives: Determine the long-term effects of prematurity on right ventricular and pulmonary vascular hemodynamics.Methods: Preterm subjects (n = 11) were recruited from the Newborn Lung Project, a prospectively followed cohort at the University of Wisconsin-Madison, born preterm with very low birth weight (≤1,500 g; average gestational age, 28 wk) between 1988 and 1991. Control subjects (n = 10) from the same birth years were recruited from the general population. All subjects had no known adult cardiopulmonary disease. Right heart catheterization was performed to assess right ventricular and pulmonary vascular hemodynamics at rest and during hypoxic and exercise stress.Measurements and Main Results: Preterm subjects had higher mean pulmonary arterial pressures (mPAPs), with 27% (3 of 11) meeting criteria for borderline pulmonary hypertension (mPAP, 19-24 mm Hg) and 18% (2 of 11) meeting criteria for overt pulmonary hypertension (mPAP ≥ 25 mm Hg). Pulmonary vascular resistance and elastance were higher at rest and during exercise, suggesting a stiffer vascular bed. Preterm subjects were significantly less able to augment cardiac index or right ventricular stroke work during exercise. Among neonatal characteristics, total ventilatory support days was the strongest predictor of adult pulmonary pressure.Conclusions: Young adults born preterm demonstrate early pulmonary vascular disease, characterized by elevated pulmonary pressures, a stiffer pulmonary vascular bed, and right ventricular dysfunction, consistent with an increased risk of developing pulmonary hypertension.

Published
2018

20. Exercise-induced irregular right heart flow dynamics in adolescents and young adults born preterm

Author

Jacob A. Macdonald, Grant S. Roberts, Philip A. Corrado, Arij G. Beshish, Kristin Haraldsdottir, Gregory P. Barton, Kara N. Goss, Marlowe W. Eldridge, Christopher J. Francois, and Oliver Wieben

Subjects
Preterm, Premature, Cardiovascular magnetic resonance, 4D flow, Ventricle, Kinetic energy, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Preterm birth has been linked to an elevated risk of heart failure and cardiopulmonary disease later in life. With improved neonatal care and survival, most infants born preterm are now reaching adulthood. In this study, we used 4D flow cardiovascular magnetic resonance (CMR) coupled with an exercise challenge to assess the impact of preterm birth on right heart flow dynamics in otherwise healthy adolescents and young adults who were born preterm. Methods Eleven young adults and 17 adolescents born preterm (

Published
2021
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21. Abstract 13113: Health-Related Quality of Life After Neonatal Treatment of Symptomatic Tetralogy of Fallot: Insights From the Congenital Cardiac Research Collaborative

Author

Zampi, Jeffrey D, Nicholson, George T, Goldstein, Bryan H, Glatz, Andrew C, Petit, Christopher J, McCracken, Courtney E, Qureshi, Athar M, Goldberg, Caren S, Romano, Jennifer C, Law, Mark A, Meadows, Jeffery J, Shahanavaz, Shabana, Batlivala, Sarosh P, Maskatia, Shiraz A, Pettus, Joelle A, Beshish, Asaad, Stack, Kathryn O, Khan, Hala Q, Parekh, Shalin, and Ilardi, Dawn L

Published
2022
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22. Abstract 11531: Neurodevelopmental Outcomes After Neonatal Tetralogy of Fallot Repair or Palliation: Scope of The Problem and Does Treatment Strategy Matter

Author

Zampi, Jeffrey D, Ilardi, Dawn L, McCracken, Courtney E, Glatz, Andrew C, Beshish, Asaad, Goldstein, Bryan H, Petit, Christopher J, Qureshi, Athar M, Goldberg, Caren S, Law, Mark A, Meadows, Jeffery J, Shahanavaz, Shabana, Batlivala, Sarosh P, Maskatia, Shiraz A, Pettus, Joelle A, Romano, Jennifer C, Stack, Kathryn O, Khan, Hala Q, Parekh, Shalin, and Nicholson, George T

Published
2022
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23. Clinical Outcomes After Tracheostomy in Children With Single Ventricle Physiology: Collaborative Research From the Pediatric Cardiac Intensive Care Society Multicenter Cohort, 2010-2021.

Author

Mastropietro, Christopher W., Sassalos, Peter, Riley, Christine M., Piggott, Kurt, Allen, Kiona Y., Prentice, Elizabeth, Safa, Raya, Buckley, Jason R., Werho, David K., Wakeham, Martin, Smerling, Arthur, Yates, Andrew R., Iliopoulos, Ilias, Sandhu, Hitesh, Chiwane, Saurabh, Beshish, Asaad, Kwiatkowski, David M., Flores, Saul, Narashimhulu, Sukumar Suguna, and Loomba, Rohit

Published
2024
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25. Staged vs Complete Repair in Tetralogy of Fallot With Pulmonary Atresia

Author

Katerina Boucek, Christopher W. Mastropietro, Jonathan Beall, Everette Keller, Asaad Beshish, Saul Flores, Meghan Chlebowski, Andrew R. Yates, Tarif A. Choudhury, Dana Mueller, David M. Kwiatkowski, Karl Migally, Karan Karki, Renee Willett, Monique R. Radman, Chetana Reddy, Kurt Piggott, Christine A. Capone, Yamini Kapileshwarkar, Niranjan Vijayakumar, Elizabeth Prentice, Sukumar Suguna Narasimhulu, Renee H. Martin, and John M. Costello

Subjects
Pulmonary and Respiratory Medicine, Surgery, Cardiology and Cardiovascular Medicine
Published
2023

32. OR1-4 | Percutaneous perforation of the atretic pulmonary valve in pulmonary atresia with intact ventricular septum: A procedural outcomes analysis of radiofrequency versus chronic total occlusion wire perforation

Author

Salavitabar, Arash, Conroy, Sara, Kistler, Isaac, Beshish, Asaad, Callahan, Ryan M., Crystal, Matthew A., El-Said, Howaida, Goldstein, Bryan H., Hainstock, Michael, Lowery, Ray, Matoq, Amr, Mclennan, Daniel, Nicholson, George T., Quinn, Brian, Sathanandam, Shyam K., Tang, Jessica, Trucco, Sara M., Whiteside, Wendy, and Berman, Darren P.

Published
2024
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33. Pulmonary Artery Hypoplasia in Neonates With Tetralogy of Fallot

Author

Petit, Christopher J., primary, Glatz, Andrew C., additional, Goldstone, Andrew B., additional, Law, Mark A., additional, Romano, Jennifer C., additional, Maskatia, Shiraz A., additional, Chai, Paul J., additional, Zampi, Jeffrey D., additional, Meadows, Jeffery J., additional, Nicholson, George T., additional, Shahanavaz, Shabana, additional, Qureshi, Athar M., additional, McCracken, Courtney E., additional, Mascio, Christopher E., additional, Batlivala, Sarosh P., additional, Asztalos, Ivor B., additional, Healan, Steven J., additional, Smith, Justin D., additional, Pettus, Joelle A., additional, Beshish, Asaad, additional, Raulston, James E.B., additional, Hock, Krissie M., additional, Pajk, Amy L., additional, and Goldstein, Bryan H., additional

Published
2023
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35. Staged vs Complete Repair in Tetralogy of Fallot With Pulmonary Atresia

Author

Boucek, Katerina, primary, Mastropietro, Christopher W., additional, Beall, Jonathan, additional, Keller, Everette, additional, Beshish, Asaad, additional, Flores, Saul, additional, Chlebowski, Meghan, additional, Yates, Andrew R., additional, Choudhury, Tarif A., additional, Mueller, Dana, additional, Kwiatkowski, David M., additional, Migally, Karl, additional, Karki, Karan, additional, Willett, Renee, additional, Radman, Monique R., additional, Reddy, Chetana, additional, Piggott, Kurt, additional, Capone, Christine A., additional, Kapileshwarkar, Yamini, additional, Vijayakumar, Niranjan, additional, Prentice, Elizabeth, additional, Narasimhulu, Sukumar Suguna, additional, Martin, Renee H., additional, and Costello, John M., additional

Published
2023
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36. Milrinone for treatment of elevated lactate in the pre-operative newborn with hypoplastic left heart syndrome

Author

Asaad G. Beshish, Alaa Aljiffry, Elizabeth Aronoff, Dhaval Chauhan, Tawanda Zinyandu, Mohua Basu, Subhadra Shashidharan, and Kevin O. Maher

Subjects
Pediatrics, Perinatology and Child Health, General Medicine, Cardiology and Cardiovascular Medicine
Abstract

Background: There is a paucity of information reported regarding the use of milrinone in patients with hypoplastic left heart syndrome prior to the Norwood procedure. At our institution, milrinone is initiated in the pre-operative setting when over-circulation and elevated serum lactate levels develop. We aimed to review the responses associated with the administration of milrinone in the pre-operative hypoplastic left heart syndrome patient. Second, we compared patients who received high- versus low-dose milrinone prior to Norwood procedure. Methods: Single-centre retrospective study of patients diagnosed with hypoplastic left heart syndrome between January 2000 and December 2019 who underwent Norwood procedure. Patient characteristics and outcomes were compared. Results: During the study period, 375 patients were identified; 79 (21%) received milrinone prior to the Norwood procedure with median lactate 2.55 mmol/l, and SpO2 93%. Patients who received milrinone were older at the time of Norwood procedure (6 vs. 5 days) and were more likely to be intubated and sedated. In a subset analysis stratifying patients to low- versus high-dose milrinone, median lactate decreased from time of initiation (2.39 vs 2.75 to 1.6 vs 1.8 mmol/l) at 12 hours post-initiation, respectively. Repeated measures analysis showed a significant decrease in lactate levels by 4 hours following initiation of milrinone, that persisted over time, with no significant difference in mean arterial pressure. Conclusions: The use of milrinone in the pre-operative over-circulated hypoplastic left heart syndrome patient is well tolerated, is associated with decreased lactate levels, and was not associated with significant hypotension or worsening of excess pulmonary blood flow.

Published
2022

37. Incidence and recovery of post-surgical heart block in children following cardiac surgery

Author

Rohit Madani, Elizabeth Aronoff, Jessica Posey, Mohua Basu, Tawanda Zinyandu, Paul Chai, Robert Whitehill, Kevin O. Maher, and Asaad G. Beshish

Subjects
Pediatrics, Perinatology and Child Health, General Medicine, Cardiology and Cardiovascular Medicine
Abstract

Background: A subset of patients who develop post-surgical heart block have recovery of atrioventricular node function. Factors predicting recovery are not understood. We investigated our centre’s incidence of post-surgical heart block and examine factors associated with recovery of atrioventricular node function. Methods: We conducted a single-centre retrospective study of patients 0 – 21 years who underwent cardiac surgery between January 2010 and December 2019 and experienced post-operative heart block. Data including patient and clinical characteristics and operative variables were collected and analysed. Results: Of 6333 surgical hospitalisations, 128 (2%) patients developed post-operative heart block. Of the 128 patients, 90 (70%) had return of atrioventricular node function, and 38 (30%) had pacemaker placement. Of the 38 patients who underwent pacemaker placement, 6 (15.8%) had recovery of atrioventricular node function noted on long-term follow-up. Median time from onset of heart block to late atrioventricular node recovery was 13 days (Interquartile range: 5 – 117). Patients with single-ventricle physiology (p = 0.04), greater weight (p = 0.03), and shorter cardiopulmonary bypass time (p = 0.015) were more likely to have recovery. The use of post-operative steroids was similar between all groups (p = 0.445). Infectious or wound complications were similar between pacemaker groups (p = 1). Conclusions: Two per cent of patients who underwent congenital cardiac surgery developed post-operative heart block, and 0.6% underwent pacemaker placement. Early recovery of atrioventricular node was associated with greater weight at the time of surgery, single-ventricle physiology, and shorter cardiopulmonary bypass time. Late recovery of atrioventricular node conduction following pacemaker placement occurred in 15.8% of patients.

Published
2022

38. D-15 | Radiation Exposure from Cardiac Catheterization in Neonates With Symptomatic Tetralogy of Fallot

Author

Wong-Siegel, Jeannette R., primary, Glatz, Andrew C., additional, McCracken, Courtney, additional, Lee, Choonsik, additional, Veiga, Lene, additional, Kitahara, Cari M., additional, Downing, Tacy, additional, Goldstein, Bryan H., additional, Petit, Christopher J., additional, Qureshi, Athar M., additional, Pettus, Joelle, additional, Nicholson, George T., additional, Law, Mark A., additional, Meadows, Jeffery, additional, Shahanavaz, Shabana, additional, O'Byrne, Michael Liam, additional, Batlivala, Sarosh Percy, additional, Beshish, Asaad, additional, Mascio, Christopher, additional, Romano, Jennifer C., additional, Stack, Kathryn O., additional, Asztalos, Ivor B., additional, and Zampi, Jeffrey D., additional

Published
2023
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40. CUMULATIVE RADIATION EXPOSURE IN NEONATES WITH SYMPTOMATIC TETRALOGY OF FALLOT REQUIRING EARLY INTERVENTION

Author

Wong-Siegel, Jeannette, primary, Glatz, Andrew C., additional, McCracken, Courtney, additional, Downing, Tacy E., additional, Goldstein, Bryan H., additional, Petit, Christopher J., additional, Qureshi, Athar M., additional, Nicholson, George T., additional, Law, Mark Aaron, additional, Meadows, Jeffery, additional, Shahanavaz, Shabana, additional, O'Byrne, Michael L., additional, Batlivala, Sarosh P., additional, Beshish, Asaad, additional, Mascio, Christopher E., additional, Romano, Jennifer C., additional, Stack, Kathryn O., additional, Asztalos, Ivor, additional, and Zampi, Jeffrey, additional

Published
2023
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42. Comparative Costs of Management Strategies for Neonates With Symptomatic Tetralogy of Fallot

Author

Michael L, O'Byrne, Andrew C, Glatz, Yuan-Shung V, Huang, Michael S, Kelleman, Christopher J, Petit, Athar M, Qureshi, Shabana, Shahanavaz, George T, Nicholson, Shawn, Batlivala, Jeffery J, Meadows, Jeffrey D, Zampi, Mark A, Law, Jennifer C, Romano, Christopher E, Mascio, Paul J, Chai, Shiraz, Maskatia, Ivor B, Asztalos, Asaad, Beshish, Joelle, Pettus, Amy L, Pajk, Steven J, Healan, Lindsay F, Eilers, Taylor, Merritt, Courtney E, McCracken, and Bryan H, Goldstein

Subjects
Treatment Outcome, Infant, Newborn, Tetralogy of Fallot, Humans, Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine, Retrospective Studies
Abstract

Recent data have demonstrated that overall mortality and adverse events are not significantly different for primary repair (PR) and staged repair (SR) approaches to management of neonates with symptomatic tetralogy of Fallot (sTOF). Cost data can be used to compare the relative value (cost for similar outcomes) of these approaches and are a potentially more sensitive measure of morbidity.This study sought to compare the economic costs associated with PR and SR in neonates with sTOF.Data from a multicenter retrospective cohort study of neonates with sTOF were merged with administrative data to compare total costs and cost per day alive over the first 18 months of life in a propensity score-adjusted analysis. A secondary analysis evaluated differences in department-level costs.In total, 324 subjects from 6 centers from January 2011 to November 2017 were studied (40% PR). The 18-month cumulative mortality (P = 0.18), procedural complications (P = 0.10), hospital complications (P = 0.94), and reinterventions (P = 0.22) did not differ between PR and SR. Total 18-month costs for PR (median $179,494 [IQR: $121,760-$310,721]) were less than for SR (median: $222,799 [IQR: $167,581-$327,113]) (P 0.001). Cost per day alive (P = 0.005) and department-level costs were also all lower for PR. In propensity score-adjusted analyses, PR was associated with lower total cost (cost ratio: 0.73; P 0.001) and lower department-level costs.In this multicenter study of neonates with sTOF, PR was associated with lower costs. Given similar overall mortality between treatment strategies, this finding suggests that PR provides superior value.

Published
2022

45. Evaluation of Bivalirudin Dosing in Pediatric Extracorporeal Membrane Oxygenation with Renal Insufficiency or Renal Replacement Therapy

Author

Mohammed Hamzah, Troy G. Seelhammer, Mouhammad Yabrodi, Asaad G. Beshish, Jonathan W. Byrnes, James Hall, Lu Wang, and Robert A. Niebler

Subjects
Biomedical Engineering, Biophysics, Anticoagulants, Bioengineering, General Medicine, Peptide Fragments, Recombinant Proteins, Biomaterials, Renal Replacement Therapy, Extracorporeal Membrane Oxygenation, Creatinine, Humans, Renal Insufficiency, Child, Retrospective Studies
Abstract

Bivalirudin offers several important advantages of relevance to the management of extracorporeal membrane oxygenation (ECMO) patients. This multicenter retrospective analysis evaluated the bivalirudin dosing in pediatric ECMO and correlated these doses with the severity of renal dysfunction. A total of 75 patients were included in this analyses: estimated glomerular filtration rate (eGFR)60 ml/min/1.73 m 2 (n = 29), eGFR 30-60 (n = 18), eGFR30 (n = 28), and of those 23 were on renal replacement therapy (RRT). The initial bivalirudin dose used to reach therapeutic anticoagulation in patients with eGFR60 was significantly higher than the dose required in those with renal impairment (0.25 mg/kg/hr in patients with eGFR60 and 0.19 mg/kg/hr in patients on RRT, 0.18 mg/kg/hr in patients with eGFR 30-60 and 0.13 mg/kg/hr in patients with eGFR30 with no RRT). Progressive dose escalations (two to threefold increase) were required to maintain therapeutic range over the initial 4 days of ECMO that coincided with improving renal creatinine clearance during that same time period. Establishing an initial starting dose of bivalirudin contingent upon eGFR is essential for the rapid achievement of target anticoagulation intensity. Further dose adjustments guided by laboratory monitoring is necessary given the dynamic changes in creatinine clearance following ECMO initiation.

Published
2022

46. Impact of Management Strategy on Feeding and Somatic Growth in Neonates with Symptomatic Tetralogy of Fallot: Results from the Congenital Cardiac Research Collaborative

Author

Nicholson, George T., primary, Goldstein, Bryan H., additional, Petit, Christopher J., additional, Qureshi, Athar M., additional, Glatz, Andrew C., additional, McCracken, Courtney E., additional, Kelleman, Michael S., additional, Meadows, Jeffery J., additional, Zampi, Jeffrey D., additional, Shahanavaz, Shabana, additional, Mascio, Christopher E., additional, Chai, Paul J., additional, Romano, Jennifer C., additional, Healan, Steven J., additional, Pettus, Joelle A., additional, Batlivala, Sarosh P., additional, Raulston, James E.B., additional, Hock, Kristal M., additional, Maskatia, Shiraz A., additional, Beshish, Asaad, additional, and Law, Mark A., additional

Published
2022
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