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i-Rounds Research and Case Studies
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Midterm Results for Collaborative Treatment of Pulmonary Atresia with Intact Ventricular Septum |
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Miami Children's Hospital
Background: We report a single-institution experience using a collaborative surgical and catheter-based approach to the initial treatment of pulmonary atresia with intact ventricular septum.
Methods: A retrospective review was conducted of all neonates admitted with pulmonary atresia with intact ventricular septum from 1996 to March, 2007.
Results: We identified 24 patients with a mean age at first intervention of 4.5 days with mean follow-up of 4.5 years (range 121 days to 11.1 years). Initial palliation was determined by right ventricular size, morphology, and presence of right ventricular dependent coronary circulation. Initial pulmonary valve perforation and valvuloplasty was performed in 41.7% (10/24) (Group A) and 58.3% (14/24) had an initial systemic-to-pulmonary artery shunt (Group B). Tricuspid valve size was significantly smaller in Group B (median z-score -0.52 Group A versus -2.40 Group B, p<0.001). Placement of a shunt after valvuloplasty in Group A was required in 70.0% (7/10). There was no mortality in Group A, and 70.0% (7/10) of patients are in a two ventricle pathway and 30.0% (3/10) are in a 1½-ventricle pathway. Group B had mortality of 14.3% (2/14), both within five days of surgery. All Group B patients are in a single ventricle pathway. Overall survival is 91.7% (22/24).
Conclusions: An individualized approach to this complex lesion has good results. If the right ventricle can be safely decompressed and appears usable, the need for a shunt after valvuloplasty does not preclude two ventricle (or 1½-ventricle) repair. Anatomy mandating a shunt as initial palliation has substantial early mortality.
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1298 K |
| Downloads |
7 |
| Date |
Mon 02/04/2008 @ 01:39 |
| Author |
Robert L. Hannan, MD, Jennifer A. Zabrinsky, Robert M. Stanfill, MD, Roque A. Ventura, Anthony F. Rossi, MD, David G. Nykanen, MD, Evan M. Zahn, MD, R |
| EMail |
Jennifer.Zabinsky@mch.com |
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RATING: DOWNLOAD
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Real-Time Outcomes for Congenital Heart Surgery on the World Wide Web |
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Miami Children's Hospital, Miami, FL
Arnold Palmer Hospital for Children and Women, Orlando, FL
Abstract:
While continuous performance measurement has driven progress in diverse fields of human endeavor, surgical outcomes may suffer from inaccurate, sporadic and biased measurement and reporting strategies. The Internet constitutes a potential platform for an information management system (IMS) capable of overcoming the limitations of traditional medical information exchange.
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3441 K |
| Downloads |
2 |
| Date |
Wed 01/16/2008 @ 11:48 |
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Redmond P. Burke, Jeffrey A. White, Robert L. Hannan, William M. DeCampli, Anthony F. Rossi |
| EMail |
redmond111@aol.com |
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RATING: DOWNLOAD
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Aristotle Comprehensive Complexity Score is not Better Than Analysis of Variance in Predicting Hospital Length of Stay After Congenital Heart Surgery |
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Arnold Palmer Hospital for Children, Orlando, FL
Background: The Aristotle comprehensive complexity score (CCS) has been developed to predict performance in congenital heart surgery. Whether CCS predicts post-operative stay (HLOS) is still unknown. We compared the use of CCS to standard analysis of variance (multiple variable linear regression, MLR) in predicting HLOS.
Methods: Using a database of our most recent 540 cases, we calculated HLOS and determined CCS using the Aristotle Institute algorithm. We calculated goodness of fit (R2 = square of regression coefficient) of log (HLOS, days) versus CCS using linear regression. We used the identical data set to identify determinants of HLOS using MLR, beginning with the following six variables: procedure complexity (RACHS score), age (AGE, months), presence of other system anomalies or syndromes (OtherSyst), pre-operative shock, prematurity (<36 weeks), and low birth weight (<2.5 kg) (LOWWT).
Results: Median HLOS was 6 days (range 1 to 153). Median CCS score was 9.1 (range 3 –25). CCS model was log(HLOS) = .09 (CCS) + .003, with R2 = 0.49. Final MLR model was log(HLOS) = 0.2 (RACHS) - .001 (AGE) + 0.4 (LOWWT) + .08 (OtherSyst) + .314, with R2 = 0.55. The root mean square difference in residuals between the two methods was high (0.22), indicating that the models were not homologous. Standard error of the estimate was lower for MLR.
Conclusions: In this single institution database, CCS was no better than four-variable MLR in predicting HLOS after congenital cardiac surgery. The two models were not homologous, and >40% of HLOS variability was due to undefined factors. The Aristotle score requires continued refinement and validation testing, and its limits of applicability must be defined.
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26 K |
| Downloads |
12 |
| Date |
Mon 01/14/2008 @ 07:36 |
| Author |
William M. DeCampli, M.D., Ph.D, FACC, Patricia Sieffert, ARNP, David Nykanen, M.D., FACC, Harun Fakioglu, M.D. |
| EMail |
william.decampli@orhs.org |
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RATING: DOWNLOAD
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Performance Improvement in Cardiac Surgery is Measured by Blood Lactate |
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Miami Children's Hospital, Miami, FL
Abstract:
Performance improvement is the concept of measuring the output of a particular process or procedure, then modifying the process or procedure in order to increase the output, increase efficiency, or increase the effectiveness of the process or procedure. The concept of performance improvement can be applied to either individual performance such as an athlete or organizational performance such as a racing team or a commercial enterprise. http://en.wikipedia.org/wiki/Performance_improvement ...
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2004 K |
| Downloads |
1 |
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Mon 01/14/2008 @ 07:34 |
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Anthony Rossi, Leo Lopez, Robert Hannan, Juan Bolivar, Christopher Tirotta, Nancy Dobrolet, George Ojito, Redmond Burke |
| EMail |
Anthony.Rossi@mch.com |
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RATING: DOWNLOAD
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