Current Readings: Long-Term Management of Patients Undergoing Successful Pediatric Cardiac Surgery

DiBardino, Daniel J.; Jacobs, Jeffrey P.

doi:10.1053/j.semtcvs.2014.08.002

Cited by 12 publications

(8 citation statements)

References 20 publications

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“…The incidence of surgical correction of congenital heart defects has increased dramatically over the last several decades. These defects, considered fatal just 30 years ago, can often be corrected successfully with overall operative mortality of <2% (refs 1 , 2 ). Reconstruction or replacement of blood vessels, valves and cardiac chambers is frequently required to repair or reform the appropriate anatomic configuration.…”

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confidence: 99%

Tissue engineering of acellular vascular grafts capable of somatic growth in young lambs

et al. 2016

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Treatment of congenital heart defects in children requiring right ventricular outflow tract reconstruction typically involves multiple open-heart surgeries because all existing graft materials have no growth potential. Here we present an ‘off-the-shelf' vascular graft grown from donor fibroblasts in a fibrin gel to address this critical unmet need. In a proof-of-concept study, the decellularized grafts are implanted as a pulmonary artery replacement in three young lambs and evaluated to adulthood. Longitudinal ultrasounds document dimensional growth of the grafts. The lambs show normal growth, increasing body weight by 366% and graft diameter and volume by 56% and 216%, respectively. Explanted grafts display physiological strength and stiffness, complete lumen endothelialization and extensive population by mature smooth muscle cells. The grafts also show substantial elastin deposition and a 465% increase in collagen content, without signs of calcification, aneurysm or stenosis. Collectively, our data support somatic growth of this completely biological graft.

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confidence: 99%

Tissue engineering of acellular vascular grafts capable of somatic growth in young lambs

et al. 2016

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“…[1][2][3][4][5][6] For these reasons, some have advocated for regular cardiac MRI (cMRI) surveillance of this patient population. While perioperative mortality has dramatically decreased as the procedure has been modified, significant longterm morbidity remains, including heart failure, thrombi, conduit stenoses, and hepatic congestion.…”

Section: Introductionmentioning

confidence: 99%

“…While perioperative mortality has dramatically decreased as the procedure has been modified, significant longterm morbidity remains, including heart failure, thrombi, conduit stenoses, and hepatic congestion. [1][2][3][4][5][6] For these reasons, some have advocated for regular cardiac MRI (cMRI) surveillance of this patient population.…”

Section: Introductionmentioning

confidence: 99%

“…For more than 40 years the Fontan procedure has played an important role in surgical palliation for patients with a functional single ventricle. While perioperative mortality has dramatically decreased as the procedure has been modified, significant long‐term morbidity remains, including heart failure, thrombi, conduit stenoses, and hepatic congestion . For these reasons, some have advocated for regular cardiac MRI (cMRI) surveillance of this patient population.…”

Section: Introductionmentioning

confidence: 99%

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The utility of cardiac magnetic resonance imaging in post‐Fontan surveillance

Zaki

Kelleman

Parks

et al. 2018

Congenital Heart Disease

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Objective: Gated cardiac MRI offers the most detailed and accurate noninvasive method of assessing cardiac anatomy, particularly in patients with complex congenital heart disease. The proposed benefits of using cMRI as a routine screening tool in the Fontan population include early recognition of asymptomatic, postoperative anatomic and physiologic changes. In 2011, we therefore instituted at our center a recommended practice of cMRI screening in patients with Fontan physiology at 3 and 8 years post-Fontan operation. The purpose of this study was to determine the impact of this standardized practice of cMRI screening on the clinical management of a Fontan population. Design: We retrospectively reviewed charts from our institutional Fontan database to determine which patients were eligible for cMRI under the current guidelines and who underwent imaging from November 2002 to June 2015. We reviewed the frequency of cMRI and number of changes in management based on the results. Statistical significance was determined using a chi-square test.Results: There were 141 cMRIs performed on 121 patients who met inclusion criteria.The odds of a change in management were significantly greater after clinically indicated cMRI compared to screening cMRI (OR = 3.79, 95% CI: 1.48-9.66, P = .004).There were near significant odds of change in management if the cMRI occurred <8 years after Fontan regardless of whether it was for screening or clinically indicated purposes (OR = 2.43, 95% CI: 0.97-6.08, P = .052). The most frequent change in management was referral for catheterization with pulmonary artery angioplasty. Conclusions:There is an important role for cMRI in routine surveillance of post-Fontan patients. Screening cMRI performed less than 8 years after Fontan palliation offers increased utility compared to studies performed later. The optimal timing of such imaging after Fontan palliation remains unclear. K E Y W O R D Scardiac MRI, Fontan palliation, outcomes, surveillance | 141 ZAKI et al.

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“…It is now estimated that 85% to 90% of patients will survive into adult life, and as of 2000, there are more adults with congenital heart disease than children. [1][2][3] Unfortunately, the infrastructure to care for patients with congenital cardiac disease that is present in most pediatric cardiac centers is lacking within the adult cardiac health-care system.…”

Section: Introductionmentioning

confidence: 99%