Impact of Medical Interventions and Comorbidities on Norwood Admission for Patients with Hypoplastic Left Heart Syndrome

Loomba, Rohit S.; Rausa, Jacqueline; Farias, Juan; Villarreal, Enrique G.; Acosta, Sebastián; Savorgnan, Fabio; Flores, Saúl

doi:10.1007/s00246-022-02818-y

Cited by 8 publications

(7 citation statements)

References 52 publications

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“…Specifically, increased pulmonary arterial pressure in these patients may exacerbate PH, which may increase risk for complications such as cardiac arrest. 6 Increased pressures were also observed in Norwood patients without PH. Similarly, these extreme pressures may limit the benefits of VAD support, offering a rationale for mixed clinical outcomes.…”

Section: Discussionmentioning

confidence: 94%

“…These findings emphasize that an atrial BH may be inappropriate for Norwood patients with PH by straining the SV. Specifically, increased pulmonary arterial pressure in these patients may exacerbate PH, which may increase risk for complications such as cardiac arrest 6 . Increased pressures were also observed in Norwood patients without PH.…”

Section: Discussionmentioning

confidence: 99%

“…3,5 Outcomes for Norwood patients are also impacted by risk factors such as pulmonary hypertension (PH), which is associated with heart failure and mortality. 3,[5][6][7] The impact of the Berlin Heart on the Norwood patient physiology has not been widely studied. Clinical experiences are limited to single-center reports, whereas prior in vitro studies of the Norwood physiology have not included VAD implantation.…”

Section: Introductionmentioning

confidence: 99%

“…Rather, clinicians cite difficulties in determining the appropriate BH volume, rate, and inflow placement at the atrium versus ventricle 3,5 . Outcomes for Norwood patients are also impacted by risk factors such as pulmonary hypertension (PH), which is associated with heart failure and mortality 3,5–7 …”

Section: Introductionmentioning

confidence: 99%

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Investigating the hemodynamics of Berlin Heart EXCOR support in Norwood patients across diverse clinical scenarios with computational modeling

et al. 2023

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Background Infants with single‐ventricle (SV) physiology undergo the 3‐stage Fontan surgery. Norwood patients, who have completed the first stage, face the highest interstage mortality. The Berlin Heart EXCOR (BH), a pediatric pulsatile ventricular assist device, has shown promise in supporting these patients. However, clinical questions regarding device configurations prevent optimal support. Methods We developed a combined idealized mechanics‐lumped parameter model of a Norwood patient and simulated two additional patient‐specific cases: pulmonary hypertension (PH) and post‐operative treatment with milrinone. We quantified the effects of BH support across different device volumes, rates, and inflow connections on patient hemodynamics and BH performance. Results Increasing device volume and rate increased cardiac output, but with unsubstantial changes in specific arterial oxygen content. We identified distinct SV–BH interactions that may impact patient myocardial health and contribute to poor clinical outcomes. Our results suggested BH settings for patients with PH and for patients treated post‐operatively with milrinone. Conclusions We present a computational model to characterize and quantify patient hemodynamics and BH support for infants with Norwood physiology. Our results emphasized that oxygen delivery does not increase with BH rate or volume, which may not meet patient needs and contribute to suboptimal clinical outcomes. Our findings demonstrated that an atrial BH may provide optimal cardiac loading for patients with diastolic dysfunction. Meanwhile, a ventricular BH decreased active stress in the myocardium and countered the effects of milrinone. Patients with PH showed greater sensitivity to device volume. In this work, we demonstrate the adaptability of our model to analyze BH support across varied clinical situations.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Investigating the hemodynamics of Berlin Heart EXCOR support in Norwood patients across diverse clinical scenarios with computational modeling

et al. 2023

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“…It is a truism that progress in preventing and treating diseases depends on understanding their causes. Palliative surgical and medical treatment for HLHS is long and arduous [ 1 ], and mortality much higher than other congenital heart diseases (CHD) [ 2 ]. HLHS is also among the most costly CHD to manage [ 3 , 4 ], creating long-term economic burdens for families and the entire health system.…”

Section: Evidence For Important Genetic Components In Hlhsmentioning

confidence: 99%

Considering the Genetic Architecture of Hypoplastic Left Heart Syndrome

Belmont

2022

JCDD

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Hypoplastic left heart syndrome (HLHS) is among the most severe cardiovascular malformations and understanding its causes is crucial to making progress in prevention and treatment. Genetic analysis is a broadly useful tool for dissecting complex causal mechanisms and it is playing a significant role in HLHS research. However, unlike classical Mendelian disorders where a relatively small number of genes are largely determinative of the occurrence and severity of the disease, the picture in HLHS is complex. De novo single-gene and copy number variant (CNV) disorders make an important contribution, but there is emerging evidence for causal contributions from lower penetrance and common variation. Integrating this emerging knowledge into clinical diagnostics and translating the findings into effective prevention and treatment remain challenges for the future.

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Association of Immediate Postoperative Hemodynamic and Laboratory Values in Predicting Norwood Admission Outcomes

et al. 2022

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BackgroundThe primary objective of this study was to determine whether or not hemodynamic parameters and laboratory values at the time of admission to the pediatric cardiac intensive care unit after the Norwood operation were associated with a composite outcome of either need for extracorporeal membrane oxygenation or inpatient mortality. MethodsThis was a single-center retrospective study of infants with functionally univentricular hearts admitted to intensive care after the Norwood procedure from January 2011 to January 2020. Data were obtained at a single point(after a Norwood procedure) and then compared between two subsets of patients based on the presence or not of the composite outcome of interest. In univariate and multiple regression analyses, a series of receiver operator curves were generated to assess the relationship between the variables of interest and the composite outcome. ResultsEight(7.6%) experienced the composite outcome out of a total of 104 patients. Those who experienced the composite endpoint had signi cantly higher oxygen extraction ratio (0.43 vs. 0.31, p = 0.01), lower systemic blood ow (2.5 L/min versus 3.1 L/min, p = 0.01), and higher systemic vascular resistance (20.2 indexed woods units versus 14.8 indexed woods units, p = 0.01). Those with systemic blood ow of less than 2.5 L/min/m 2 had a 17% risk of experiencing the composite endpoint AUC = 0.79. Those with systemic vascular resistance of greater than 19 indexed woods units had a 22% risk of experiencing the composite endpoint AUC 0.80. ConclusionSystemic blood ow and systemic vascular resistance are independently associated with this composite outcome.

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Impact of Medical Interventions and Comorbidities on Norwood Admission for Patients with Hypoplastic Left Heart Syndrome

Cited by 8 publications

References 52 publications

Investigating the hemodynamics of Berlin Heart EXCOR support in Norwood patients across diverse clinical scenarios with computational modeling

Investigating the hemodynamics of Berlin Heart EXCOR support in Norwood patients across diverse clinical scenarios with computational modeling

Considering the Genetic Architecture of Hypoplastic Left Heart Syndrome

Association of Immediate Postoperative Hemodynamic and Laboratory Values in Predicting Norwood Admission Outcomes

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