30 results on '"Setty SP"'
Search Results
2. Tracheal bronchus: case presentation, literature review, and discussion.
- Author
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Setty SP and Michaels AJ
- Published
- 2000
- Full Text
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3. Trisomy 21 and Congenital Heart Disease: Impact on Health and Functional Outcomes From Birth Through Adolescence: A Scientific Statement From the American Heart Association.
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Peterson JK, Clarke S, Gelb BD, Kasparian NA, Kazazian V, Pieciak K, Pike NA, Setty SP, Uveges MK, and Rudd NA
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- Humans, Adolescent, Child, United States, Infant, Newborn, American Heart Association, Infant, Child, Preschool, Functional Status, Health Status, Down Syndrome psychology, Down Syndrome therapy, Heart Defects, Congenital therapy, Heart Defects, Congenital psychology, Heart Defects, Congenital physiopathology, Quality of Life
- Abstract
Due to improvements in recognition and management of their multisystem disease, the long-term survival of infants, children, and adolescents with trisomy 21 and congenital heart disease now matches children with congenital heart disease and no genetic condition in many scenarios. Although this improved survival is a triumph, individuals with trisomy 21 and congenital heart disease have unique and complex care needs in the domains of physical, developmental, and psychosocial health, which affect functional status and quality of life. Pulmonary hypertension and single ventricle heart disease are 2 known cardiovascular conditions that reduce life expectancy in individuals with trisomy 21. Multisystem involvement with respiratory, endocrine, gastrointestinal, hematological, neurological, and sensory systems can interact with cardiovascular health concerns to amplify adverse effects. Neurodevelopmental, psychological, and functional challenges can also affect quality of life. A highly coordinated interdisciplinary care team model, or medical home, can help address these complex and interactive conditions from infancy through the transition to adult care settings. The purpose of this Scientific Statement is to identify ongoing cardiovascular and multisystem, developmental, and psychosocial health concerns for children with trisomy 21 and congenital heart disease from birth through adolescence and to provide a framework for monitoring and management to optimize quality of life and functional status.
- Published
- 2024
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4. Racial Health Disparity Associated With Poor Pediatric Cardiac Surgery Outcomes: A Multicentered, Cross-Sectional Study.
- Author
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Setty SP, Reynolds LC, Chou VC, Yu MT, Kang S, Allen PM, Tran L, and Le J
- Abstract
Background: Health disparities are known to play a role in pediatric cardiac surgery outcomes., Objectives: Risk factors associated with poor clinical outcomes were assessed., Methods: Using Pediatric Health Information System Database, pediatric subjects undergoing cardiac surgery using International Classification of Diseases 10th Revision from October 2015 to December 2020 were evaluated. Subjects were categorized by case complexity using the newly validated Risk Adjustment for Congenital Heart Surgery-2 (RACHS-2). Multivariable regression analyses were conducted to ascertain risk factors., Results: A total of 59,856 subjects, median age 7.4 months (IQR: 1.5-61 months) were included; 38,917 (low), 9,833 (medium), and 11,106 (high) RACHS-2. Overall, hospital mortality was 3% and postoperative length of stay (LOS) was 7 days (IQR: 4-18 days), with significant increases in both mortality and postoperative LOS from low to high RACHS-2 scores by multivariable analysis, Kaplan-Meier, and Cox regression. Mechanical ventilation, extracorporeal membrane oxygenation, infection, and surgical complication were most significantly associated with increased mortality by 1.198 to 10.227 times ( P < 0.008). After controlling for these significant variables as well as RACHS-2, age at surgery and emergency/urgent admission type, multivariable analysis revealed that non-White race was associated with increased mortality (relative risk: 1.2, 95% CI: 0.729-0.955, P = 0.008) and increased postoperative LOS by 1.04 days (95% CI: 0.95-0.97, P < 0.001). This significant increase in both clinical outcomes was concordant in non-White neonates (mortality relative risk: 1.3, 95% CI: 1.1-1.6, P = 0.003; and postoperative LOS by 2.05 weeks (95% CI: 1.36-3.10, P < 0.001)., Conclusions: The influence of racial differences in neonates and children should be further evaluated to mitigate any disparity in those undergoing cardiac surgery., Competing Interests: This study was funded by 10.13039/100019582The Larry and Helen Hoag Foundation. The development of the RACHS-2 code used in this publication was supported by the 10.13039/100000050National Heart, Lung, and Blood Institute of the 10.13039/100000002National Institutes of Health, under award number R01 HL150044 (PI: Anderson) and supported by the New York Congenital Heart Surgery-Collaborative for Longitudinal Outcomes and Utilization of Resources (CHS-COLOUR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or of CHS-COLOUR. Dr Setty is a Chief Medical Officer of HD Medical Group. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.PERSPECTIVESCOMPETENCY IN MEDICAL KNOWLEDGE: The role of race continues to be a significant factor in the outcomes of pediatric cardiac surgery, when compared with other risk factors. TRANSLATIONAL OUTLOOK: Racial, ethnic, and socioeconomic factors should be further investigated to mitigate any disparity among infants and children undergoing cardiac surgery., (© 2024 The Authors.)
- Published
- 2024
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5. Insights and perspectives into clinical biomarker discovery in pediatric heart failure and congenital heart disease-a narrative review.
- Author
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Liem DA, Cadeiras M, and Setty SP
- Abstract
Background and Objective: Heart failure (HF) in the pediatric population is a multi-factorial process with a wide spectrum of etiologies and clinical manifestations, that are distinct from the adult HF population, with congenital heart disease (CHD) as the most common cause. CHD has high morbidity/mortality with nearly 60% developing HF during the first 12 months of life. Hence, early discovery and diagnosis of CHD in neonates is pivotal. Plasma B-type natriuretic peptide (BNP) is an increasingly popular clinical marker in pediatric HF, however, in contrast to adult HF, it is not yet included in pediatric HF guidelines and there is no standardized reference cut-off value. We explore the current trends and prospects of biomarkers in pediatric HF, including CHD that can aid in diagnosis and management., Methods: As a narrative review, we will analyze biomarkers with respect to diagnosis and monitoring in specific anatomical types of CHD in the pediatric population considering all English PubMed publications till June 2022., Key Content and Findings: We present a concise description of our own experience in applying plasma BNP as a clinical biomarker in pediatric HF and CHD (tetralogy of fallot vs. ventricular septal defect) in the context of surgical correction, as well as untargeted metabolomics analyses. In the current age of Information Technology and large data sets we also explored new biomarker discovery using Text Mining of 33M manuscripts currently on PubMed., Conclusions: (Multi) Omics studies from patient samples as well as Data Mining can be considered for the discovery of potential pediatric HF biomarkers useful in clinical care. Future research should focus on validation and defining evidence-based value limits and reference ranges for specific indications using the most up-to-date assays in parallel to commonly used studies., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at: https://cdt.amegroups.com/article/view/10.21037/cdt-22-386/coif). All authors report that this work is supported by the Larry and Helen Hoag Foundation. The authors have no other conflicts of interest to declare., (2023 Cardiovascular Diagnosis and Therapy. All rights reserved.)
- Published
- 2023
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6. Long-Term Survival and Causes of Death in Children with Trisomy 21 After Congenital Heart Surgery.
- Author
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Peterson JK, Kochilas LK, Knight J, McCracken C, Thomas AS, Moller JH, and Setty SP
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- Cardiac Surgical Procedures, Cause of Death, Child, Preschool, Cohort Studies, Down Syndrome complications, Female, Heart Defects, Congenital complications, Humans, Infant, Infant, Newborn, Male, Retrospective Studies, Survival Rate, Time Factors, Down Syndrome mortality, Heart Defects, Congenital mortality, Heart Defects, Congenital surgery
- Abstract
Objective: To evaluate long-term transplant-free survival and causes of death in the trisomy 21 (T21) population after surgery for congenital heart disease (CHD) in comparison with patients who are euploidic., Study Design: This is a retrospective cohort study from the Pediatric Cardiac Care Consortium, enriched with prospectively collected data from the National Death Index and the Organ Procurement and Transplantation Network for patients with sufficient direct identifiers. Kaplan-Meier survival plots were generated and multivariable Cox proportional hazards models were used to examine risk factors for mortality between patients with T21 and 1:1 matched patients with comparable CHD who are euploidic., Results: A long-term survival analysis was completed for 3376 patients with T21 (75 155 person-years) who met inclusion criteria. The 30-year survival rate for patients with T21 ranged from 92.1% for ventricular septal defect to 65.3% for complex common atrioventricular canal. Of these, 2185 patients with T21 were successfully matched with a patient who was euploidic. After a median follow-up of 22.86 years (IQR, 19.45-27.14 years), 213 deaths occurred in the T21 group (9.7%) compared with 123 (5.6%) in the euploidic comparators. After adjustment for age, sex, era, CHD complexity, and initial palliation, the hazard ratio of CHD-related mortality was 1.34 times higher in patients with T21 (95% CI, 0.92-1.97; P = .127)., Conclusions: CHD-related mortality for patients with T21 after cardiac surgical intervention is comparable with euploidic comparators. Children with T21 require lifelong surveillance for co-occurring conditions associated with their chromosomal abnormality., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2021
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7. Sterility and performance of open and closed extracorporeal circuits after long-term dry-wet setups.
- Author
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Deptula J, McGrath C, Preston T, Miller H, Yen B, Munari L, and Setty SP
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- Cardiopulmonary Bypass, Escherichia coli, Humans, Oxygenators, Membrane, Extracorporeal Membrane Oxygenation, Infertility
- Abstract
Background: The timeframe for safely using previously setup dry, crystalloid, and blood-primed extracorporeal circuits has long been debated. This study was undertaken to determine a safe deviation from standardized recommendations., Methods: Open (cardiopulmonary bypass) circuits and closed extracorporeal membrane oxygenation circuits were setup dry for up to 60 days and wet primed for up to 6 weeks with one control inoculated with Escherichia coli . Open circuits were cultured daily, closed circuits weekly. Circuits were primed with blood, albumin, heparin, NaHCO
3 , and CaCl2 . Baseline pCO2 , pO2 , hemoglobin, lactate dehydrogenase, and plasma free hemoglobin were measured. Circuits were recirculated at a blood flow of 6 Liters/minute with a sweep gas of 1 Liter/minute at 100% FiO2 for 1 minute. Post oxygenator blood gases were collected at 8-, 16-, and 24-hour intervals., Results: There was no observed compromise to the sterility of the circuits and no clinically significant gas exchange abnormalities observed over the duration of the study period. Statistical significance (p < 0.01) was seen in free hemoglobin and lactate dehydrogenase levels, most significant in between the 16- and 24-hour time point in the closed systems intentionally inoculated with E. coli ., Conclusion: Open and closed circuits can be safely setup dry for up to 60 days. Open, wet-primed circuits can be used safely up to 5 days. Closed, wet-primed circuits can be used safely up to 6 weeks. Blood-primed circuits can be safely run up to 16 hours prior to patient use but should be validated in a randomized clinical study.- Published
- 2021
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8. Postoperative and long-term outcomes in children with Trisomy 21 and single ventricle palliation.
- Author
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Peterson JK, Setty SP, Knight JH, Thomas AS, Moller JH, and Kochilas LK
- Subjects
- Adolescent, Cause of Death trends, Child, Child, Preschool, Down Syndrome mortality, Follow-Up Studies, Genetic Testing, Heart Defects, Congenital diagnosis, Heart Ventricles diagnostic imaging, Heart Ventricles surgery, Humans, Infant, Infant, Newborn, Postoperative Period, Retrospective Studies, Survival Rate trends, United States epidemiology, Young Adult, Abnormalities, Multiple, Down Syndrome diagnosis, Forecasting, Heart Defects, Congenital surgery, Heart Ventricles abnormalities
- Abstract
Objective: Patients with Trisomy 21 (T21) and single ventricle (SV) physiology present unique challenges compared to euploidic counterparts. This study reports postoperative and long-term outcomes in patients with T21 and SV palliation., Design: This retrospective cohort study from the Pediatric Cardiac Care Consortium (PCCC) included patients with T21 (<21 years old) that underwent surgical palliation for SV between 1982 and 2008 and control patients without known genetic anomaly following Fontan palliation for similar diagnoses. Kaplan-Meier survival plots were created based on death events obtained from the PCCC and by linkage with the National Death Index (NDI) and the Organ Procurement and Transplantation Network (OPTN) through 2014 for patients with adequate identifiers., Results: We identified 118 children with T21 who underwent initial surgical SV palliation. Among 90 (75.6%) patients surviving their first surgery, 66 (73.3%) underwent Glenn anastomosis and 25 (27.8%) completed Fontan palliation with in-hospital survival of 80.3% and 76.0%, respectively. Fifty-three patients had sufficient identifiers for PCCC-NDI-OPTN linkage. Ten-year survival, conditioned on discharge alive after the Fontan procedure, was 66.7% compared to 92.2% for 51 controls without genetic anomaly (P = .001). Median age at death for T21 patients following initial surgical SV palliation was 2.69 years (IQR 1.34-7.12) with most deaths (89.2%) attributed to the underlying congenital heart disease (CHD)., Conclusions: Children with T21 and SV are at high risk for procedural and long-term mortality related to their genetic condition and underlying CHD. Nevertheless, a select group of patients can successfully complete Glenn or Fontan palliation, reaching satisfactory long-term survival., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2019
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9. An Unusual Cardiac Cause of Unilateral Neonatal Wheezing.
- Author
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Brock J, Nussbaum E, Shows J, Nguyen S, and Setty SP
- Abstract
A neonate presented three days after birth with left-sided unilateral inspiratory wheezing, intermittent respiratory distress, and desaturations. She was found to have a large ductus arteriosus aneurysm that caused compression of her left mainstem bronchus and left pulmonary artery. This lesion was not identified prior to birth on routine prenatal screening, which included fetal ultrasonography. Diagnosis was made on day of life (DOL) 5 by a computed tomography with angiography scan. On DOL 7, she underwent cardiac surgery which included resection of the ductal aneurysm, patch reconstruction of the transverse aortic arch and descending aorta, patent ductus arteriosus excision, and atrial secundum septal defect repair. There were no postoperative complications, and she has been asymptomatic since.
- Published
- 2019
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10. Cloud-Based Phrase Mining and Analysis of User-Defined Phrase-Category Association in Biomedical Publications.
- Author
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Sigdel D, Kyi V, Zhang A, Setty SP, Liem DA, Shi Y, Wang X, Shen J, Wang W, Han J, and Ping P
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- Algorithms, Databases, Factual, Humans, Biomedical Research, Cloud Computing, Data Mining methods, Publications
- Abstract
The rapid accumulation of biomedical textual data has far exceeded the human capacity of manual curation and analysis, necessitating novel text-mining tools to extract biological insights from large volumes of scientific reports. The Context-aware Semantic Online Analytical Processing (CaseOLAP) pipeline, developed in 2016, successfully quantifies user-defined phrase-category relationships through the analysis of textual data. CaseOLAP has many biomedical applications. We have developed a protocol for a cloud-based environment supporting the end-to-end phrase-mining and analyses platform. Our protocol includes data preprocessing (e.g., downloading, extraction, and parsing text documents), indexing and searching with Elasticsearch, creating a functional document structure called Text-Cube, and quantifying phrase-category relationships using the core CaseOLAP algorithm. Our data preprocessing generates key-value mappings for all documents involved. The preprocessed data is indexed to carry out a search of documents including entities, which further facilitates the Text-Cube creation and CaseOLAP score calculation. The obtained raw CaseOLAP scores are interpreted using a series of integrative analyses, including dimensionality reduction, clustering, temporal, and geographical analyses. Additionally, the CaseOLAP scores are used to create a graphical database, which enables semantic mapping of the documents. CaseOLAP defines phrase-category relationships in an accurate (identifies relationships), consistent (highly reproducible), and efficient manner (processes 100,000 words/sec). Following this protocol, users can access a cloud-computing environment to support their own configurations and applications of CaseOLAP. This platform offers enhanced accessibility and empowers the biomedical community with phrase-mining tools for widespread biomedical research applications.
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- 2019
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11. A reference set of curated biomedical data and metadata from clinical case reports.
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Caufield JH, Zhou Y, Garlid AO, Setty SP, Liem DA, Cao Q, Lee JM, Murali S, Spendlove S, Wang W, Zhang L, Sun Y, Bui A, Hermjakob H, Watson KE, and Ping P
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- Computational Biology, Data Analysis, Humans, Clinical Studies as Topic, Data Curation methods, Data Curation standards, Metadata standards
- Abstract
Clinical case reports (CCRs) provide an important means of sharing clinical experiences about atypical disease phenotypes and new therapies. However, published case reports contain largely unstructured and heterogeneous clinical data, posing a challenge to mining relevant information. Current indexing approaches generally concern document-level features and have not been specifically designed for CCRs. To address this disparity, we developed a standardized metadata template and identified text corresponding to medical concepts within 3,100 curated CCRs spanning 15 disease groups and more than 750 reports of rare diseases. We also prepared a subset of metadata on reports on selected mitochondrial diseases and assigned ICD-10 diagnostic codes to each. The resulting resource, Metadata Acquired from Clinical Case Reports (MACCRs), contains text associated with high-level clinical concepts, including demographics, disease presentation, treatments, and outcomes for each report. Our template and MACCR set render CCRs more findable, accessible, interoperable, and reusable (FAIR) while serving as valuable resources for key user groups, including researchers, physician investigators, clinicians, data scientists, and those shaping government policies for clinical trials.
- Published
- 2018
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12. Anomalous left subclavian artery from the pulmonary artery in a neonate.
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Catton KG and Setty SP
- Subjects
- Cineangiography, Coronary Angiography, Female, Humans, Infant, Newborn, Pulmonary Artery diagnostic imaging, Pulmonary Artery surgery, Subclavian Artery diagnostic imaging, Subclavian Artery surgery, Vascular Malformations diagnosis, Abnormalities, Multiple, Cardiac Surgical Procedures methods, Heart Defects, Congenital diagnosis, Pulmonary Artery abnormalities, Subclavian Artery abnormalities, Vascular Malformations surgery
- Abstract
The presence of an isolated left subclavian artery arising from the pulmonary artery in a patient with d-transposition of the great arteries is exceedingly rare. Prior to undertaking repair of this congenital cardiac anomaly, identification of an isolated left subclavian artery originating from the pulmonary artery is imperative in order to plan the appropriate intervention to prevent the development of subclavian artery steal or vertebrobasilar insufficiency. We describe the case of a 5 day-old girl in whom an isolated left subclavian artery arising from the pulmonary artery was detected after surgical entry for repair of transposition of the great arteries.
- Published
- 2018
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13. Healthcare Disparities in Outcomes of a Metropolitan Congenital Heart Surgery Center: The Effect of Clinical and Socioeconomic Factors.
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Peterson JK, Catton KG, and Setty SP
- Subjects
- Adolescent, Asian, Child, Child, Preschool, Delayed Diagnosis, Emergency Service, Hospital, Female, Heart Defects, Congenital diagnostic imaging, Hispanic or Latino, Humans, Infant, Infant, Newborn, Male, Native Hawaiian or Other Pacific Islander, Outcome Assessment, Health Care, Respiration, Artificial statistics & numerical data, Retrospective Studies, Time Factors, White People, Cardiac Surgical Procedures, Healthcare Disparities ethnology, Heart Defects, Congenital surgery, Length of Stay statistics & numerical data, Postoperative Complications ethnology
- Abstract
Objective: The purpose of this study is to identify the impact of demographic, socioeconomic, and clinical factors on congenital heart surgery outcomes., Study Design: This retrospective cohort study included 234 congenital heart surgery patients from 2011 through 2015, in a racially/ethnically diverse metropolitan children's hospital. Outcomes included length of stay (LOS), age at first echocardiogram, length of mechanical ventilation, and incidence of complications., Results: Compared to others, black children underwent their first echocardiogram at a later age (median 23 versus 2 days, p = 0.014) and were more likely to be diagnosed with congenital heart disease in the emergency room (p = 0.026). Hispanic children were more likely to have major non-cardiac congenital anomalies (p = 0.045). Increased LOS during elective admissions was associated with higher surgical complexity (STAT category 4 and 5 Estimate 3.905 days, p = 0.001), compared to STAT category 1, and number of complications (Estimate = 2.306 days per complication, p < 0.001). Increased LOS in non-elective admissions was associated with the number of complex chronic conditions (Estimate = 15.446 days, p = 0.045) and the number of complications (Estimate = 11.591 days per complication, p < 0.001). However, in multivariate analysis, race and ethnicity was not associated with increased LOS or age at first echocardiogram., Conclusion: In this diverse setting, race/ethnicity was not associated with increased LOS, age at first echocardiogram, length of ventilation, or complications. Surgical complexity, chronic conditions, and complications were associated with increased LOS. We discuss some interventions to reduce disparities in congenital heart surgery outcomes.
- Published
- 2018
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14. Current trends in racial, ethnic, and healthcare disparities associated with pediatric cardiac surgery outcomes.
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Peterson JK, Chen Y, Nguyen DV, and Setty SP
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- Adolescent, Child, Child, Preschool, Female, Heart Defects, Congenital surgery, Hospital Mortality trends, Humans, Infant, Infant Mortality trends, Infant, Newborn, Male, Morbidity trends, Odds Ratio, Prognosis, Retrospective Studies, Risk Factors, Socioeconomic Factors, Cardiac Surgical Procedures, Ethnicity statistics & numerical data, Healthcare Disparities trends, Heart Defects, Congenital ethnology, Racial Groups statistics & numerical data
- Abstract
Objective: Despite overall improvements in congenital heart disease outcomes, racial and ethnic disparities have continued. The purpose of this study is to examine the effect of race and ethnicity, as well as other risk factors on congenital heart surgery length of stay and in-hospital mortality., Design: From the 2012 Healthcare Cost and Utilization Project Kids Inpatient Database (KID), we identified 13 130 records with Risk Adjustment in Congenital Heart Surgery complexity score-eligible procedures. Multivariate logistic and linear regression modeling with survey weights, stratification and clustering was used to examine the relationships between predictor variables and length of stay as well as in-hospital mortality., Results: No significant mortality differences were found among all race and ethnicity groups across each age group. Black neonates and black infants had a longer length of stay (neonatal estimate = 8.73 days, P = .0034; infant estimate 1.10 days, P = .0253), relative to whites. Government-sponsored insurance was associated with increased odds of neonatal mortality (odds ratio = 1.51, P = .0055), increased length of stay in neonates (estimate = 4.26 days, P = .0009) and infants (estimate = 1.52 days, P = .0181), relative to private insurance. Government-sponsored insurance was associated with increased number of chronic conditions, which were also associated with increased LOS (estimate 8.39 days, P < .001 in neonates; estimate 3.60 days, P < .001 in infants; estimate 1.87 days, P < .001 children)., Conclusions: Racial/ethnic disparities in congenital heart surgical outcomes may be changing compared with previous studies using the KID database. Increased length of stay in children with government-sponsored insurance may reflect expansion of individual states government-sponsored insurance eligibility criteria for children with complex chronic medical conditions. These findings warrant cautious optimism regarding racial and ethnic disparities in congenital heart surgery outcomes., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2017
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15. Long-Term Outcomes of Children With Trisomy 13 and 18 After Congenital Heart Disease Interventions.
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Peterson JK, Kochilas LK, Catton KG, Moller JH, and Setty SP
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- Canada, Cause of Death, Chromosome Disorders complications, Chromosomes, Human, Pair 13, Chromosomes, Human, Pair 18, Female, Follow-Up Studies, Heart Defects, Congenital complications, Heart Defects, Congenital mortality, Humans, Infant, Infant, Newborn, Male, Retrospective Studies, Trisomy 13 Syndrome, Trisomy 18 Syndrome, United States, Chromosome Disorders mortality, Heart Defects, Congenital surgery, Hospital Mortality, Trisomy
- Abstract
Background: The purpose of this study is to report short- and long-term outcomes after congenital heart defect (CHD) interventions in patients with trisomy 13 or 18., Methods: A retrospective review of the Pediatric Cardiac Care Consortium (PCCC) identified children with trisomy 13 or 18 with interventions for CHD between 1982 and 2008. Long-term survival and cause of death were obtained through linkage with the National Death Index., Results: A total of 50 patients with trisomy 13 and 121 patients with trisomy 18 were enrolled in PCCC between 1982 and 2008; among them 29 patients with trisomy 13 and 69 patients with trisomy 18 underwent intervention for CHD. In-hospital mortality rates for patients with trisomy 13 or trisomy 18 were 27.6% and 13%, respectively. Causes of in-hospital death were primarily cardiac (64.7%) or multiple organ system failure (17.6%). National Death Index linkage confirmed 23 deaths after discharge. Median survival (conditioned to hospital discharge) was 14.8 years (95% confidence interval [CI]: 12.3 to 25.6 years) for patients with trisomy 13 and 16.2 years (95% CI: 12 to 20.4 years) for patients with trisomy 18. Causes of late death included cardiac (43.5%), respiratory (26.1%), and pulmonary hypertension (13%)., Conclusions: In-hospital mortality rate for all surgical risk categories was higher in patients with trisomy 13 or 18 than that reported for the general population. However, patients with trisomy 13 or 18, who were selected as acceptable candidates for cardiac intervention and who survived CHD intervention, demonstrated longer survival than previously reported. These findings can be used to counsel families and make program-level decisions on offering intervention to carefully selected patients., (Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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16. Anomalous aortic origin of the right coronary artery: Embryology over genetics.
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Patel AM, Sunkara NT, Choy RM, and Setty SP
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- Cardiac Surgical Procedures, Coronary Angiography methods, Coronary Vessel Anomalies diagnosis, Coronary Vessel Anomalies surgery, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Diseases in Twins diagnosis, Diseases in Twins surgery, Genetic Predisposition to Disease, Humans, Male, Phenotype, Risk Factors, Tomography, X-Ray Computed, Treatment Outcome, Young Adult, Coronary Vessel Anomalies embryology, Coronary Vessel Anomalies genetics, Coronary Vessels embryology, Diseases in Twins embryology, Diseases in Twins genetics, Twins, Monozygotic genetics
- Published
- 2015
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17. Molecular- and organelle-based predictive paradigm underlying recovery by left ventricular assist device support.
- Author
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Liem DA, Nsair A, Setty SP, Cadeiras M, Wang D, Maclellan R, Lotz C, Lin AJ, Tabaraki J, Li H, Ge J, Odeberg J, Ponten F, Larson E, Mulder J, Lundberg E, Weiss JN, Uhlen M, Ping P, and Deng MC
- Subjects
- Animals, Humans, Myocardium metabolism, Myocardium pathology, Organelles metabolism, Heart Failure metabolism, Heart Failure physiopathology, Heart Failure therapy, Heart-Assist Devices, Recovery of Function physiology
- Published
- 2014
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18. Bilateral superior vena cavae with anomalous criss-cross atrial drainage.
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Catton K, Blurton D, Vorobiof G, and Setty SP
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- Anastomosis, Surgical methods, Contrast Media, Cyanosis diagnosis, Cyanosis etiology, Echocardiography, Doppler methods, Follow-Up Studies, Heart Atria surgery, Humans, Infant, Male, Multidetector Computed Tomography methods, Risk Assessment, Tomography, X-Ray Computed methods, Treatment Outcome, Vena Cava, Superior surgery, Angiography methods, Cardiac Surgical Procedures methods, Heart Atria abnormalities, Vena Cava, Superior abnormalities
- Published
- 2013
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19. Double-chambered right ventricle with cough, endocarditis, and lung mass.
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Wilder T, Shah S, Mello D, and Setty SP
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- Adult, Cough etiology, Female, Humans, Endocarditis, Bacterial etiology, Heart Ventricles abnormalities, Lung Diseases etiology, Streptococcal Infections etiology
- Abstract
Pulmonary valve endocarditis is an uncommon complication of a double-chambered right ventricle. A persistent cough is an atypical presentation for a double-chambered right ventricle, and in this patient it was the result of pulmonary valve bacterial endocarditis with eventual bacterial vegetation embolization to the lung. Our patient underwent surgical repair of all cardiac defects, which resulted in the resolution of all of her symptoms., (Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2010
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20. Treatment of right ventricle to coronary artery connections in infants with pulmonary atresia and intact ventricular septum.
- Author
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Foker JE, Setty SP, Berry J, Jain P, Catton K, Gittenberger-de-Groot AC, and Pyles LA
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- Cardiac Surgical Procedures methods, Child, Preschool, Coronary Angiography, Echocardiography, Echocardiography, Transesophageal, Heart Septum, Heart Ventricles abnormalities, Humans, Infant, Infant, Newborn, Ligation, Pulmonary Atresia complications, Treatment Outcome, Tricuspid Valve abnormalities, Coronary Vessel Anomalies surgery, Coronary Vessels surgery, Heart Ventricles surgery, Pulmonary Atresia surgery
- Abstract
Objective: At the severe end of the spectrum of infants with pulmonary atresia and intact ventricular septum, the likelihood of significant right ventricle to coronary artery connections increases. Our purpose is to present the first series of right ventricle to coronary artery connections ligated off bypass before right ventricular decompression and to evaluate the consequences of this approach., Methods: From 1988 to 2007, 19 patients with pulmonary atresia and intact ventricular septum had a total of 69 right ventricle to coronary artery connections identified preoperatively, and 10 more were located intraoperatively. Of these, 71 were judged large enough to warrant off-pump direct ligation. Preoperative diagnosis was by transthoracic echocardiography and angiography. Transesophageal and surface echocardiography were used for intraoperative location. Direct visualization and echocardiographic assessment for regional wall motion abnormalities determined the effects of ligation. Right ventricular decompression was done in all patients., Results: After ligation, coronary flow converted from moderately or largely retrograde to antegrade perfusion. Ligation produced no visual myocardial consequences or immediate local wall motion abnormalities. For 3 patients, however, apical-septal wall motion abnormalities appeared from 2 hours to 3 days postoperatively. Serial studies were done to assess the later effects in the 16 of 19 30-day survivors. No evidence for myocardial injury was found, and all continued on a 2-ventricle repair course., Conclusion: The location and ligation of right ventricle to coronary artery connections can be reliably accomplished off bypass. Coronary flow became antegrade, improving myocardial oxygenation. No myocardial damage was observed. Inapparent right ventricle to coronary artery connections occasionally enlarge secondarily after right ventricular decompression, making early follow-up evaluation necessary after ligation. Despite the initial presence of significant right ventricle to coronary artery connections, 2-ventricle repairs are possible with long-term benefits.
- Published
- 2008
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21. Partial cardiopulmonary bypass in infants with coarctation and anomalous right subclavian arteries.
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Setty SP, Brizard CP, and d'Udekem Y
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- Cardiopulmonary Bypass adverse effects, Humans, Infant, Cardiopulmonary Bypass methods, Collateral Circulation, Subclavian Artery abnormalities
- Published
- 2007
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22. Transesophageal echocardiography guidance for repair of complex cardiac injuries.
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Setty SP, Bass JL, Madhusoodanan KP, and Liao KK
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- Adult, Coronary Vessels, Fistula diagnostic imaging, Heart Aneurysm diagnostic imaging, Heart Septal Defects, Ventricular diagnostic imaging, Heart Ventricles, Humans, Male, Mitral Valve Insufficiency diagnostic imaging, Echocardiography, Transesophageal, Heart Injuries diagnostic imaging, Heart Injuries surgery, Wounds, Stab
- Abstract
Our patient suffered a single stab wound to the heart that resulted in a coronary artery to ventricle fistula, a ventricular septal defect, mitral regurgitation from chordal transection, and a delayed left ventricular aneurysm. We used transesophageal echocardiography to characterize these multiple defects to help guide successful surgical repair. The patient recovered uneventfully.
- Published
- 2006
- Full Text
- View/download PDF
23. Fontan procedure: old lessons and new frontiers.
- Author
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Setty SP and Herrington CS
- Subjects
- Arrhythmias, Cardiac etiology, Bronchitis etiology, Heart Bypass, Right, Heart Failure drug therapy, Heart Transplantation, Humans, Patient Selection, Protein-Losing Enteropathies etiology, Treatment Outcome, Fontan Procedure adverse effects
- Abstract
The Fontan procedure is an operation created for patients with single ventricular physiology. These patients have the potential to survive well into adulthood, however new problems can arise. Various topics, including physiological constraints, patient care, morbidity and clinical outcomes are discussed. The aim of this review is to identify current topics within the care of the Fontan patient population for the physician not comfortable with their unique physiology and complications.
- Published
- 2006
- Full Text
- View/download PDF
24. Congenital esophageal stenosis: a case report and review of the literature.
- Author
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Setty SP and Harrison MW
- Subjects
- Child, Preschool, Esophageal Stenosis congenital, Esophageal Stenosis surgery, Female, Humans, Thoracotomy, Treatment Outcome, Deglutition Disorders etiology, Esophageal Stenosis complications, Esophageal Stenosis diagnosis
- Abstract
A child with congenital esophageal stenosis (CES) demonstrates the need for accuracy in the diagnosis and management of this rare problem. Other etiologies of dysphagia must be looked into, but when the expected results are not realized CES should be considered. A range of diagnoses and diagnostic studies may help to get children with dysphagia the treatment that they need to resolve their symptoms.
- Published
- 2004
- Full Text
- View/download PDF
25. Acute transanal evisceration of the small bowel: report of a case and review of the literature.
- Author
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Morris AM, Setty SP, Standage BA, and Hansen PD
- Subjects
- Acute Disease, Aged, Aged, 80 and over, Female, Humans, Rectal Diseases surgery, Rupture, Spontaneous, Stress, Physiological complications, Stress, Physiological etiology, Tissue Adhesions complications, Constipation complications, Intestine, Small surgery, Rectal Diseases complications
- Abstract
We report a patient who presented with rectal rupture and transanal evisceration, a rare entity with only 52 cases previously described in the world literature. Our case is the first to implicate sheer stress on the anterior rectum caused by postoperative adhesions as the major etiologic contributing feature. Moreover, this case is the third reported with chronic constipation without rectal prolapse as an additional preexisting contributory condition. A summary of the medical literature including etiology, treatment, and outcomes is presented.
- Published
- 2003
- Full Text
- View/download PDF
26. Extracardiac conduit with a limited maze procedure for the failing Fontan with atrial tachycardias.
- Author
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Setty SP, Finucane K, Skinner JR, and Kerr AR
- Subjects
- Adolescent, Adult, Cardiovascular Surgical Procedures methods, Exercise Tolerance, Female, Humans, Length of Stay, Male, Pacemaker, Artificial, Postoperative Complications, Reoperation, Tachycardia, Ectopic Atrial etiology, Tachycardia, Ectopic Atrial physiopathology, Treatment Outcome, Fontan Procedure, Tachycardia, Ectopic Atrial surgery
- Abstract
Background: Atrial arrhythmias are a frequent late complication of Fontan procedures. Conversion to an extracardiac conduit combined with reducing right atrial size should improve hemodynamics and reduce the development of tachyarrhythmias. More effective control may be achieved by interrupting atrial arrhythmia circuits and atrial pacing., Methods: Between May 1997 and October 2001, 6 patients underwent a revision of their intracardiac Fontan anastomosis. The conversion included an extracardiac conduit insertion, limited right atrial maze procedure, and pacemaker placement. Ages ranged from 14 to 34 years (mean, 22.8 years) at an average of 14.6 +/- 4.4 years after their original Fontan procedure. All of the patients had medically uncontrollable atrial tachyarrhythmias with markedly reduced exercise tolerance., Results: All of the patients survived with an average hospital stay of 16.7 days. Exercise tolerance has improved in all 6 patients, and atrial tachycardias have either decreased (n = 2) or disappeared (n = 4). Two patients are taking antiarrhythmic medications other than digoxin. Follow-up is a mean of 28.5 months., Conclusions: Limited right atrial maze procedure, atrial size reduction, and pacemaker implantations are worthwhile additions to simple conversion to an extracardiac conduit in the failing Fontan.
- Published
- 2002
- Full Text
- View/download PDF
27. Noninvasive measurement of shear rate in autologous and prosthetic bypass grafts.
- Author
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Setty SP, Salles-Cunha S, Scissons R, Begeman G, Farison J, and Beebe HG
- Subjects
- Aged, Aged, 80 and over, Blood Flow Velocity, Chi-Square Distribution, Female, Femoral Artery transplantation, Humans, Male, Middle Aged, Polytetrafluoroethylene, Popliteal Artery transplantation, Risk Factors, Systole, Transplantation, Autologous, Ultrasonography, Doppler, Color, Blood Vessel Prosthesis, Femoral Artery diagnostic imaging, Hemorheology, Popliteal Artery diagnostic imaging
- Abstract
There is a major difference in thrombogenicity between lower extremity prosthetic and autologous vein bypass grafts, and arterial blood flow shear rate is known to influence thrombus formation. Despite this association, there has been little direct clinical observation of shear rates in bypass grafts. The authors developed a new noninvasive method to quantitate human arterial shear rate and used it in a pilot study to characterize differences in lower extremity bypasses. Shear rates were measured in 10 prosthetic and 14 autologous vein femoropopliteal bypass grafts. With CVI-M-mode color flow ultrasonography in resting supine patients, a velocity profile was recorded from a midgraft longitudinal section in the ultrasound beam direction. Shear rates were calculated by using a mathematical-graphic computer program at the anteromedial (near) and posterolateral (far) graft walls by averaging values immediately before and after peak systolic velocity (PSV). Comparison between prosthetic and autologous graft groups respectively revealed that differences in age (67 +/- 12 [SD] vs 71 +/- 10 yr), male gender (60% vs 43%), prevalence of hypertension (50% vs 71%), diabetes (40% vs 64%), smoking (50% vs 50%), hypercholesterolemia (30% vs 29%), coronary artery disease (60% vs 50%), and critical ischemia (60% vs 86%) did not reach statistical significance (p>0.19). Median PSVs were significantly less in prosthetic than in autologous vein bypasses (37 +/- 13 vs 57 +/- 22 cm/s, p=0.018). Prosthetic and autologous graft diameters were not statistically significantly different (6.3 +/- 1.1 vs 5.6 +/- 1.3 mm, p = 0.18). Shear rates were significantly less in prosthetic than in autologous vein bypasses both at the near wall (382 +/- 146 vs 698 +/- 271 s(-1), p=0.003) and at the far wall (551+/-235 vs 827+/-339 s(-1), p-0.037). This mathematical model can be used to calculate shear rate from observed ultrasound flow patterns. Prosthetic bypass grafts had lower shear rates than autologous vein grafts.
- Published
- 2002
- Full Text
- View/download PDF
28. Asymmetric primary ringless repair of mitral valve endocarditis: a case report.
- Author
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Setty SP, Milsom FP, and Armstrong G
- Subjects
- Echocardiography, Transesophageal, Humans, Male, Middle Aged, Mitral Valve diagnostic imaging, Cardiopulmonary Bypass, Endocarditis, Bacterial complications, Endocarditis, Bacterial surgery, Heart Valve Prosthesis, Mitral Valve pathology, Mitral Valve surgery, Streptococcal Infections complications, Streptococcal Infections surgery, Streptococcus sanguis
- Abstract
The case is presented of a patient with a large mitral valve vegetation. A technique of mitral valve repair involving ringless annuloplasty repair following bileaflet resection of the infected regions of the valve is described. No pledgets or prosthetic material were used in the repair. The patient recovered uneventfully, with trivial mitral regurgitation documented on post-repair echocardiography. This technique may suggest a method for early intervention in mitral endocarditis.
- Published
- 2002
29. Noninvasive ultrasound measurement of shear rate in leg bypass grafts.
- Author
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Setty SP, Salles-Cunha S, Scissons R, Begeman GA, Farison JB, and Beebe HG
- Subjects
- Adult, Aged, Aged, 80 and over, Blood Flow Velocity, Female, Femoral Artery surgery, Humans, Male, Middle Aged, Popliteal Artery surgery, Risk Factors, Saphenous Vein transplantation, Systole, Tibial Arteries surgery, Ultrasonography, Doppler, Duplex, Femoral Artery diagnostic imaging, Hemorheology, Popliteal Artery diagnostic imaging, Tibial Arteries diagnostic imaging
- Abstract
Shear has been implicated in the etiology of atherosclerosis, thrombosis and graft stenosis. We measured shear rate noninvasively in infrainguinal bypasses. Velocity profiles were recorded from 35 femoropopliteal and 40 tibial grafts. Flow rate (Q), systolic shear rate (SSR), diameter, and bluntness factor (BF) were measured at midgraft using ultrasound (US). Mean shear rate (MSR) was calculated from flow and diameter. SSR, 671 +/- 260 (SD) vs. 659 +/- 304 s(-1) (p = 0.85), and MSR, 168 +/- 84 vs. 193 +/- 110 s(-1) (p = 0.26), were similar for popliteal and tibial bypasses, but differences in Q, 126 +/- 57 vs. 104 +/- 38 mL/min, were borderline significant (p = 0.058). Popliteal grafts had larger diameters, 5.2 +/- 1.1 mm vs. 4.7 +/- 0.8 mm (p = 0.048), and BF, 3.4 +/- 0.9 vs. 2.8 +/- 0.7 (p = 0.0014). Shear rates were obtained noninvasively in humans. Larger diameters in popliteal vs. tibial bypasses did not result in lower shear rates and were compensated for by larger bluntness factors. Velocity profile bluntness cannot be ignored in shear rate analysis.
- Published
- 2001
- Full Text
- View/download PDF
30. Stage one Norwood procedure results: the green lane experience.
- Author
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Setty SP, Finucane K, Wilson N, Beca J, and Kerr AR
- Abstract
Aims: This study examined the presentation outcome, morbidity and mortality of infants who have undergone the stage one Norwood procedure for single ventricle reconstruction., Methods: A retrospective review was done on the first 20 patients to undergo this procedure at Green Lane Hospital, Auckland, New Zealand. Seven patients were diagnosed antenatally. Fetal cardiology records in the same time period were reviewed., Results: Twelve of the 20 patients (60%) have survived, and all of these patients have undergone their bi-directional Glenn procedure with no mortality. Eight patients died, with five of the deaths occurring in the perioperative period. Initial surgical mortality was 75%, decreasing to 25% since 1998. Antenatal diagnosis has not improved surgical outcome to date., Conclusion: With advances in surgical technique and pre- and postoperative care, neonates born with single ventricle anatomy have an acceptable surgical option. Babies who survive the Norwood operation have a good chance of surviving the later stages of the cardiac reconstruction process, and they have a reasonable outlook in the intermediate term.
- Published
- 2001
- Full Text
- View/download PDF
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